You may not want to talk to anyone about pain or discomfort in the anus and the surrounding area. You may think it is a bit embarrassing and uncomfortable topic. But it is never a good idea to ignore such situations. Because even a small problem can become a big problem later. Today we are talking about a very important topic that many people are reluctant to talk about. That is the condition called Anal Fistula and the surgical procedure called Fistulotomy that is performed as a treatment for it.
Simply put, what is an anal fistula?
Imagine that a small tunnel forms around your anus, connecting the skin around it to the inside of your anus. That's what we simply call an anal fistula. It usually starts with an infection or abscess around your anus. It's like a small pus-filled lump that forms under your skin. When this pus-filled lump stays there for a long time, it creates a path for the pus to come out. That's what becomes this tunnel called a fistula.
The main reasons for this may be:
- Infections and accumulation of pus around the anus.
- Some other injury to that area.
- Long-term inflammatory bowel conditions, such as Crohn's disease.
What are the symptoms of this condition?
If you have this condition, you may experience one or more of the following symptoms. It is very important to be aware of these.
| Symptom | Description |
|---|---|
| Pain and discomfort | The pain may increase when sitting, walking, coughing, and especially when defecating. |
| Skin changes | The skin around the anus may become red, swollen, and itchy. |
| Discharge | A discharge of pus or blood may come out of the anus. Sometimes this can have a bad odor. |
| Difficulty controlling bowel movements | In some cases, there may be difficulty controlling bowel movements. |
| Fever | A fever may occur due to an infection in the body. |
So what is this surgery called Fistulotomy?
Fistulotomy is the most successful and widely used surgical procedure to treat anal fistula. It is a very simple procedure. The doctor completely opens up the fistula tract that I mentioned earlier. That is, he cuts it open like a canal. Then he thoroughly cleans and removes the pus, infected tissue, and any other debris that may be inside.
When opened and cleaned in this way, the wound begins to heal from the inside out. This eliminates the chance of pus collecting again and forming a tunnel. In many cases, this surgery is the best solution for this disease.
The most important thing is that an anal fissure will never heal on its own. It definitely requires medical treatment. If left untreated, the infection can spread throughout the body and lead to life-threatening conditions like sepsis .
How is fistulotomy surgery performed?
The way this surgery is performed depends on the nature of your vagina.
- For a simple and superficial hernia: This surgery can sometimes be performed on an outpatient basis, without having to stay in the hospital.
- If it is a deep and complex hernia: This surgery is performed while you are in the hospital and under general anesthesia in the operating room.
During surgery, the doctor cuts open the vagina and cleans the inside thoroughly. Then, sometimes the wound is closed with stitches. But most often, the wound is left open and packed with something like gauze. Then the wound begins to heal from the inside.
How does the doctor decide this is the best treatment?
Before deciding whether you need a fistulotomy or another treatment, your doctor will perform several tests to determine the exact location, depth, and path of the fistula.
| Test | How to do it |
|---|---|
| Physical examination | The doctor will use a gloved finger to examine the rectum (Digital Rectal Exam). This will give a basic idea of the size and location of the anus. |
| MRI scan | This allows the soft tissues around the anus and the vaginal canal to be viewed in a very clear, three-dimensional image. |
| Endoscopy | A small tube with a camera attached is inserted through the anus to examine the internal tissues and the internal opening of the vagina. |
| Other tests | Sometimes tests such as X-rays and fistulography (an X-ray taken after injecting a contrast fluid) may also be performed. |
The results of these tests will determine the most appropriate treatment for you. If the vagina passes through the anal sphincter, special care will be taken to avoid damaging the muscles during surgery.
Are there other treatments?
Yes, fistulotomy is not always the only surgery performed. Other methods are used, especially for very complex fistulas.
- Seton procedure: In this procedure, a rubber band-like suture or elastic band is placed through the perianal tunnel. This allows pus to drain continuously, gradually helping the perianal opening to heal.
- LIFT procedure: This is a special surgery performed on the vagina that passes through the anal ring muscles.
- Fibrin glue or Collagen plug: The incision is closed using a special type of glue or plug.
Your specialist surgeon will decide which of these treatments is right for you. So don't be afraid to talk about this, and be open with your doctor.
What will happen after the surgery?
There may be some discomfort after the surgery, but it is usually temporary.
- Pain: You may experience some pain at the surgery site. The doctor will give you painkillers for this.
- Bleeding: A few drops of blood may be present. However, if there is excessive bleeding, you should inform your doctor immediately.
- Headache and drowsiness: This condition can be caused by anesthesia.
- Recurrence: Very rarely, the fistula or abscess may recur.
Recovery time varies from person to person. After a simple surgery, you can return to normal life within a few weeks. However, it may take a month or more for the wound to heal completely. During this time, it is very important to follow your doctor's instructions carefully, especially regarding keeping the wound clean and diet.
Take-Home Message
- An anal fistula is an infected tunnel-like passageway that develops from the skin around the anus.
- This condition never heals on its own. So if you have symptoms like pain, swelling, or pus, don't be shy and see a doctor immediately.
- Fistulotomy is a very successful surgical procedure for this purpose. It involves opening the fistula, cleaning it, and allowing it to heal.
- Following medical instructions exactly after surgery is essential for a speedy recovery.
- If you have any questions about this, don't be afraid to ask your doctor. Your health is the most important thing.
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