Managing Recurring Anal Fistulas: Surgical Options and Recovery Tips

After the development of an anal fistula, a common complication is the leakage of fecal fluid, which can result in soiling of the underwear?

I have had two surgeries for my anal fistula, and now I have small bumps resembling acne below my anus.
After squeezing them, they bleed and then disappear naturally, but they keep recurring.
Do I need another surgery? After the surgeries, I have experienced side effects such as gas passing with a watery discharge that stains my underwear, which does not smell like feces.
Has my sphincter been damaged, making it difficult to live normally? What rehabilitation should I pursue? If a third surgery is necessary, would laser treatment cause less damage? I want to avoid sphincter laxity that could affect my bowel movements.
Thank you.

Qiang Qiang, 60~69 year old female. Ask Date: 2024/05/11

Dr. Zhang Shuhao reply Surgery

Fistula surgery requires cutting part of the sphincter muscle.
Postoperatively, there may occasionally be a sensation of incontinence during bowel movements, but it should not reach the level of being unable to hold it.
Dietary adjustments or medication can improve bowel function, and normal daily activities can still be maintained.
It is recommended to return to the original surgeon for an evaluation to determine if a repeat surgery is necessary, or to consider medication to address the current gastrointestinal symptoms first.
I do not have expertise in laser treatment for fistulas, so it would be best to consult a specialist in that area.

Reply Date: 2024/05/11

More Info

Managing recurring anal fistulas can be quite challenging, especially after multiple surgical interventions. It sounds like you are experiencing a frustrating cycle of symptoms, including the appearance of small bumps that resemble acne, which bleed when squeezed and then resolve only to reappear. This could indicate that the fistula is not fully healed or that there is a new issue developing.

Surgical Options
1. Fistulotomy: This is the most common surgical procedure for treating anal fistulas. It involves cutting open the entire length of the fistula to allow it to heal from the inside out. This method is effective but can sometimes lead to complications, such as damage to the anal sphincter, which may affect bowel control.

2. Seton Placement: In cases where the fistula is complex or involves a significant portion of the sphincter muscle, a seton (a piece of surgical thread) may be placed to help drain the fistula and promote healing over time. This method is less invasive and can help preserve sphincter function.

3. Flap Procedures: For more complicated fistulas, a flap procedure may be performed, where tissue is moved from another area to cover the fistula tract. This can be more effective in preventing recurrence but may involve a longer recovery period.

4. Laser Treatment: Laser therapy is a newer option that can be less invasive than traditional surgery. It uses focused light to treat the fistula while minimizing damage to surrounding tissues. This method may reduce recovery time and complications, but its effectiveness can vary based on the complexity of the fistula.

Recovery Tips
- Post-Operative Care: After surgery, it’s crucial to follow your surgeon's post-operative care instructions. This typically includes keeping the area clean, using sitz baths to soothe discomfort, and possibly taking prescribed medications for pain management.

- Dietary Adjustments: A high-fiber diet can help prevent constipation and straining during bowel movements, which is essential for healing. Staying hydrated is also important.

- Physical Therapy: If you are concerned about sphincter function, pelvic floor physical therapy can be beneficial. A trained therapist can guide you through exercises to strengthen the pelvic floor muscles and improve bowel control.

- Monitoring Symptoms: Keep a close eye on any changes in your symptoms. If you notice the return of bumps or any new symptoms, it’s essential to consult your healthcare provider promptly.

Concerns About Sphincter Damage
You mentioned experiencing leakage that does not have the typical odor associated with feces. This could indicate that the anal sphincter has been affected, which is a common concern after multiple surgeries. If you suspect that your sphincter function is compromised, it is vital to discuss this with your surgeon or a specialist in colorectal surgery. They may recommend additional tests, such as an anal manometry, to assess sphincter function.

Conclusion
In summary, if you are experiencing recurring symptoms, it may be necessary to consider another surgical intervention. Discuss the possibility of laser treatment with your surgeon, as it may offer a less invasive option with a lower risk of complications. Additionally, focusing on recovery strategies, including dietary changes and possibly pelvic floor therapy, can help improve your quality of life post-surgery. Always communicate openly with your healthcare provider about your concerns and symptoms to ensure you receive the best possible care.

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