Anal Fistula Surgery: Symptoms and Treatment Options

Fistula surgery, anal issues?

Hello Dr.
Chang: I started experiencing some pain during anal contractions from February 9th, which continued until February 12th and 13th when I began having severe pain during bowel movements.
I also have a persistent sensation of wanting to have a bowel movement, accompanied by a feeling of external expansion in the anal area.
There has been no bleeding during bowel movements, but there is significant pain at the moment of anal contraction during defecation.
On February 14th, I went to the hospital for an examination, and the doctor told me that I have an anal fistula that requires surgery.
Given this situation, is it indeed an issue with the anal fistula? I haven't found any information online regarding pain during anal contractions.
I would appreciate your clarification, Dr.
Chang.
Thank you!

Mr. Lin, 30~39 year old female. Ask Date: 2022/02/15

Dr. Zhang Shuhao reply Surgery

The most common cause of severe pain during bowel movements is anal fissure, but lesions around the anus such as thrombosed hemorrhoids, perianal abscesses, and even anal fistulas can also cause varying degrees of pain when inflamed.
When a doctor recommends surgery in an outpatient setting, it indicates that the physician believes the surgical procedure can effectively address your pain (other conditions of the anus observed during fistula surgery can also be managed simultaneously).
If you are still considering whether to undergo surgery, you can ask your doctor about other conservative treatment options, and only proceed with surgery if those options prove ineffective.

Reply Date: 2022/02/15

More Info

Understanding anal fistulas and their treatment options is crucial for anyone experiencing symptoms related to this condition. An anal fistula is an abnormal connection between the anal canal and the skin surrounding the anus. It often arises after an infection in the anal glands, leading to the formation of an abscess. When the abscess drains, it can leave a tract or tunnel, which is the fistula.

In your case, the symptoms you describe—pain during bowel movements, a sensation of anal expansion, and the absence of blood—are consistent with an anal fistula. The pain you experience during bowel movements could be due to the inflammation and irritation of the tissues surrounding the fistula. The feeling of needing to have a bowel movement, even when you do not, can also be a result of the fistula affecting the normal function of the anal sphincter muscles.

When it comes to treatment, surgery is often the most effective option for anal fistulas. The surgical procedure typically involves the following steps:
1. Fistulotomy: This is the most common surgical procedure for treating anal fistulas. The surgeon opens the fistula tract and allows it to heal from the inside out. This method is effective for most simple fistulas.

2. Seton Placement: In cases where the fistula is more complex or involves the sphincter muscles, a seton (a piece of surgical thread) may be placed in the fistula tract. This helps to keep the tract open and allows for gradual drainage and healing over time.

3. Flap Procedures: For more complicated fistulas, especially those that do not respond to other treatments, a flap procedure may be necessary. This involves using healthy tissue to cover the internal opening of the fistula.

4. Fibrin Glue or Bioprosthetic Plug: In some cases, a surgeon may use a special glue or a plug made from biological materials to close the fistula. This is less invasive but may not be suitable for all types of fistulas.

Post-surgery, patients may experience some discomfort, but this can usually be managed with pain relief medications. It is also essential to maintain good hygiene and follow any specific post-operative care instructions provided by your surgeon.

Recovery from anal fistula surgery can vary depending on the complexity of the fistula and the type of procedure performed. Most patients can expect to return to normal activities within a few weeks, but complete healing may take longer.

In summary, your symptoms suggest that you may indeed have an anal fistula, and surgical intervention is likely necessary to resolve the issue. It is essential to discuss your symptoms and treatment options thoroughly with your healthcare provider to ensure the best possible outcome. If you have any further questions or concerns, do not hesitate to reach out to your doctor for clarification and support.

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