Anal Fistula and Anal Fistulotomy

Anal fistula is an abnormal tunnel that develops between the bowel and the skin near the outside of the anus, where stool (feces) comes out. The anus has many tiny glands that make lubricating fluid.

Sometimes, these glands become plugged and infected, and that can cause a fluid-filled pocket (abscess) to form. An anal fistula often develops after this infection or abscess.

What are the causes of Anal fistula ?

In most cases, an anal fistula is caused by a past or current anal abscess. Other causes include:

  • A complication of surgery.
  • Trauma to the rectal area.
  • Radiation to the area.
  • Medical conditions or diseases, such as:
    • Chronic inflammatory bowel disease, such as Crohn disease or ulcerative colitis.
    • Colon cancer or rectal cancer.
    • Diverticular disease, such as diverticulitis.
    • An STD (sexually transmitted disease), such as gonorrhea, chlamydia, or syphilis.
    • An infection that is caused by HIV (human immunodeficiency virus).
    • Foreign body in the rectum.

What are the signs or symptoms of Anal fistula ?

Symptoms of this condition include:

  • Throbbing or constant pain that may be worse while you are sitting.
  • Swelling or irritation around the anus.
  • Drainage of pus or blood from an opening near the anus.
  • Pain with bowel movements.
  • Fever or chills.

How Anal fistula is diagnosed?

Your health care provider will examine the area to find the openings of the anal fistula and the fistula tract. The external opening of the anal fistula may be seen during a physical exam. You may also have tests, including:

  • An exam of the rectal area with a gloved hand (digital rectal exam).
  • An exam with a probe or scope to help locate the internal opening of the fistula.
  • Imaging tests to find the exact location and path of the fistula. These tests may include X-rays, an ultrasound, a CT scan, or MRI. The path is made visible by a dye that is injected into the fistula opening.

You may have other tests to find the cause of the anal fistula.

How is this treated?

The most common treatment for an anal fistula is surgery. The type of surgery that is used will depend on where the fistula is located and how complex the fistula is. Surgical options include:

  • A fistulotomy. The whole fistula is opened up, and the contents are drained to promote healing.
  • Seton placement. A silk string (seton) is placed into the fistula during a fistulotomy. This helps to drain any infection to promote healing.
  • Advancement flap procedure. Tissue is removed from your rectum or the skin around the anus and is attached to the opening of the fistula.
  • Bioprosthetic plug. A cone-shaped plug is made from your tissue and is used to block the opening of the fistula.

Some anal fistulas do not require surgery. A nonsurgical treatment option involves injecting a fibrin glue to seal the fistula. You also may be prescribed an antibiotic medicine to treat an infection.

Follow these instructions at home:

Medicines

  • Take over-the-counter and prescription medicines only as told by your health care provider.
  • If you were prescribed an antibiotic medicine, take it as told by your health care provider.Do notstop taking the antibiotic even if you start to feel better.
  • Use a stool softener or a laxative if told to do so by your health care provider.

General instructions

  • Eat a high-fiber diet as told by your health care provider. This can help to prevent constipation.
  • Drink enough fluid to keep your urine clear or pale yellow.
  • Take a warm sitz bath for 15–20 minutes, 3–4 times per day, or as told by your health care provider. Sitz baths can ease your pain and discomfort and help with healing.
  • Follow good hygiene to keep the anal area as clean and dry as possible. Use wet toilet paper or a moist towelette after each bowel movement.
  • Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

  • You have increased pain that is not controlled with medicines.
  • You have new redness or swelling around the anal area.
  • You have new fluid, blood, or pus coming from the anal area.
  • You have tenderness or warmth around the anal area.

Get help right away if:

  • You have a fever.
  • You have severe pain.
  • You have chills or diarrhea.
  • You have severe problems urinating or having a bowel movement.

Anal Fistulotomy

Anal fistulotomy is a surgical procedure to open and drain an anal fistula. An anal fistula is an abnormal tunnel that develops between the bowel and the skin near the outside of the anus, where stool (feces) comes out. During this procedure, the fistula is opened up and the contents are drained to promote healing.

Tell a health care provider about:

  • Any allergies you have.
  • All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
  • Any problems you or family members have had with anesthetic medicines.
  • Any blood disorders you have.
  • Any surgeries you have had.
  • Any medical conditions you have.
  • Whether you are pregnant or may be pregnant.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

  • Infection.
  • Bleeding.
  • Allergic reactions to medicines or dyes.
  • Damage to other structures or organs.
  • Not being able to control when you have bowel movements (incontinence).
  • Being unable to empty your bladder (urinary retention).

What happens before the procedure?

Staying hydrated

Follow instructions from your health care provider about hydration, which may include:

  • Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.

Eating and drinking restrictions

Follow instructions from your health care provider about eating and drinking, which may include:

  • 8 hours before the procedure – stop eating heavy meals or foods such as meat, fried foods, or fatty foods.
  • 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.
  • 6 hours before the procedure – stop drinking milk or drinks that contain milk.
  • 2 hours before the procedure – stop drinking clear liquids.

Medicines

  • Ask your health care provider about:
    • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
    • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood.Do nottake these medicines before your procedure if your health care provider instructs you not to.
  • You may be given antibiotic medicine to help prevent infection.

