Anal Fistula

What is a fistula? An anal fistula is a track between the skin on the outside of the buttock/anal area and the anal canal on the inside. There are many different types of fistulae from relatively simple to a complex branching network of tracks. Some fistulae may involve the muscles responsible for bowel control. Each fistula is different.

What are the different operations for fistula?

Fistula has many different types of operations. They are To lay open the fistula To excise the fistula To remove it in stages To use fistula plug LIFT technique Fistuloscope You should discuss with your surgeon exactly what is planned for you. The aim is to cut out or lay open the infected track so as to promote healing from the base of the wound out to the surface without infection.

Are there any risks or side effects of operation?

Fistula can come back after operation in some cases. Risk of it coming back is dependent on the type of fistula. Complicated fistulas comeback more often than simple ones. Rarely if someone has weak muscles around the back passage or leakage this may worsen after the operation.

How will the operation help me?

Many different operations can be done for a fistula. This healing can be a slow process, taking from a week or so up to a few months. It is impossible to predict how long it will take in each patient. Further treatment may be required. Sometimes a stitch (called a Seton suture) is inserted to avoid dividing the muscle.

What will happen after the operation?

You will usually have a dressing in place around the entrance to the anus. This is to control any bleeding in the area. This will feel strange and possibly uncomfortable and it may make you feel that you want to open your bowels. Some pain and discomfort is expected. You will normally have a bath or shower the next day and this will soak the dressing out. It is possible that there may be some bleeding but mostly it is harmless.

How will I open my bowels?

From the day after your operation you will be given laxatives. This will soften the stools. You may not open your bowels for a day or two. When you open your bowels some discomfort and a little bleeding may be present. This is to be expected. You may need pain killers as you require them or 15 to 20 minutes before you open your bowels. Dressing your wound This will be done daily or alternately. You should take a bath or a shower before each dressing is done. Having a bath or shower helps to remove the previous dressing and also to cleanse the external part of the wound. Fistula track should heal from the base upwards towards the outside surface. To stop small pockets forming during the healing process, the medical personnel who is dressing your wound may gently insert a finger along the track at the time of the dressing. This is called digitation. This is uncomfortable but gives your fistula wound the best opportunity for successful healing. Local anaesthetic gel will be used to help discomfort. Some patients may be asked to use an anal dilator. The wound may be lined with gauze soaked in lotion and local anaesthetic gel to make sure it heals in the right way.

How long will I be in hospital?

This varies between individuals, and depends on the type and complexity of the fistula. For a simple fistula it will be around one to two days; for a more complex one it is likely to be up to a week. Your dressings at home After you go home you will need to continue to have your dressing done each day. The dressing should be laid in the wound flat. “Packing” the wound with ribbon gauze is not always required as it can prevent drainage. The dressing is done as a clean, not a sterile procedure. It is important to insert a finger with anaesthetic gel into the wound each time that the dressing is done to make sure that healing is from the base upwards. The fistula track is then washed out with fluid and lined with gauze soaked in lotion and anaesthetic gel. Some discharge will occur until healing is complete. If hairs start to grow you may need to have these shaved to prevent them from growing into the wound. You should take a bath or use a commode shower to clean the area after opening your bowels.

What should I do if I bleed after I go home? You are likely to have a small amount of bleeding from the wound or the anus after the operation. You may notice this particularly after your dressing has been done, or on your stool or on the toilet paper when you wipe yourself. This is normal and nothing to worry about. You may also have a discharge from the wound for some weeks. You can wear a small pad inside your pants to protect your clothes from any staining.

How long should I stay off work?

The time taken to get back to normal activities varies for different people. It depends on your job and the extent of your fistula and surgery. Do as much as you feel comfortable doing. Most people need two weeks off work once they go home. It is advisable to avoid sitting still or walking for long periods at first. Start with gentle walking and build up your activity level gradually.