Recovering from anal fistula surgery

Most anal fistula surgery is done as an outpatient (a day case where you don’t need to stay overnight), or in the cases of more complex fistulas you may be required to stay for one night.

After the surgery, you will need to be monitored to ensure there are no immediate complications. Once the anaesthesia has worn off, you will be allowed to move around and eat and drink as usual and then go home. You may be required to have someone to stay with you for 24 hours after your surgery if you aren’t staying overnight.

Looking after the wound and washing

After you have left hospital you will need to be able to look after the wound to ensure it heals well and you don’t experience an infection.

When you leave hospital you may have a surgical dressing on the wound. You may be asked to change this regularly, often daily, and you will be shown how to do this yourself. In some cases you will be asked to remove this dressing in the bath the day after the surgery and another dressing may not be required. Your doctor will give you information on what to do.

Sometimes you will need to visit the hospital or GP to get the wound checked or the dressing changed for you. You may also be asked to ‘digitate’ the wound. This is where you move a finger along the wound to prevent the top layer of skin healing too quickly and can help to prevent the fistula from coming back. If you don’t feel comfortable doing this then you should let your doctor know and they may be able to arrange for someone to do it for you.

It’s likely there will be some bleeding or discharge from the wound for a few weeks, particularly if you have had a seton inserted. Using a sanitary towel, which you change regularly, can help to stop any discharge going onto your clothes. If you experience heavy bleeding or discharge, increasing pain, or redness/swelling around the wound you should talk to your doctor.

You should also avoid wearing tight clothing and try to wear underwear that is made from a breathable fabric

Hygiene

Maintaining good hygiene after anal fistula surgery is really important. It’s been found that inadequate hygiene is a significant risk factor for complications and recurrence of the fistula¹.

Some tips for washing the wound include:

• Using warm warm water and cotton wool to clean the area. Avoid using perfumed products and talcum powder
• Pat the skin dry with a clean towel, rather than wiping. Try to dry as much as possible as moisture around the wound can lead to an infection
• After going to the toilet use a peri-bottle, a specially designed bottle to help with gentle cleaning, to clean the area around the wound. Again, dry gently by patting with a clean towel
• You may be asked to have a warm bath each day, if possible. Your doctor or nurse will give you guidance on this

Pain after anal fistula surgery

After anal fistula surgery, it's common to experience pain and discomfort around the surgical site. While this pain is normal and expected, it can be challenging to manage. 

Types of pain after anal fistula surgery

After anal fistula surgery you may experience different types of pain, including:

1. Surgical site pain: This is the most common type of pain after surgery. You may experience pain, discomfort, or swelling around the surgical site. This can be managed with pain medications, ice packs, or warm compresses
2. Muscle spasms: You may experience muscle spasms in the area around the anus, which can cause additional pain and discomfort. Muscle relaxants may be prescribed to manage these spasms
3. Bowel movement pain: You may experience pain or discomfort during bowel movements. This can be managed by taking stool softeners or laxatives to help ease bowel movements

Managing post-operative pain

There are several things you can do to manage post-operative pain after anal fistula surgery:

1. Pain medications: You may be prescribed pain medications to help manage the pain. It's important to take these medications as directed and not to exceed the recommended dosage. If you weren’t prescribed these medications but are struggling with the pain you should speak to your doctor
2. Ice packs or warm compresses: Applying ice packs or warm compresses to the surgical site can help reduce swelling and alleviate pain
3. Muscle relaxants: If you experience muscle spasms, you may be prescribed muscle relaxants to help. Speak to your doctor if this is something you experience
4. Stool softeners or laxatives: Taking stool softeners or laxatives can help ease bowel movements and reduce pain during bowel movements
5. Rest and relaxation: Resting and avoiding strenuous activity can help reduce pain and promote healing after surgery

When to seek medical attention

While some pain after anal fistula surgery is normal, there are certain symptoms that may indicate a complication or infection. If you experience any of the following symptoms, you should seek medical attention:

1. Severe or worsening pain
2. Fever or chills
3. Increased swelling or redness around the surgical site
4. Pus or drainage from the surgical site
5. Difficulty urinating or having a bowel movement

Medication after anal fistula surgery

After having anal fistula surgery, your doctor may prescribe medications to help manage your pain, prevent infection, and promote healing. Some of the medications you may be given after anal fistula surgery include:

1. Pain relievers: Anal fistula surgery can be painful, and your doctor may prescribe pain relievers to help manage your discomfort. These may include over-the-counter medications like acetaminophen or ibuprofen, or stronger prescription painkillers like opioids. It's important to take these medications as directed and not exceed the recommended dosage, as opioids can be addictive
2. Antibiotics: Antibiotics may be prescribed to prevent infection after anal fistula surgery. These medications work by killing bacteria that can cause infection in the surgical site. It's important to take antibiotics exactly as directed and finish the entire course of medication, even if you start feeling better
3. Stool softeners: After anal fistula surgery, you may experience constipation or difficulty passing stool. Your doctor may prescribe stool softeners to help make bowel movements more comfortable. These medications work by drawing water into the stool, making it easier to pass
4. Anti-inflammatory drugs: Anal fistula surgery can cause inflammation in the surgical site, which can be painful and slow down the healing process. Your doctor may prescribe anti-inflammatory medications like corticosteroids to help reduce inflammation and promote healing
5. Topical creams: Your doctor may prescribe a topical cream to help soothe the surgical site and relieve pain. These creams may contain lidocaine or other numbing agents, as well as anti-inflammatory drugs
6. If you have Crohn’s disease then you may also be given a biologic medication, such as infliximab or adalimumab, to try to prevent the recurrence of anal fistulas and manage any other symptoms of Crohn’s disease you may be having

It's important to follow your doctor's instructions carefully when taking medications after anal fistula surgery. Be sure to take all medications as directed, and report any side effects or concerns to your doctor right away. In addition to medications, there are other steps you can take to promote healing after anal fistula surgery, such as maintaining good hygiene, eating a healthy diet, and avoiding strenuous activity. With proper care, you can recover fully from anal fistula surgery and return to your normal activities.

Resting after anal fistula surgery

It's important to rest and take care of yourself after anal fistula surgery to ensure proper healing and minimise the risk of complications.

Take Time Off Work

After anal fistula surgery, it's important to take some time off work to rest and recover. The amount of time you need will depend on the extent of the surgery and your individual healing process. Your healthcare provider will provide you with specific instructions regarding how long to take off work and what activities you should avoid during your recovery period. 

Get Plenty of Rest

Rest is critical for proper healing after anal fistula surgery. It's important to avoid strenuous activities, including exercise and heavy lifting, for at least a few days after surgery. You may also need to avoid sitting for long periods of time or engaging in activities that put pressure on the area around the anus. Your healthcare provider may recommend that you rest in bed for the first few days after surgery and gradually increase your activity level as you heal.

Getting back to normal activities after anal fistula surgery

Recovering from anal fistula surgery can be a slow process, but with proper care and patience, most people are able to return to their normal activities within two weeks^{2, 3} .

You will likely have a follow-up appointment around four to eight weeks after your surgery. You should make sure you attend this as anal fistulas can be difficult to treat and heal.