Anal Fistula Surgery: When to Operate and What to Expect

Surgery for anal fistula?

Hello Doctor, I was scheduled for surgery to address my anal fistula in May, but it was postponed the day before the surgery due to the pandemic.
Now that it is the end of June, I can proceed with the surgery.
However, the external wound of my anal fistula has healed, and there have been no new abscesses for about two weeks.
It feels flat and is not painful to the touch.
The doctor suggested that I should wait and observe for now.
I would like to ask: 1.
How long should I observe? 2.
Should I still undergo surgery for the anal fistula? 3.
If this condition persists, how can I manage to coexist with it? Thank you, Doctor, for your assistance.

Ian, 20~29 year old female. Ask Date: 2021/06/28

Dr. Ke Fangxu reply Surgery

1.
If there is no redness, swelling, or pain, it is fine to continue monitoring.
2.
If a complete cure is desired, surgical treatment is still necessary.
3.
If there are no recurring symptoms, it is important to maintain cleanliness and good bowel habits.

Reply Date: 2021/06/28

More Info

When it comes to anal fistula surgery, understanding the condition and the timing of the procedure is crucial for effective management. An anal fistula is an abnormal connection between the anal canal and the skin surrounding the anus, often resulting from an infection or abscess. The decision to operate is typically based on the severity of the fistula, the presence of symptoms, and the overall health of the patient.

1. Observation Period: If your external wound has healed and you have not experienced any new symptoms such as pain, swelling, or discharge, your doctor may recommend a period of observation. The duration of this observation can vary, but it is generally advisable to monitor the situation for several weeks to a few months. During this time, it is essential to maintain good hygiene and report any changes to your healthcare provider. If the fistula remains asymptomatic, your doctor may suggest continuing to observe it, but if symptoms recur or worsen, surgery may become necessary.

2. Need for Surgery: Even if the external wound has healed, the underlying fistula may still require surgical intervention. Surgery is often the definitive treatment for anal fistulas, as it aims to remove the fistulous tract and prevent recurrence. The decision to proceed with surgery will depend on factors such as the complexity of the fistula, your overall health, and the potential risks and benefits of the procedure. If the fistula is simple and not causing significant issues, your doctor may choose to delay surgery, but if it is complex or symptomatic, surgery is usually recommended.

3. Living with a Fistula: If you find yourself in a situation where the fistula is not causing significant problems, you may be able to manage it conservatively for a time. This includes maintaining proper hygiene, avoiding constipation (which can exacerbate symptoms), and monitoring for any changes. However, it is important to understand that anal fistulas do not typically resolve on their own and may lead to complications if left untreated. If you experience any new symptoms, such as pain, discharge, or changes in bowel habits, it is crucial to consult your healthcare provider promptly.

In summary, while your doctor may suggest a period of observation for your anal fistula, it is essential to remain vigilant for any changes in your condition. Surgery is often the best long-term solution, especially for persistent or symptomatic fistulas. If you have concerns about the timing of the surgery or the potential risks involved, discussing these with your healthcare provider can help you make an informed decision. Remember, each case is unique, and your doctor will tailor their recommendations based on your specific situation.

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