Anal fistula surgery
An anal fistula is an abnormal tunnel that develops between the anal canal and the skin around your back passage. A fistula can be uncomfortable and unpleasant, and they don't heal without surgery.
Quick facts
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What is it for?
Treat an anal fistula and prevent ongoing pain, discharge, and infections
Treatment overview
Most anal fistulas will not heal spontaneously without surgery. Anyone with a suspected fistula should see an experienced colorectal surgeon.
The London Clinic’s specialists will provide expert assessment and individual advice.
In consultation with you, your surgeon will plan your admission for anal fistula surgery and advise you about any preparation needed.
There are different procedures available. The best technique will depend on the location of your fistula and whether it affects the sphincter muscle.
Your consultant will explain the options and take the time to answer all your questions.
Anal fistula consultation at The London Clinic
The specialist surgeons will assess and advise you in The London Clinic's comfortable, private, and well-equipped consulting rooms.
They will take a detailed medical history, examine your fistula, and ask about the impact your symptoms have on your health, wellbeing, and quality of life.
Your consultant may arrange tests and investigations in the cutting-edge imaging suite.
These may include:
- Blood tests to exclude underlying conditions such as inflammatory bowel disease
- Stool samples to check for inflammation
- Swabs to check for infection
- An internal ultrasound scan of your back passage
- Magnetic resonance imaging, or MRI scan
- Computer tomography or CT scan
Anal fistula surgery at The London Clinic
The surgeons at The London Clinic usually perform anal fistula surgery under general anaesthetic. The type of procedure will depend on the position of your fistula.
Some procedures can be performed using spinal anaesthesia, so you’ll be awake during surgery, but your lower body will be numb.
Fistulotomy
The most commonly performed fistula surgery is suitable for simple fistulas that are below the sphincter, or that cross the muscles that make up the lower part of the sphincter muscles only.
Your consultant surgeon will carefully place a surgical probe into the fistula. They will cut the skin and tissue above the fistula, then open up the fistula's roof.
They will clean and dress the fistula, leaving it open with no stitches. It will gradually heal from the base up, with healthy tissue.
For branching or high fistulas, your surgeon may need to perform more complex or staged surgery over several months.
This helps reduce the risk of damage to the anal sphincter muscles, which can lead to incontinence:
Seton insertion
The specialist may insert a specially designed thread called a seton through the fistula. The thread helps the fistula drain effectively, reducing infection, and aiding healing. Some fistulas will heal using setons alone; for others, it can be the first stage of treatment.
Staged fistulotomy
The surgeon performs a series of operations over several months. They gradually open up the fistula, inserting a seton after each procedure to aid drainage.
Cutting seton
A specially-designed seton can progressively cut through the muscle of the sphincter. It gradually opens the fistula while allowing the tissue to heal and form scar tissue, reducing the incontinence risk.
Glues and plugs
Products can sometimes be inserted into the fistula to block the canal and allow it to heal.
LIFT procedure
If your fistula passed through the sphincter muscles, this procedure might be necessary. The surgeon closes one end of the fistula, then cuts the rest open, reducing damage to the sphincter.
Anal advancement flaps
The surgeon can create a tissue flap from the anal canal and fix it over the fistula opening.
Temporary colostomy
Rarely a colostomy is necessary to rest the bowel and allow the fistula to heal.
Why choose The London Clinic
Excellence in one place
We operate as teams of experts with world-class resources dedicated to maintaining the highest standards of medical care. You are surrounded by the latest treatments and advice with everything you need to get back to your best health.
Personal care, every time
Exceptional patient care is a way of life for us. Our nurses, clinicians and support teams are dedicated to the care of a very small number of patients, so have more time for you. They’ll be with you every step of the way, tailoring your care around you and giving the peace-of-mind that comes with knowing you’re in the best hands.
Effortlessly simple
We work together as one to guide you through each step of your experience, with complexities unravelled and answers readily to hand. Your personal treatment plan will be laid out for you, with all the details taken care of so you can focus on you.
What's included in your package?
Choosing The London Clinic means your treatment plan will be laid out for you, with all the details taken care of so you can focus on you.
Your treatment package will include:
- Enhanced pre-admission assessment
- Your treatment with our complete care team at your fingertips
- Personalised aftercare and follow-up
We want you to be in control of your health. That’s why we also offer optional services such as comprehensive recovery packages and extra touches for you to choose from during your stay with us.
How to pay
- You can use private medical insurance (PMI) to access this treatment. We work with all major PMI providers in the UK and many internationally
- You can pay for yourself (self-pay)
- If you’re paying for yourself, we have finance options available with Chrysalis
FAQs
An anal fistula is an abnormal connection that develops between the inside of the back passage and the skin around the anus.
It can leak discharge, it can cause skin irritation and infection, and it can cause pain and swelling in the area.
Anal fistulas develop as a result of abscesses in the anal canal. When the abscess bursts, a canal can form following the track of the pus.
As many as one in three people with perianal abscesses can develop a fistula. They are also more common with chronic bowel conditions, such as Crohn’s disease.
Most anal fistulas will not heal without surgery. Anyone with an anal fistula should have surgical treatment to get rid of their fistula and resolve their symptoms.
The signs and symptoms include:
- An offensive discharge leaking from the skin around the back passage
- Diarrhoea
- Skin irritation
- Swelling
- Pain around the anus
- Recurrent infections
- A lump or hole in the skin around the back passage
Your recovery and aftercare will depend on your health and your procedure. Many people can go home on the day of surgery.
However, some patients will need to stay overnight so that the team can monitor their recovery.
The London Clinic's staff will provide support, arrange follow-up to assess your progress, and give you a bespoke plan to dress your wound, keep it clean and prevent infection as it heals.
Take time to rest and recover. Walk as little as possible for the first few days to help your wound heal.
Over-the-counter painkillers like paracetamol and ibuprofen can help ease any pain. The area can take up to six weeks to heal. You should wear a pad to protect your clothing.
Bathing or showering regularly, up to three times a day, can keep the wound clean and soothe discomfort as well as keeping your wound clean.
Gently pat the area dry afterwards and don't use any gels, soaps, or perfumed products.
Constipation can be a problem for some people. The specialist team may suggest stool-softeners or laxatives to make it easier to open your bowels.
You can return to work when you can move around and sit comfortably.
The team will always be on hand if you have any problems, worries, or questions.
It's important to contact The London Clinic if you develop a fever if the area is red and inflamed if there's pus or increased bleeding.
You should not drive after your anaesthetic. It's essential to get someone to pick you up from the clinic and escort you home.
The anaesthetic can still have an impact for 48 hours, and following this, the discomfort from your wound could affect your ability to sit, drive, and respond effectively.
Discuss any concerns with your consultant.
All surgery has risks. The surgeons and The London Clinic team are dedicated to reducing complications and helping your recovery.
Problems with pain, bleeding, scarring, and infection can happen after any operation.
Specific issues with anal fistula surgery include the fistula's recurrence, narrowing the anal canal, and slow wound healing.
Sometimes surgery on fistulas that involve the sphincter muscles can affect bowel control, meaning you can't control passing wind or poo. Speak to your surgeon if you have any concerns.
They will always take time to discuss the pros and cons of the procedure and answer any questions.