Anal Fistulas: Surgical Options and Recovery Tips

Anal fistula

Last September, I underwent hemorrhoid surgery.
By December, I noticed a lump near the anus that was extremely painful.
I consulted a specialist, and in late February, I was given a seton placement.
However, there is still a small lump in that area, and a few days before my menstrual period, the lump becomes larger and more painful.
After my period starts, the pain and the lump decrease.
Now, the doctor is recommending surgery, likely a high or low fistulotomy, and mentioned that the choice between high or low excision will depend on the situation during the surgery.
I would like to know if surgery is absolutely necessary in this case.
What should I pay attention to post-surgery to ensure a good recovery, as I am concerned about the possibility of recurrence? Additionally, how can I avoid having a bowel movement for a week after the surgery, since not having a bowel movement would help the wound heal better?

Niming, 30~39 year old female. Ask Date: 2021/05/06

Dr. Hong Yuanbin reply Internal Medicine

Hello, the surgical removal of an anal fistula primarily depends on whether it causes infection and related complications.
Based on your description, it seems to frequently cause discomfort, which is why your physician recommended surgery.
As for postoperative care, your doctor should provide you with comprehensive advice before the procedure, including dietary recommendations and how to keep the wound clean, among other things.
To reduce stool volume, you might consider a low-residue diet and decreasing your intake of fiber-rich foods; however, it is advisable to follow your surgeon's recommendations regarding this matter.
Thank you for your question.

Reply Date: 2021/05/06

More Info

Anal fistulas can be a challenging condition to manage, especially following previous surgeries such as hemorrhoidectomy. Your experience with pain and swelling around the anal area, particularly in relation to your menstrual cycle, suggests that there may be underlying inflammation or infection associated with the fistula. The fact that your doctor has recommended surgery indicates that they believe this is the best course of action to address the issue effectively.

Understanding Anal Fistulas
An anal fistula is an abnormal connection between the anal canal and the skin surrounding the anus. They often develop as a result of an infection in the anal glands, leading to an abscess. If the abscess does not heal properly, it can form a fistula. Symptoms typically include pain, swelling, and sometimes discharge from the fistula opening. The cyclical nature of your symptoms, worsening before your menstrual cycle, may be due to hormonal changes affecting inflammation or blood flow in the area.

Surgical Options
The surgical options for treating anal fistulas include:
1. Seton Placement: This is a common initial treatment for complex fistulas. A seton is a piece of surgical thread that is placed through the fistula to help drain any infection and keep the fistula open. This allows for gradual healing and can help prevent abscess formation.

2. Fistulotomy: This is a more definitive surgical procedure where the fistula tract is cut open to allow it to heal from the inside out. Depending on the complexity of the fistula, this may be done as a high or low fistulotomy. A high fistulotomy may involve more tissue and potentially affect the anal sphincter, while a low fistulotomy is less invasive.

3. Flap Procedures: In cases where the fistula is complex or involves significant tissue loss, a flap procedure may be necessary. This involves using nearby tissue to cover the fistula tract.

Is Surgery Necessary?
In your case, surgery is likely recommended due to the persistent symptoms and the potential for complications if left untreated. While some fistulas can heal on their own, surgical intervention is often necessary to prevent recurrence and to alleviate pain. Your doctor will assess the fistula's characteristics during surgery to determine the best approach.

Post-Surgery Recovery Tips
1. Pain Management: After surgery, pain management is crucial. Your doctor may prescribe pain relievers, and over-the-counter medications can also be helpful.

2. Wound Care: Keeping the surgical site clean and dry is essential. Follow your surgeon's instructions regarding bathing and dressing changes.

3. Dietary Adjustments: To avoid straining during bowel movements, a high-fiber diet is recommended. This can help soften stools and promote regularity. Staying hydrated is also important.

4. Avoiding Strain: It is advisable to avoid heavy lifting and straining for at least a week post-surgery. Your concern about not having bowel movements for a week is valid; however, it is essential to find a balance. You may want to discuss with your doctor the use of stool softeners or mild laxatives to prevent constipation without causing strain.

5. Follow-Up Appointments: Regular follow-ups with your surgeon are important to monitor healing and address any concerns promptly.

6. Signs of Complications: Be aware of signs of infection, such as increased pain, swelling, redness, or discharge. If you experience these symptoms, contact your healthcare provider immediately.

Conclusion
While anal fistulas can be distressing and painful, surgical intervention is often the most effective way to achieve long-term relief. By following your surgeon's recommendations and taking proactive steps in your recovery, you can minimize the risk of recurrence and promote healing. Always communicate openly with your healthcare provider about your concerns and any symptoms you experience during your recovery process.

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