What is anal fistulotomy?

An anal fistulotomy is a type of surgery. It opens and drains an anal fistula and helps it heal. An anal fistula is a small tunnel from the anal canal to a hole in the skin near the anus.

Your doctor will give you medicine to make you sleep or feel relaxed. To do the surgery, the doctor puts a lighted tube into the anus. This tube is called a scope. It lets the doctor see the inside of the anus. Then the doctor puts special surgical tools through the scope. They are used to make a cut through one side of the fistula. This cut is called an incision. It opens the fistula so it can drain and heal from the inside out.

After surgery, you may have gauze in the opening of your fistula. It may come out with your first bowel movement. Or your doctor may tell you to remove it 1 day after surgery.

You will probably go home the same day. Most people have very little pain after several days. You can probably go back to work or your normal routine in 1 to 2 weeks. Most people heal completely in several weeks. After the area heals, the fistula will be gone.

Activity

• Rest when you feel tired. Getting enough sleep will help you recover.
• Be active. Walking is a good choice.
• Ask your doctor when you can drive again.
• Most people are able to return to work within 1 to 2 weeks after surgery.
• Shower or take baths as usual. Pat your anal area dry with a towel when you are done.

Diet

• You can eat your normal diet. If your stomach is upset, try small amounts of food.
• Drink plenty of fluids (unless your doctor tells you not to).
• Include high-fiber foods, such as fruits, vegetables, beans, and whole grains, in your diet each day.
• You may notice that your bowel movements are not regular right after your surgery. This is common. Try to avoid constipation and straining with bowel movements. You may want to take a fiber supplement every day. If you have not had a bowel movement after a couple of days, ask your doctor about taking a mild laxative.

Medicines

• Your doctor will tell you if and when you can restart your medicines. You also will be given instructions about taking any new medicines.
• If you stopped taking aspirin or some other blood thinner, your doctor will tell you when to start taking it again.
• Be safe with medicines. Take pain medicines exactly as directed.
  • If the doctor gave you a prescription medicine for pain, take it as prescribed.
  • If you are not taking a prescription pain medicine, take an over-the-counter medicine such as acetaminophen (Tylenol), ibuprofen (Advil, Motrin), or naproxen (Aleve). Read and follow all instructions on the label.
  • Do not take two or more pain medicines at the same time unless the doctor told you to. Many pain medicines have acetaminophen, which is Tylenol. Too much acetaminophen (Tylenol) can be harmful.
• If your doctor prescribed antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics.
• If you think your pain medicine is making you sick to your stomach:
  • Take your medicine after meals (unless your doctor has told you not to).
  • Ask your doctor for a different pain medicine.

Incision care

• You may have gauze and bandages over the opening of your fistula, or you may have a string coming from the fistula. Your doctor will tell you how to take care of these.
• After a bowel movement, use a baby wipe or take a shower or sitz bath to gently clean the anal area.

Other instructions

• Place a maxi pad or gauze in your underwear to absorb drainage from your fistula while it heals.
• Sit in a few inches of warm water (sitz bath) for 15 to 20 minutes. Then pat the area dry. Do this as long as you have pain in your anal area.
• Support your feet with a small step stool when you sit on the toilet. This helps flex your hips and places your pelvis in a squatting position. This can make bowel movements easier after surgery.
• Try lying on your stomach with a pillow under your hips to decrease swelling.

Surgery can be stressful. This information will help you understand what you can expect. And it will help you safely prepare for surgery.

Preparing for surgery

• You may need to empty your colon with an enema or laxative. Your doctor will tell you how to do this.
• Be sure you have someone to take you home. Anesthesia and pain medicine will make it unsafe for you to drive or get home on your own.
• Understand exactly what surgery is planned, along with the risks, benefits, and other options.
• If you take a medicine that prevents blood clots, your doctor may tell you to stop taking it before your surgery. Or your doctor may tell you to keep taking it. (These medicines include aspirin and other blood thinners.) Make sure that you understand exactly what your doctor wants you to do.
• Tell your doctor ALL the medicines, vitamins, supplements, and herbal remedies you take. Some may increase the risk of problems during your surgery. Your doctor will tell you if you should stop taking any of them before the surgery and how soon to do it.
• Make sure your doctor and the hospital have a copy of your advance directive. If you don’t have one, you may want to prepare one. It lets others know your health care wishes. It’s a good thing to have before any type of surgery or procedure.

You had an anal fistulotomy. This surgery opens and drains an anal fistula and helps it heal.

You may be worried about having a bowel movement after your surgery. You will likely have some pain and bleeding with bowel movements for the first 1 to 2 weeks. You can make your bowel movements less painful by getting enough fiber and fluids. And you can use stool softeners or laxatives. Sitting in warm water (sitz bath) after bowel movements will also help.

You may notice a small amount of pus or blood draining from the opening of your fistula. This is normal in the days after your surgery. You can put a gauze pad over the opening of the fistula to absorb the drainage, if needed.

Most people can go back to work and their normal routine 1 to 2 weeks after surgery. It will probably take several weeks to several months for your fistula to completely heal. This depends on the size of your fistula and how much surgery you had.

• Follow the instructions exactly about when to stop eating and drinking. If you don't, your surgery may be canceled. If your doctor told you to take your medicines on the day of surgery, take them with only a sip of water.
• Follow your doctor's instructions about when to bathe or shower before your surgery. Do not apply lotions, perfumes, deodorants, or nail polish.
• Do not shave the surgical site yourself.
• Take off all jewelry and piercings. And take out contact lenses, if you wear them.

At the hospital or surgery center

• Bring a picture ID.
• The area for surgery is often marked to make sure there are no errors.
• You will be kept comfortable and safe by your anesthesia provider. The anesthesia may make you sleep. Or it may just numb the area being worked on.
• The surgery will take about 30 minutes.