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Anal fistula surgery

The purpose of anal fistula surgery is to close fistulas near the anus. The nature of surgical intervention required depends on the location of your fistula. If it runs close to the surface of the skin and does not affect the sphincter muscles a relatively simple surgical procedure is performed to open the skin under local anesthesia and clean the inside of the fistula. After that, it is left open without any stitches to heal like a wound.

However, if the fistula is located higher in the rectum and extends into the sphincter muscle, more complex techniques are used. The operation must be carried out very carefully to prevent damage to the muscle.

What is an anal fistula?

An anal fistula is a tunnel that runs from inside the anus to the surface of the surrounding skin. It usually forms after an infection causes an abscess on the inside of the rectum. When pus is no longer present, an abnormal hole is left behind through which liquid and solid waste may leave the body.

What do the colon and the rectum look like?

Anatomy of the colon
Anatomy of the colon

The colon is located in the abdominal cavity, surrounding the small intestine like a frame. It can be divided into various parts: the first section is called the cecum, followed by the ascending colon, the transverse, descending and sigmoid colons. The final bit is called rectum and is located in the pelvic cavity.

The anus is the external opening of the rectum. The primary function of the anus is to control the exit of feces during defecation with the help of two sphincters. These are called the internal and external anal sphincters – circular muscles that normally maintain constriction of the orifice and relax as required by normal physiological functioning. The control of the inner sphincter is involuntary while that of the outer sphincter is voluntary.

Proctologists are doctors who specialise in treating the diseases of this part of the gastrointestinal tract.

What causes anal fistulas?

Anal fistulas can develop from earlier inflammations or abscesses. They may rarely be caused by other things such as the passage of a foreign body through the rectum, Crohn’s disease and sexually transmitted diseases. When the small glands inside the anus are clogged, the buildup of bacteria can create a swollen pocket of infected tissue and liquid. Doctors call this an abscess – a painful collection of pus which is often accompanied by fever and requires medical attention.

If it is not treated it starts to grow. making its way to the outside by punching a hole in the skin somewhere near the anus so the accumulated pus can drain. The fistula is the channel that connects the gland to that opening.

What are the symptoms of anal fistula?

The most common symptoms of an anal fistula are pain which usually gets worse when you have a bowel movement, sit down or cough. There is often a discharge draining from the fistula which may irritate the skin around the anus and cause swelling and redness. Stools may contain blood or pus. If there is an abscess, it is usually accompanied by fever and requires urgent medical attention. If an abscess is not treated properly and is present for a long time it causes chronic inflammation which may impair the function of the internal anal sphincter, leading to fecal incontinence.

This can even damage the function of the rectum muscle.

Anal disorders
Anal disorders

How is anal fistula diagnosed?

Doctors can usually diagnose anal fistula by examining the area around the anus. They check for an external opening on the skin. If one is found, your physician will try to determine the depth and direction of the fistula tract. Often drainage can be produced from the external opening.

Some fistulas may not be visible on the surface. In this case, anoscopy might be necessary, in which a special instrument is used to see inside your anus and rectum. Your physician may also order an ultrasound or MRI to better define the fistula tract. If your he or she suspects that you might have other problems alongside anal fistula, colonoscopy might be indicated.

How is anal fistula treated?

Chronic fistulas which have been present for several months are treated surgically. The procedure is called a fistulotomy, and it is the most effective treatment for superficial fistulas which do not pass through much of the sphincter muscles. This technique involves cutting along the whole length of the fistula to open it up, allowing the opening to heal from the inside out. These procedures are performed under local anesthesia and do not require an overnight stay in hospital.

Fistulas passing through a significant portion of the anal sphincter muscle require a more complex intervention under general or spinal anesthesia. Your doctor may have to cut into the sphincter muscles that open and close your anus. They will make every attempt to reduce the risk of incontinence, but it may be harder to control your bowels after the procedure.

For this type of surgery we use absorbable suture which is naturally degraded by the body and does not need to be removed later on. In the first few days following the procedure you will be advised to keep your stool looser than usual by drinking plenty of fluids and stayin away from solid food as much as possible. Moving forward it is important to avoid constipation (by drinking plenty of water, increasing your fiber intake, and consuming probiotics regularly).

The initial pain you will likely feel after surgery can be relieved by non-steroidal painkillers.

How to prepare for the surgery?

  • Prepare a list of all of your symptoms and any known medical conditions, past illnesses and allergies, recent lifestyle changes and possible sources of stress even if they seem unrelated to your current condition. For this purpose, you will be given a detailed form to be filled out, followed by a physical examination.
  • Be aware of any restrictions to adhere to prior to and following the procedure ( solid food ont he day of the surgery). Your surgeonwill provide you with all the information you need to prepare for the diagnostic tests.
  • List all the drugs and medications you take, including vitamins and supplements
  • Ask a family member or friend to accompany you to your appointment and aks them to help you recall the information to be provided during your consultation.
  • Before your surgery you will receive a patient information sheet and an informed consent form which you will be requested to read carefully and sign. These documents will contain everything you need to know regarding preparation, the surgery itself and recovery.

What to expect after anal fitula surgery?

Since fistulas can be diverse, the length and course of recovery may vary from patient to patient. Superficial fistulas heal faster, but even so, full recovery may take months. In order to ensure a safe and fast recovery follow your doctor’s recommendation at all times regarding post-operative care.

Fistulas which are located higher, branch off in different directions or have been negleted for a long time are more difficult to treat. They often require the use of more complicated surgical procedures. For this reason it is very important to seek medical help as soon as you notice the first symptoms of anal fistula.