A perianal fistula is a small tract between the inside of the anus and the skin. Its treatment is routine and well established; it sometimes requires more than one surgical stage to heal while preserving continence. Your team will explain the plan for your case.
Before surgery
FastingNo solids for 6 hours before; clear fluids up to 2 hours before.
MedicationTell us if you take blood thinners or antiplatelets: you will receive instructions to stop them safely.
PreparationAn enema may be prescribed on the morning of surgery. Follow the instructions you are given.
Bowel habitDrink plenty of water and eat fibre in the days beforehand to avoid constipation.
CompanionYou will need someone to take you home and cannot drive that day.
The day of surgery
AnaesthesiaUsually spinal or general. The anaesthetist will assess this with you.
TechniqueThere are several options (laying open the tract, placing a seton, sphincter-preserving techniques). Your surgeon will choose the safest one for your continence.
DurationUsually between 20 and 45 minutes.
SetonSometimes a fine thread (seton) is left in place to help drain and mature the fistula. This is normal and is removed later.
After surgery
Wound careThe wound heals from the inside out and may take several weeks. You will receive care and follow-up instructions.
Sitz bathsWarm water 2–3 times a day and after every bowel movement: they clean the area and soothe.
Bleeding and dischargeA little bleeding or discharge during healing is expected. You may use gauze or a pad.
Avoiding constipationPlenty of water, fibre and a laxative if prescribed. Avoid long straining on the toilet.
Follow-upAttend your check-ups: if you have a seton, its removal or the next step will be scheduled.
⚠ When to seek help immediately
Go to the emergency department or contact your team if you have:
Fever of 38 °C (100.4 °F) or higher
Pain that does not improve with your prescribed medication
Persistent vomiting or inability to keep fluids down
A wound that is red, warm, oozing or opening up
Difficulty breathing or chest pain
No gas or bowel movements together with abdominal bloating
Fever with chills
Increasing pain and swelling with redness of the area
Heavy bleeding that does not stop
Inability to pass urine within 8–12 h after surgery
