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Anal fistula, fissura surgery
Anal fistula
Anal fistula and anal fissura are two common problems that can occur in the rectum and anus area.
An anal fistula is a tiny tunnel between an infected gland inside the anus and the outer skin, which develops as a result of infection or inflammation. The major symptoms include pus or blood near your anus, pain and discomfort in the area, swelling and irritation of the skin. Symptoms may vary from a person to person. Some patients may not have any symptoms, and only a proctologist can diagnose anal fitsula. If left untreated, it can cause inflammation in the anal region such as paraproctitis and fascitis.
Anal fissure
Anal fissure is a damaged part of anus skin. Typically it is located in anal channel closer to coccygeal region. The most common symptoms of anal fissures are:
• a sharp pain when you poo, sometimes people are afraid of pooping causing bigger damage. After a poo a deep burning pain that may last several hours, itching is possible.
• bleeding when you poo – most people notice a small amount of bright red blood either in their poo or on the toilet paper.
Usually but not always it occur in people who have constipation. When a hard or large poo tears the lining of the anal canal there is a risk for skin damage. Sometimes it is healing spontaneously, but sometimes it becomes a fissura which needs to be treated.
Who is it suitable for
✔ Patients with anal fistula
✔ Patients with anal fissure
✔ Patients experiencing severe symptoms such as pain, bleeding, irritation when they poo
✔ People who tried non-surgical treatments and they failed
Treatment duration
✔ Both anal fistula and fissure surgeries usually take less than 1 hour
✔ Most patients can go home same day
✔ The complexity and duration of your procedure may vary from patient to patient, depending on their individual situation
Recovery
✔ Usually it takes 1 or 2 weeks before you can return to work. In case of fistula surgery when seton is used, recovery might take longer.
✔ Need to use local cremes and painkillers to reduce post-operative symptoms
✔ You may need to use Laxative after surgery that helps with constipation
Before The Treatment
Before scheduling the treatment, you will need to meet with a doctor to discuss your treatment plan and perform an examination:
• Medical history - You should provide a complete medical history including your past and current medical conditions, and medications that you are taking.
• Examination - Your doctor is going to perform physical examination to determine the best treatment approach for you. Ususally examination is performed manually when a doctor checks visual condition, then finger is inserted into your anus. A doctor might also perform an anoscopy to see the lining of your anus and rectum.
• Diagnostics, tests and additional examination - Be prepared to undertake additional examination, diagnostics, a specialist consultation and blood tests. Your doctor may request 3D trans-anal ultrasound or MRI scan before preceding with the treatment.
• Goals and expectations - Treatment plan will be discussed and agreed before your surgery. Your doctor should explain you different types of surgery, potential risks, recovery and expected outcomes.
You will be advised by your doctor how to prepare for the procedure which may include dietary and medication requirements. It's recommended that you arrange for help during recovery and drive you home from a hospital.
What does it involve?
There are different types of anal fistula and anal fissura surgery, but generally the following is involved:
Anal fistula
• Before surgery you are generally advised to follow a prescribed diet and then you should normally stop eating the day before your surgery.
• This procedure is generally performed under general anaesthesia.
• The surgery involves cutting the fistula so that it can open up, cleaning out the contents and leaving it to heal as a flat scar.
• After this, a seton is placed into the fistula and left there after surgery for some time to keep it open and let it heal
Anal fistula operation usually takes 30 minutes to an hour. In most cases, patients can go home same day.
Anal fissure
• Before surgery you are generally advised to follow a prescribed diet and then you should normally stop eating the day before your surgery.
• This procedure is generally performed under general anaesthesia.
• The surgery involves cutting a small portion of the the anal sphincter muscle which helps to reduce symptoms and promote healing
Anal fistula operation usually takes 30 minutes to an hour. In most cases, patients can go home same day.
After the treatment
Your recovery and your ability to return to work depends on your treatment type and complexity of the operation. For more complex operations, you may need to take at least 2 weeks time-off for your recovery. After operation it is common to experience some discomfort and following:
• Bruising
• Swelling
• Scars
• Inflammation
• Bleedin after defecation
• Local pain
You may need to take antibiotics after the operation to reduce the risk of infection. It normally takes at least 6 weeks to get back to your usual physical activities. Recovery usually takes around 4-6 weeks but it can take up to 6 months with continuing swelling and healing. Some bleeding is possible till the healing process is complete.
Risks
As with any major surgery, anal fistula, fissura surgery carries risks such as:
• bleeding
• incontinence
• constipation
• delayed healing
• urinary retention
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