What are the treatments for an anal fistula?

Surgery is almost always necessary to cure an anal fistula. The surgery is performed by a colon and rectal surgeon. The goal of the surgery is a balance between getting rid of the fistula while protecting the anal sphincter muscles, which could cause incontinence if damaged.

Fistulas in which there is no or little sphincter muscle involved are treated with a fistulotomy. In this procedure, the skin and muscle over the tunnel are cut open to convert it from a tunnel to an open groove. This allows the fistula tract to heal from the bottom up.

In the case of a more complex fistula, the surgeon may have to place a special drain called a seton, which remains in place for at least 6 weeks. After a seton is placed, a second operation is almost always performed:

  • A fistulotomy, or
  • An advancement flap procedure (the fistula is covered with a flap, or piece of tissue, taken from the rectum, like a trap door), or
  • A lift procedure (the skin above the fistula is opened up, the sphincter muscles are spread, and the fistula is tied off).

A new treatment for Crohn’s disease fistulas is to inject stem cells into the fistula. Your colorectal surgeon will discuss all of your options before the surgery.

Fistula surgery is usually done on an outpatient basis, which means the patient can go home the same day. Patients who have very large or deep fistula tunnels may have to stay in the hospital for a short time after the surgery. Some fistulas may require several operations to get rid of the fistula.

Is any follow-up treatment necessary for an anal fistula?

Most fistulas respond well to surgery. After the surgery, your surgeon may recommend that you soak the affected area in a warm bath, known as a sitz bath, and that you take stool softeners or laxatives for a week.

Since you may also have some pain or discomfort in the area after surgery, your physician will usually inject local anesthetic such as lidocaine to decrease your discomfort, and may prescribe pain pills. If opioids are prescribed, they are usually used for a very short period.

If the abscess and fistula are treated properly and heal, they will probably not come back.

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