An anal fistula is a tunnel connecting the skin near the anus to the inside of the bowel (usually the rectum). This means that the inside of the bowel is connected to the outside of the body through an additional opening. A fistula is usually the result of an infection or abscess in the anus, and surgery is usually needed to remove it.
There are many different kinds of fistula. Some have a single tract (route) running from the bowel to the skin. Others branch into more than one tract. Sometimes they cross the muscles that control the opening and closing of the anus (sphincters).
Anal fistulas are painful and the skin around the anus can swell. Your skin may also be itchy and irritated, and the fistula opening may be infected. Surgical treatment is usually needed to remove them.
According to clinical sources, an anal fistula affects as many as half of all people with Crohn's disease, up to 30% of people with HIV, and between 30 and 50% of people with an anal abscess.
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You will have a formal consultation with a healthcare professional. During this time you will be able to explain your medical history, symptoms and raise any concerns that you might have.
We will also discuss with you whether any further diagnostic tests, such as scans or blood tests, are needed. Any additional costs will be discussed before further tests are carried out.
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Anal fistula surgery is usually done under general anaesthesia, which means you'll be asleep during the procedure and won't feel pain.
During the procedure, your surgeon will examine the fistula and decide the best way to treat it. Usually, the aim is to open up the fistula tract to the outside so that the wound can heal from the base upwards. Stitches are generally not used, but sometimes a piece of suture (thread used for stitches) is left in place to help with healing. This is called a seton.
The operation usually lasts about half an hour.
Usually, you will need to stay overnight in hospital following anal fistula surgery.
After the procedure, you will be taken from the operating theatre to a recovery room, where you will come round from the anaesthesia under close supervision.
After this, you will be taken to your room or comfortable area where you can rest and recuperate until we feel you’re ready to go home.
After an operation to repair an anal fistula, you are likely to feel sore for a number of days. The exact length of time will depend on the type of the procedure you have. If you need them, continue taking painkillers as advised by the hospital.
We will provide you with a supply of all the medicines your consultant feels you need to take home with you after you've left hospital, up to 14 days. This may be at an additional cost to some patients.
At your follow-up appointment, your surgeon will decide whether you need to continue with daily dressings. You may experience some bleeding or discharge for the first couple of weeks. The time the wound takes to heal varies from a few weeks to a few months. You will also be given advice about going back to work and other activities.
You should avoid sitting or walking for long periods while you recover, and avoid swimming until your wound has healed. You might find it more comfortable to lie on your side when you're in bed and to wear loose-fitting clothes.
We may prescribe you laxatives to help you to go to the toilet after your surgery.
Once you’re ready to be discharged from hospital, you’ll need to arrange a taxi, friend or family member to take you home as you won’t be able to drive.
Even after you've left hospital, we still look after you every step of the way. After surgery for an anal fistula, we will provide you with advice on looking after your wound and follow-up support.
On rare occasions, complications following surgery for an anal fistula can occur. If you experience any of these symptoms – heavy bleeding, difficulty urinating or constipation, a high temperature, nausea or vomiting, increasing pain, swelling, redness or discharge – call us straight away.
The chance of complications depends on the exact type of operation you are having and other factors such as your general health. Ask your surgeon to explain how these risks apply to you. We will talk to you about the possible risks and complications of having this procedure and how they apply to you.
If you have any questions or concerns about your recovery, we're ready to help.
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The treatment described on this page may be adapted to meet your individual needs, so it's important to follow your healthcare professional's advice and raise any questions that you may have with them.
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