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Saint Joseph Hospital

Anal Fistula

Living with an anal fistula offers serious health considerations; however, it also can change the way you live your life and your happiness. Trust us to provide the specialized medical attention you need to get you back to feeling more like yourself. 

An anorectal disorder occurs at the junction of your anal canal and rectum. Often treatment is available in your provider's office. For some care, you might need more complex treatments available at a hospital.

Anal fistula

An anal fistula is a tunnel that forms between an infected anal gland and the skin on the outside of your body. This is a complication of an anal abscess. Fistulas usually start as an anal abscess. Over time abscesses create an abnormal tunnel to the skin surface so the infection can drain. About 25-30% of people with an anal abscess will develop a chronic anal fistula. Anal fistulas can cause persistent drainage around the rectum, even after treatment for the abscess.

Symptoms of an anal fistula

The symptoms of an anal fistula are the same as the symptoms of an anal abscess. But the pain is not as bad and may happen only during a bowel movement. Other symptoms can include:

  • Red, itchy skin near the anus
  • Pus or cloudy fluid draining from the anus

Testing for anal abscesses or fistulas

To check for an anal abscess or a fistula, your doctor or nurse will look at your anus and do a “digital rectal exam.” During the exam, your provider will put a gloved finger into your anus to feel for abnormalities.

He or she might also order an “imaging test,” such as an MRI or a CT scan. Imaging tests create pictures of the inside of the body. These images can help determine how severe or how large your abscess is.

Your doctor may also need to do other tests to check for inflammatory bowel disease or rectal cancer.

Treatment for anal fistula

To treat a fistula, your doctor will need to cut open the abnormal tunnel that has formed. This will remove the pus and inflamed tissue, helping the wound heal. We do this surgery under anesthesia, where you are asleep. If you have a large or deep fistula, you might need treatment in the hospital for a few days.

Risks of surgery for anal fistula

The main concern with surgery is the development of anal incontinence. If the anal fistula is deep, the doctor may need to cut through the anal sphincter to open the tunnel. If your doctor needs to cut the anal sphincter entirely, it could result in anal incontinence.

Anal incontinence can include:

  • Inability to control gas
  • Mild fecal soiling
  • Loss of solid stool

In up to 45 percent of patients, minor leakage can occur during the recovery period. This is normal. This immediate post-surgical incontinence is rarely permanent and is usually mild.

The risk of incontinence after surgery is higher:

  • For women who have had previous vaginal childbirth
  • For any patient that has had previous anal or rectal surgery.

Discuss all risks with your surgeon during your pre-surgery appointment.

After surgery

The most important care instruction is to not allow yourself to become constipated. Staring the mornign after surgery, avoid constipation by:

  • Starting a high fiber diet of bran cereal, wheat bread, fresh fruits and veggies
  • Drinking one tablespoon of Metamucil mixed with eight ounces of water twice a day
  • Taking 100mg of a stool softener twice a day starting on the day before your surgery
  • Continuing your stool softener until you are no longer taking pain medication
  • Drinking two tablespoons of Milk of Magnesia every six hours until your first bowel movement if you go 48 hours without at BM
  • Calling your doctor if you go more than 2 days without a BM
  • Calling your doctor if you are having abdominal pain or abdominal distension
  • Drinking plenty of water and juice and eat fresh fruits and vegetables.

Learn more about anal fistulas.

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