Surgery for Anal Fistula

It is a small tunnel that forms between the inside of your anus and your skin just outside the anus. This is an abnormal connection of your anal canal and skin organs.

Sometimes additional tracts can develop from this small tunnel or the tunnel can pass through the sphincter muscles of your anus. These are known as complex anal fistulas.

The symptoms of an anal fistula can include:

• Skin irritation around the anus
• A continuous throbbing pain that worsens whenever you sit down, move around, poo or cough
• A smelly discharge coming from near your anus
• Passing pus or blood when you poo
• Swelling and redness around your anus, coupled with a high fever if you also have an abscess
• Difficulty controlling your bowel movements

It can appear as a boil-like opening near your anus and may discharge pus or bleed which may be noticeable when you poo. Not everyone with an anal fistula will have an opening on their skin around the anus. Some have a blind-ending tunnel which ends below the skin. Often the skin around your anus is red and inflamed.

Other symptoms of an anal fistula include a continual throbbing pain that is often worse when you sit down, move around, poo or cough, and a smelly discharge from near your anus.

It usually begins with an infection near your anus that causes a collection of pus, called an abscess, in the nearby tissue. When the pus drains away it can leave a small channel behind between your anus and skin, and this channel or tunnel is an anal fistula.

It can also be caused by long-term bowel conditions, such as Crohn’s disease, diverticulitis and hidradenitis suppurativa.

Anal fistulas are more common in men, and those that are 30-50 years old. Other risk factors can include:

• Previous history of anal abscess or fistula
• Crohn disease
• Ulcerative colitis
• Trauma
• Previous surgery or radiation therapy
• Cancer
• Infections such as HIV and tuberculosis

To get a diagnosis for anal fistula, you should first see your GP. At your appointment, your GP will ask you about your symptoms that you have been experiencing, and also ask if you have any other bowel conditions. Your GP may also ask to perform a rectal examination, which is basically where they will examine your anus by gently inserting a finger inside to check for signs of a fistula.

If your GP suspects you may have an anal fistula, they will refer you to a specialist known as a colorectal surgeon to do some further testing to confirm the diagnosis. These tests may include another rectal examination, an ultrasound scan, MRI scan, CT scan or a proctoscopy, which involves using a special telescope with a light on the end of it to look inside your anus.

You can expect your fistulotomy recovery to take about two weeks. Most people then return to work and normal activity.

For a week or so after your surgery, you can anticipate feeling some discomfort. You can take over-the-counter pain relief or have a warm bath whilst making sure to dry the affected area carefully afterwards.

You may be worried about having a bowel movement. You are likely to feel some pain and have bleeding when you go for a poo for a couple of weeks after your surgery. Make sure you get plenty of fluids and fibre as this will help prevent constipation. Your surgeon may recommend a laxative to soften your stools and help make your bowel movements less painful.

Your wound should heal within six weeks. You might find it helpful to wear a sanitary towel or a soft gauze pad in your underwear to protect your clothes from any wound discharge. You can expect a follow-up appointment around this time to check that your fistulotomy recovery is going well.

Follow your surgeon’s advice about driving, having sex and taking exercise. Swimming should be avoided until your wound has healed completely.

A full fistulotomy recovery for your fistula to completely heal can take several weeks or months. It will depend on the size of your fistula and the type of anal fistula surgery you had.

If an anal fistula is left untreated, or is not treated properly, it could result in the condition worsening or more complications arising. This includes recurrent perianal abscesses, infections and even the possibility of a complex fistula network developing which can cause pain, faecal incontinence, skin infections and even sepsis.

Anal fistulas usually develop as a result of abscesses in the anal region, which can be caused by things such as Crohn’s disease, trauma or STIs. You can significantly reduce the risk of developing an anal fistula by avoiding constipation, ensuring your poo stays soft by drinking a lot of fluids and doing regular exercise, and making sure to go to the toilet as soon as you feel the urge to go.

Anal fistulas tend to respond quite well to treatment, however you may be asked to take certain precautionary steps such as soaking the affected area in a warm bath or taking stool softeners or laxatives for a week after the treatment.

The cost of surgery for the procedure will depend on the exact type of surgery you require and your Ramsay hospital of choice.

You will receive a formal quotation price following your consultation and any required tests with one of our expert surgeons. This formal quote for your surgery will be valid for 60 days and includes unlimited aftercare.

Anal fitsula is recognised by all major medical insurers. The procedure is covered by most medical insurance policies. We advise you to obtain written authorisation from your insurance provider before starting your treatment.

We have a number of finance options if you are paying for your surgery yourself. These include:

• Interest-free finance – 0% interest, no deposit and affordable monthly instalments.
• All-inclusive Total Care - one-off pre-agreed payment for access to all the treatment you need for complete reassurance.
• Pay as you go – flexible funding to pay for treatment as and when costs arise. Often used if your treatment costs are difficult to assess.