Understanding Anal Fistulas: Treatments and Recovery

What Is an Anal Fistula?

Colorectal cancer is the most common cancer among men and the second most common among women in Singapore. While it is prevalent, colorectal cancer is one of the most preventable and treatable cancers when detected early through regular screening.

While most cases are linked to infections of the anal glands, less common causes include Crohn’s disease, tuberculosis, trauma or previous radiation therapy to the pelvic area. These symptoms include:

• Recurrent abscesses
• Pain
• Swelling
• Pus or discharge
• Bleeding

Treatments for Anal Fistulas

Anal fistula treatment aims to eliminate the fistula while preserving anal sphincter function to prevent complications such as incontinence. The choice of procedure depends on the fistula’s location, complexity and involvement of muscle tissue. Common treatment options available:

Fistulotomy

A fistulotomy is the most common and straightforward procedure for treating anal fistulas. It is best suited for superficial, low-lying fistulas that do not involve significant sphincter muscle tissue. The procedure involves surgically opening the entire fistula tract, allowing it to heal naturally from the inside out. Typically performed as a day surgery, recovery is usually relatively quick for uncomplicated cases, allowing patients to return to their daily activities sooner.

Seton Placement

A seton is a thin surgical thread or rubber loop placed through the fistula tract to keep it open, promote drainage and reduce infection risk. This method is particularly useful for complex fistulas involving a significant portion of the sphincter muscle.

Setons are often used as the first step before more definitive treatment options, such as LIFT or advancement flap repair, as they help preserve sphincter control and minimise the risk of incontinence.

LIFT Procedure (Ligation of Intersphincteric Fistula Tract)

The LIFT procedure is a minimally invasive option for transsphincteric fistulas where a fistulotomy would risk incontinence. This technique involves closing the internal fistula opening and dividing the tract at the intersphincteric plane. It strikes a balance between effectively treating the fistula and preserving sphincter function, making it a preferred choice for higher-risk, more complex cases.

Advancement Flap Repair

Advancement flap repair is a procedure that involves removing the internal opening of the fistula and covering it with a flap of healthy tissue from the rectum or anal area. This is recommended for high, complex or recurrent fistulas, especially when other treatments have failed.

While effective for challenging cases, this approach requires good tissue health for optimal healing and may involve a slightly longer recovery period compared with simpler techniques.

Anal Fistula Plug / Fibrin Glue

For patients seeking less invasive alternatives, an anal fistula plug or fibrin glue can be used. These methods involve inserting biocompatible materials into the fistula tract to seal it from the inside out. Although minimally invasive and typically causing little discomfort, their success rates can vary depending on the complexity of the fistula.

Recovery Journey

Here, we’ll guide you through the recovery journey after anal fistula surgery, helping to make the healing process smoother, less stressful, and allowing you to regain comfort more quickly.

• Pain Management:

  Mild discomfort after surgery is common and can usually be managed with oral painkillers. Warm sitz baths, taken two to three times daily, might also be recommended to ease pain and relax the area.

• Wound Care:

  Keeping the surgical site clean and dry is crucial. Dressings should be changed regularly according to your doctor’s instructions to aid with healing.

• Diet:

  A high-fibre diet and plenty of fluids will help prevent constipation, reducing strain during bowel movements and supporting recovery.

• Return to Activities:

  Most patients can return to desk work within three to five days after a simple fistulotomy. For more complex procedures, one to two weeks of rest may be needed. Heavy lifting and strenuous activities should also be avoided.

During your recovery, follow-up appointments are crucial to monitor your healing progress and prevent complications, including recurrence. Your first consultation is typically scheduled two weeks after surgery, with subsequent visits guided by your overall progress.

Preventing Recurrence

Preventing anal fistula recurrence requires a proactive approach to overall health and post-treatment care. Key steps include managing underlying conditions such as Crohn’s disease, maintaining good anal hygiene, and seeking prompt evaluation for any new perianal pain or swelling.

At HKS Colorectal, Dr Ho Kok Sun creates personalised treatment plans tailored to each patient’s unique condition and needs, ensuring long-term success and minimal disruption to daily life.

If you have experienced symptoms such as persistent discomfort, swelling or recurrent abscesses, book a consultation today to get expert advice and protect your long-term colorectal health.