General Instructions

  • You may have an exam or testing.
  • You may have a blood or urine sample taken.
  • You may be instructed to take a laxative or use an enema to clean your bowels before surgery.
  • Plan to have someone take you home from the hospital or clinic.
  • If you will be going home right after the procedure, plan to have someone with you for 24 hours.

What happens during the procedure?

  • To reduce your risk of infection:
    • Your health care team will wash or sanitize their hands.
    • Your skin will be washed with soap.
  • An IV tube will be inserted into one of your veins to give you fluids and medicines.
  • You will be given one or more of the following:
    • A medicine to help you relax (sedative).
    • A medicine to numb the area (local anesthetic).
    • A medicine to make you fall asleep (general anesthetic).
  • Your surgeon will locate the internal opening of your fistula.
  • An incision will be made in the fistula opening. The incision may extend into the muscles around the anus (sphincter muscles).
  • The fistula will be cut open and drained.
  • The sides of the fistula may be stitched (sutured) to the sides of the incision.
  • Gauze bandages (dressings) may be placed inside of the fistula.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

  • Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until the medicines you were given have worn off.
  • You may have to wear compression stockings. These stockings help to prevent blood clots and reduce swelling in your legs.
  • Do notdrive for 24 hours if you received a sedative.
  • You may continue to receive fluids and medicines through an IV tube.
  • You may have some bleeding from the surgical area. You may have to wear an absorbent pad.

Anal Fistulotomy, Care After

What can I expect after the procedure?

After the procedure, it is common to have:

· Some pain, discomfort, and swelling.

·         Increased pain during bowel movements.

·         Some bleeding from the wound.

Follow these instructions at home:

Medicines

·         Take over-the-counter and prescription medicines only as told by your health care provider.

·         If you were prescribed an antibiotic medicine, take it as told by your health care provider.Do notstop taking the antibiotic even if you start to feel better.

Activity

·         Do notdrive for 24 hours if you received a medicine to help you relax (sedative) during your procedure.

·         Do notdrive or use heavy machinery while taking prescription pain medicine.

·         Do notlift anything that is heavier than the limit that your health care provider tells you until he or she says that it is safe.

·         Rest as told by your health care provider. It is also important to move around in between periods of rest. Get up and move around as often as you can tolerate.

·         Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.

Lifestyle

·         Limit alcohol intake to no more than 1 drink a day for nonpregnant women and 2 drinks a day for men. One drink equals 12 oz of beer, 5 oz of wine, or 1½ oz of hard liquor.

·         Do notuse any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. If you need help quitting, ask your health care provider.

Incision care

·         Follow instructions from your health care provider about how to take care of your incision.

o    If gauze (dressing) was placed in your incision during surgery, you may be told to remove it yourself after a certain period of time. Make sure you wash your hands with soap and water before and after removing your dressing. If soap and water are not available, use hand sanitizer.

o    Do notremove your dressing unless told by your health care provider. You may be told to allow the dressing to come out with your first bowel movement after surgery, instead of removing the dressing.

o    Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to stay in place for 2 weeks or longer. Do notremove adhesive strips completely unless your health care provider tells you to do that.

·         Keep the incision clean and dry.

·         Check your incision area every day for signs of infection. Check for:

o    More redness, swelling, or pain.

o    More fluid or blood.

o    Warmth.

o    Pus or a bad smell.

·         After having a bowel movement, clean the incision area using one of the following methods:

o    Gently wipe with a moist towelette.

o    Gently wipe with mild soap and water.

o    Take a shower.

o    Take a sitz bath. This is a warm water bath that is taken while you are sitting down.

·         You may apply ice to the incision area to reduce discomfort:

o    Put ice in a plastic bag.

o    Place a towel between your skin and the bag.

o    Leave the ice on for 20 minutes, 2–3 times a day.

Eating and drinking

·         Follow instructions from your health care provider about eating or drinking restrictions.

·         Drink enough fluid to keep your urine clear or pale yellow.

·         Eat lots of fiber. Fiber helps regulate bowel movements and prevent constipation. Foods that contain a lot of fiber include:

o    Fruits.

o    Vegetables.

o    Whole grains.

General instructions

·         Do notswim or use a hot tub until your health care provider says that this is safe.

·         If you have bleeding from your wound, wear an absorbent pad and change it often.

·         Wear compression stockings as told by your health care provider. These stockings help to prevent blood clots and reduce swelling in your legs.

·         Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

·         You have more redness, swelling, or pain around your incision area.

·         Your incision area feels warm to the touch or firm.

·         You have pus or a bad smell coming from your incision area.

·         You have a fever or chills.

·         You develop swelling or tenderness in your groin area.

·         You cannot control when you have bowel movements.

·         You are leaking stool (incontinent).

·         You have trouble urinating.

·         You have pain that does not get better with medicine.

Get help right away if:

·         You have severe pain in your:

o    Wound area.

o    Abdomen.

·         You have sudden chest pain.

·         You become weak or you pass out (faint).

·         You have more fluid or blood coming from your incision.

·         You have bleeding from your incision that soaks 2 or more pads during 24 hours.

 

 

 

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