Fistula surgery aims to eradicate the track between the opening inside the anus and the opening on the anal skin. It is essential that the anal sphincter muscle is protected so that continence is preserved. There are various surgical techniques available to correct fistulas. Some patients will require a series of procedures to achieve cure of a complex fistula.
Procedures available include:
Insertion of seton
Ligation of the intersphincteric fistula tract (LIFT) procedure
Mucosal advancement flap
Your specialist will discuss which of these procedures is appropriate for you.
Local anaesthetic has been used to provide pain relief today but this will wear off over the next few hours. It is important to take some painkillers before the pain becomes intense, as it will then be harder to control. Unless otherwise directed you should use Panadol 1 gram every six hours and Ibupfrofen 400 milligrams every eight hours for the next 48 hours. You should check with your doctor hat it is appropriate for you to take Ibupfrofen. If you require stronger pain relief Endone 5 milligram may be used but this will require a prescription. You must not drive or work while using this medication.
Wounds around the anus cannot be stitched closed because of the risk of infection. As a result you may have an open wound, which will have been dressed in the operating theatre. The outer dressing can be removed in the evening of your surgery. Any other dressing can be easily removed in the bath or shower at the same time. Unless otherwise instructed, the wound requires no dressing, and you should wear a pad inside your underwear to absorb any fluid leaking from the wound. These secretions can irritate the skin around the anus. This can be prevented by using a barrier cream like Bepanthen or Vaseline. You may have a seton (a thin silastic tube) inserted into the fistula. You will be able to feel this but it should not be uncomfortable.
Your bowels will continue to work normally after your surgery. It is best to avoid becoming constipated, as hard motions will increase you level of discomfort. Normafibe, one teaspoon twice daily may be used for the first week after surgery. It is normal to experience pain with bowel movements for the first week or so after surgery. You may see blood on the toilet paper or in then bowl with the first few bowel motions.
Warm baths are very soothing when you are in pain. A handful of cooking salt may be added to the bathwater in order to help keep the wound clean. If you find it helpful you can bathe 2–3 times per day and after bowel movements.
Things to watch out for
If you experience high fevers, large volume bleeding, difficulty passing urine or increasing pain, you should notify your doctor as soon as practicable.
Resuming normal activities
Anal surgery is often painful. Depending on the type of procedure performed, you may need 5–14 days off work. Sport and vigorous physical activities should be avoided for 2–3 weeks.