A variety of different surgical approaches are used to treat an anal fistula, and the choice of which one is most appropriate will depend on the location and extent of the fistula itself.
Fistula surgery involves closing the fistula itself, that is the 'tunnel' or 'track' connecting the opening inside the anus and the corresponding opening on the external skin. It is very important that the anal sphincter muscle is not impacted in any way by the surgery as this can cause faecal incontinence. Where a fistula is complex, more than one procedure may be required to fully treat the condition.
Your surgeon will fully discuss the options that relate to your particular condition before deciding which approach is the most suitable. There are five common approaches - these are:
- Anal fistulotomy.
- Fistula plug.
- Ligation of intersphincteric fistula tract.
- Mucosal advancement flap.
- Seton drain.
The following information has been put together so that you know what to expect after anal surgery.
During the operation you were provided with some pain relief medication, but this wears off after a few hours and it is important to have pain medication available for when this happens. It is much better to take pain medication as the pain begins to return rather than wait until it is severe. Unless you have been given different specific instructions, we recommend the following regime...
•Two (500mg) Paracetamol tablets every four to six (4-6) hours.
•Two (200mg) Ibuprofen tablets every six to eight (6-8) hours (check with your surgeon first that you can take this).
If pain continues beyond this period, or if it becomes severe, you should contact your surgeon.
Another effective option for dealing with any pain in the anal area is to take salt baths two or three times a day and after any bowel movements. All you need to do is add a handful of table salt to a shallow bath - the salt helps keeps the wound clean.
After surgery to the anal region, any incisions or wounds are generally allowed to heal naturally as closure with stitches can increase infection risk. Instead incisions and wounds are dressed after the procedure in the operating theatre. You should then...
- wait until the evening on the day of surgery to remove any dressing / s - these will come off reasonably easily in a shower or bath.
- not need to put any other dressing / s on after these have come off.
- wear an absorbent pad in your underwear - this will absorb any small leakage from the wound.
- use a barrier cream (such as Vasoline or Bepanthen) to prevent any fluid from the wound from irritating the skin around the anus.
It is very common to experience some pain when going to the toilet for about a week after the procedure, and there may be some blood either appearing on toilet paper or in the toilet bowl, however otherwise everything should be functioning as normal. It's best to avoid getting constipation, as hard stools will cause more pain.
When you should get in contact with your surgeon
Most surgical procedures are uneventful, with minimal complications. However, you need to be aware of the following symptoms as they may indicate a developing serious complication...
- Excess bleeding.
- Difficulty urinating.
- Severe or increasing pain.
If you experience any of these symptoms or have any concerns after your surgery, please contact the rooms on 07 5598 0955 for advice.
A post operative appointment will be made for you before you are discharged from hospital. If you are discharged on a weekend, after normal surgery hours or it is not clear what follow up appointments are required, then contact the rooms the next working day to make an appointment.
Resuming day-to-day activity
It is sensible to take a break from your normal routine (including work) for at least four days after the procedure, since it is likely you will be in some pain during this time. Anything more vigorous than normal domestic activity, for example sport or heavy manual work, should not be resumed for 2-3 weeks after surgery, and then in a gradual fashion.