You consulted your doctor with symptoms of skin irritation around the anus, a throbbing, constant pain that may be worse when you sit down, move around, have a bowel movement or cough, a discharge of pus or blood when you have a bowel movement. You may have had previous episodes of anal abscess which was drained. Doctors after thorough evaluation confirmed that you had an anal fistula. An anal fistula is a small channel that develops between the end of the bowel, known as the anal canal or back passage, and the skin near the anus. The anus is the opening where waste leaves the body. The fistula ends can appear as holes on the surface of the skin around the anus. An anal fistula is painful and can cause bleeding when you go to the toilet. Anal fistulae are broadly classified as high and low fistulae depending upon the internal opening. If the internal opening is above the anal sphincter then it is high fistula which are usually complex compared to the fistulae with internal opening below the anal sphincter which are low fistula and usually simple. The assessment is done clinically along with other investigations and tests as and when required including probing, methylene blue dye injection, X-ray and MRI. Doctors recommended you to remove the anal fistula through surgical procedures called anal fistulotomy.(1)
The two primary aims of treatment of fistula include complete eradication of the infection and retention of the ability to control defecation (continence). With these two primary interests in mind your surgeon decided on the course of surgery. There are many options including fistulectomy, fistulotomy and glue injections. Sometimes surgeries have to be conducted in phases to avoid damaging the sphincters and in turn reduce the patients ability to control defecation. Your surgeon decided on fistulotomy surgery for you after carefully considering your condition. You have undergone anal fistulotomy surgery when you were in the hospital. Doctors had cut open the whole length of the fistula, from the internal opening to the external opening. The surgeon then flushed out the contents and flattened it out. After one to two months, the fistula would heal into a flat scar.(1)
Take a sitz bath at least 3-4 times a day and after each bowel movement. This will help decrease the pain of rectal spasms and aid healing. Sit in a bathtub of warm water for 10-20 minutes.
Avoid hard wiping of the anal area for the first few days. Do not use toilet paper, instead, use alcohol-free baby wipes.
You will have reddish-yellow drainage from the rectum for at least 7-14 days. You will need mini-pads or sanitary pads for your undergarments during this time. The drainage will decrease in amount and become lighter in color. With bowel movements and increased activity you may notice an increase of bloody drainage.
While on pain medicine, you need to take a stool softener and a bulk fiber laxative to prevent constipation.
Do not drink alcoholic beverages, drive a car or operate machinery while you are on the narcotic pain medicine.
Do not smoke: Smoking may slow your healing process.(2)
Common things to expect at home:
Following your fistulotomy, you may experience some mild to moderate pain or discomfort in your rectal area. You may also experience constipation, difficulty urinating and possibly some rectal bleeding.
Risks after fistulotomy surgery may include:
Infection: Any type of surgery carries a risk of infection.
Incontinence: In some cases, especially in high anal fistulas, surgery can damage the anal sphincter muscles (the ring of muscles that open and close the anus). If the muscles are damaged, you may lose control of your bowels, leading to faeces leaking uncontrollably from your rectum (the area where they are stored). This is known as faecal or bowel incontinence.
Reoccurrence of the anal fistula: In some cases, the fistula can reoccur despite surgery.(1)