By Yolanda Smith, BPharm
Surgery is required in the vast majority of cases of anal fistula. It is usually a simple procedure that can be undertaken in day surgery, and most patients can return home shortly after the operation.
This article outlines the stages of recovery of anal fistula, including the different areas of care that patients may require after surgery.
Most patients will need a dressing over the surgical incision following the surgical procedure while the wound heals. The dressing needs to be changed regularly, so it is important that they understand how they can do this themselves at home.
To wash the wound, patients can use warm water and soft gauze pads to wash the skin, making sure to softly pat the skin dry rather than rubbing. Perfume, talcum powder and other potentially irritating products should be avoided. In some cases, the use of a bland barrier cream in this area is recommended to prevent irritants from reaching the skin.
There may be some bleeding or discharge from the wound, especially when patients go to the toilet, particularly in the first couple of weeks after surgery. Some patients find that it is helpful to wear a sanitary towel or a soft gauze pad inside their underwear to avoid staining of clothes during this time.
Most wounds take around six weeks to heal, and there will likely be follow-up appointments during this time to monitor the healing process and check that it is going well.
Patients may need to take several different types of medication for a short period after the surgery to manage or prevent pain, constipation and infections.
Simple analgesics such as paracetamol or ibuprofen are a good choice to relieve pain after the anesthetic from the procedure has worn off. It is best to avoid opioid medications such as codeine, which can cause constipation. Non-pharmacological techniques such as a sitz bath may also help to relieve pain. Do not take over-the-counter pain medication if you are on prescription medication for pain. Pain medication may be taken a quarter of an hour before going to the toilet to ease the pain of defecation in this period.
Fiber and bulk laxatives are useful to assist in regular emptying of the bowel and prevent constipation, which can put stress on the operated area.
Prophylactic antibiotics may also be indicated to reduce the risk of infection in the area before and after the procedure.
If you are on any other regular medication for other health conditions, make sure you know whether you should continue them, or if you need to stop them, for how long.
Resting and General Precautions
It is important that patients are able to rest for several days following the surgical procedure. During this time, they should allow their bodies to recover, and avoid sitting or walking for too long.
Many people find it more comfortable to wear loose-fitting clothes during the recovery period. They may prefer to lie on their side, using pillows or cushions to relieve the pressure on the rectal area.
Depending on the type of surgery and their workplace, patients will need to stay at home for a varied amount of time. Most people may return to work and start gentle exercise as and when they feel able to, usually after several days. Driving and other activities such as operating heavy machinery should be avoided for at least 48 hours after the surgery. Patients should be advised to avoid swimming until the wound has healed completely.
Patients may feel some pain as well as bleeding from the wound when they go to the toilet. This is alleviated by ensuring that stools are soft and regular, using appropriate medications or supplements. A good position on the potty is with your feet on a low stool as it opens up the rectum and makes the passage of stool easier.
Regular mild exercise is advisable starting as early as possible for its benefits on your emotional and physical health. Regular showering, sleeping and rest will help your recovery.
A diet which is not overly oily or spicy, and is high in fiber, with plenty of clear fluids, will help achieve regular soft stools.
When Patients Should Seek Advice
When patients go home following surgery, it is important that they have a clear idea of what to expect and what they should do if they experience worrying symptoms. They should be aware of the following signs and seek medical advice if they notice them:
- Heavy bleeding from wound
- Increasing pain, inflammation or discharge
- Nausea or vomiting
- Constipation (no bowel motion for 3 days or more)
- Difficulty passing urine
- Redness, swelling or pain in the anal region
- Swelling of the lymph nodes in the groin
- Lack of bowel control
If these symptoms present, patients should see a doctor as soon as possible to discuss their concerns, and decide upon the appropriate action.
Reviewed by Dr Liji Thomas, MD.
Last Updated: Jul 1, 2016