Surgery for anal fistula

You should no longer have any infection or pain.

Most anal fistulas do not heal without surgery.

The fistula may get more complicated and painful with time.

The operation is usually performed under a general anaesthetic but various anaesthetic techniques are possible. The operation usually takes 15 to 30 minutes.

To lessen the risk of bowel incontinence (when you pass a bowel movement without wanting to) your treatment may involve several operations over a number of months.

The type of surgery you need will depend on where the fistula is.

• If the fistula is below or crosses the lower part of the sphincter muscles (the muscles around your anal canal that control when you open your bowels), your surgeon will cut the fistula open to your skin and leave your wound open so that it can heal with healthy tissue.
• If the fistula has branches that pass through the upper part of the sphincter muscles, your surgeon may instead place a special stitch (called a seton stitch) in the fistula to allow pus to drain easily. The fistula may be suitable for treatment with special glue, clips or a plug made from pig-bowel tissue.
• If the fistula reaches above your sphincter muscles, you may need to have a temporary colostomy (your large bowel opening onto your skin). However, this is not common.

If you smoke, stopping smoking now may reduce your risk of developing complications and will improve your long-term health.

Try to maintain a healthy weight. You have a higher risk of developing complications if you are overweight.

Regular exercise should help to prepare you for the operation, help you to recover and improve your long-term health. Before you start exercising, ask the healthcare team or your GP for advice.

Speak to the healthcare team about any vaccinations you might need to reduce your risk of serious illness while you recover. When you come into hospital, practise hand washing and wear a face covering when asked.

The healthcare team will try to reduce the risk of complications.

Any numbers which relate to risk are from studies of people who have had this operation. Your doctor may be able to tell you if the risk of a complication is higher or lower for you. Some risks are higher if you are older, obese, you are a smoker or have other health problems. These health problems include diabetes, heart disease or lung disease.

Some complications can be serious and can even cause death.

General complications of any operation

• Bleeding during or after the operation. You may need a blood transfusion or another operation.
• Infection of the surgical site (wound).
• Allergic reaction to the equipment, materials or medication.
• Chest infection — your risk will be lower if you have stopped smoking and you are free of Covid-19 (coronavirus) symptoms for at least 7 weeks before the operation.

Specific complications of this operation

• Difficulty passing urine. You may need a catheter (tube) in your bladder for 1 to 2 days.
• Involuntarily passing wind or loose faeces.
• Bowel incontinence.
• The problem coming back. You may need another procedure to fix it.

Consequences of this procedure

• pain
• unsightly scarring of your skin

You should be able to go home the same day or the day after.

Rest for a few days, walking as little as possible, to help your wound to heal.

You should be able to return to work as soon as you can move about and sit freely.

The wound often takes several weeks to heal completely and you may need to wear a pad until then.

Regular exercise should help you to return to normal activities as soon as possible. Before you start exercising, ask the healthcare team or your GP for advice.

Most people make a full recovery and can return to normal activities. For a small number of people the fistula can come back.

An anal fistula can cause continued infection and pain. Symptoms usually get worse without surgery.