Anal Fistulas: Surgical Options and Care Tips

Q: Anal Fistulas: Surgical Options and Care Tips

Hello, in response to your question： If an anal fistula is left untreated, it may lead to a bacterial infection, resulting in the formation of an abscess, which can cause swelling and pain. <br>In such cases, an incision and drainage procedure is necessary, which is considered an

Issues related to anal fistulas?

Question:
Asking person: Ah Xiang / Male / 29
Hello, doctor: Sometimes when I have a bowel movement, I notice blood when I wipe with toilet paper, and sometimes I don’t.
I thought it was hemorrhoids, and I also experience itching at times.
I previously saw a doctor who told me I had hemorrhoids, but recently I went to another doctor who confirmed that I have an anal fistula and told me that surgery is necessary to resolve it.
Doctor, does an anal fistula really require surgery? The doctor mentioned that my anal fistula is still mild and advised me to schedule the surgery myself.
However, I have some matters to attend to and cannot undergo surgery immediately.
I was considering waiting for a year before having the surgery, but I am worried that the fistula might worsen.
I would like to ask the doctor if there are any methods to prevent the anal fistula from worsening and to maintain it in a mild state.
Response:
Doctor: Ke Fang-Hsu, Keelung Hospital / Surgery
Hello: In response to your question, an anal fistula indeed requires surgical treatment for a complete cure.
If not addressed in a timely manner, it can potentially progress from a simple to a complex type.
If surgery is temporarily inconvenient, you must closely monitor for any pain, swelling, or pus formation in the fistula.
If any discomfort arises, you should undergo incision and drainage treatment or antibiotic therapy to prevent infection, which could increase pressure and lead to the fistula spreading.
However, conservative treatment does not guarantee that it will not worsen; it is merely an alternative palliative treatment option.
In fact, surgery for a simple fistula is relatively straightforward.
I recommend that you muster the courage to undergo surgical treatment as soon as possible, as it is the fundamental solution.
Follow-up Question:
Doctor, I apologize for bothering you again.
The incision and drainage you mentioned, is that considered surgery? Will I need to be hospitalized? How many days does it typically take for the wound to heal? I am currently soaking my buttocks in warm water every day; does this help slow the progression of the anal fistula? What should the water temperature be? Since my testicles also soak in the water, if the temperature is too high, could it harm the sperm?

Axiang, 20~29 year old female. Ask Date: 2009/12/18

Dr. Ke Fangxu reply Surgery

Hello, in response to your question: If an anal fistula is left untreated, it may lead to a bacterial infection, resulting in the formation of an abscess, which can cause swelling and pain.
In such cases, an incision and drainage procedure is necessary, which is considered an outpatient surgery.
This can typically be performed under local anesthesia and takes about ten minutes, with no need for hospitalization.
The wound generally takes one to two weeks to heal.
Warm sitz baths can help maintain anal cleanliness and control symptoms, but they cannot guarantee that the condition will not worsen.
It is recommended that the water temperature does not exceed 38 degrees Celsius to avoid skin damage.
A sitz bath at this temperature should not pose any risk to sperm.
Please do not worry.
Dr.
Ke Fang-Hsu, Department of Surgery, Keelung Hospital, Ministry of Health and Welfare.

Reply Date: 2009/12/18

More Info

Anal fistulas are abnormal connections 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 the formation of an abscess. If left untreated, these fistulas can cause discomfort, pain, and recurrent infections. In your case, it seems that you have been diagnosed with an anal fistula after initially thinking it was hemorrhoids.
The primary treatment for anal fistulas is surgical intervention. While some patients may be hesitant to undergo surgery due to various reasons, it is essential to understand that surgery is often the only definitive way to resolve the issue and prevent complications. The type of surgery required will depend on the complexity of the fistula. Simple fistulas can often be treated with a straightforward procedure, while more complex cases may require more extensive surgery.

You mentioned that your doctor indicated your fistula is mild and suggested scheduling surgery at your convenience. It is crucial to heed this advice, as delaying treatment can lead to the fistula becoming more complicated. Complications can include increased pain, the development of abscesses, or the fistula becoming more extensive, which can complicate surgical repair.

In the meantime, while you are waiting for surgery, there are some conservative measures you can take to manage your symptoms and potentially prevent the fistula from worsening. Regular warm sitz baths can help soothe the area and promote healing. You should aim for the water temperature to be comfortable, typically around body temperature (98.6°F or 37°C), to avoid any risk of burns or discomfort. It’s important to ensure that your testicles are not exposed to excessively hot water, as prolonged exposure to high temperatures can affect sperm production.

Maintaining good hygiene is also vital. After bowel movements, gently clean the area with mild soap and water, and avoid using harsh wipes or products that can irritate the skin. Keeping the area dry and clean can help prevent infections.

You should also monitor for any changes in your symptoms. If you experience increased pain, swelling, or discharge, it’s essential to seek medical attention promptly. These could be signs of an infection or worsening of the fistula.

While conservative measures can provide temporary relief, they do not replace the need for surgical intervention. Surgery is the most effective way to ensure that the fistula does not progress to a more complicated state. If you have concerns about the timing of your surgery or the procedure itself, it is advisable to discuss these with your healthcare provider. They can provide you with more information about the surgery, recovery time, and any potential risks involved.

In summary, while it is understandable to want to delay surgery due to personal commitments, it is crucial to prioritize your health. Anal fistulas typically require surgical treatment for a complete resolution, and delaying this can lead to complications. In the meantime, practice good hygiene, take warm sitz baths, and monitor your symptoms closely. If you have any further questions or concerns, do not hesitate to reach out to your healthcare provider for guidance.

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