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| Anal Fistula |
These notes give an overall guide to your stay in hospital. You may see some differences in the details of your treatment, since it is tailored to suit your own condition.
WHAT IS AN ANAL FISTULA? An anal fistula is a narrow tunnel running from the skin near the back passage and opening into the anal canal higher up. This discharges pus irregularly and may be uncomfortable. It often shows up after there has been an abscess near the back passage. What does the operation consist of? The fistula has its roof cut away converting it from a tunnel into a trench. The trench becomes shallower as it heals, and ends up as a flat scar after a month or two.  Reception When registering at reception your medical aid details will be required. If you are not on a member of a medical aid you will be required to pay a deposit or to sign an indemnity form. As far as possible we will try to advise you about hospital costs before your admission. Welcome to the ward You will be welcomed to the ward by the nurses or the receptionist and will have your details checked. Some basic tests will be done such as pulse, temperature, blood pressure and urine examination. You will be asked to hand in any medicines or drugs you may be taking, so that your drug treatment in hospital will be correct. Please tell the nurses of any allergies to drugs or dressings. The surgeon will have explained the operation and you will be asked to sign your consent for the operation. If you are not clear about any part of the operation, then read this again and then ask for more details from the surgeon or from the nurses. Visit by the anaesthetist If you are having a general anaesthetic, the anaesthetist who will be giving your anaesthetic will interview and examine you. He will be especially interested in chest troubles, dental treatment and any previous anaesthetics you have had. Diet You will have your usual diet until 6 hours before the operation when you will be asked to take nothing by mouth. This will let your stomach empty to prevent vomiting during the operation. Shaving The operation area will be shaved to remove excess hair. Timing of the operation The timing of your operation is usually arranged the day before so that the nurses will tell you when to expect to go to the operating theatre. Do not be surprised, however, if there are changes to the exact timing. Transfer to theatre You will be taken on a trolley to the operating suite by the staff. You will be wearing a cotton gown, wedding rings will be fastened with tape and removable dentures will be left on the ward. There will be several checks on your details on the way to the operating theatre where your anaesthetic will begin. The operation is then performed. Coming round after the anaesthetic Although you will be conscious a minute or two after the operation ends, you are unlikely to remember anything until you are back in your bed on the ward. Some patients feel a bit sick for up to 24 hours after operation, but this passes off. You will be given some treatment for sickness if necessary. Will it hurt? There is discomfort on moving rather than severe pain. You will be given injections or tablets to control this as required. Ask for more if the pain is still unpleasant. You will be expected to get out of bed the day after operation despite the discomfort. You will not do the wound any harm, and the exercise is very helpful for you. Opening bowels The first time you open your bowels it may be a bit painful but this rapidly improves. If you have not opened your bowels after two days and you feel uncomfortable, ask the nurses for a laxative. Once your bowels have opened you can make plans to go home. Passing urine It is important that you pass urine and empty your bladder within 6-12 hours of the operation. If you find using a bed pan or a bottle difficult, the nurses will assist you to commode or the toilet. If you still cannot pass urine let the nurses know and steps will be taken to correct the problem. Sleeping You will be offered painkillers rather than sleeping pills to help you to sleep. If you cannot sleep despite the painkillers please let the nurses know. The wound The wound has a dressing held on with elastic netting pants. There may be some staining with old blood during the first 12 hours. The dressings will be removed the day after operation. They are soaked off in a bath of warm water. A new dressing is placed over the wound and held in place by underpants. You will usually be able to go home a day or two after the operation. Each day you must remove the dressing, have a bath and apply a new dressing morning and evening. There may be a bloody discharge for a day or two, but the discharge will then become yellow. You will be seen as necessary at the consulting rooms by both the doctor and the nursing staff to see that the wound is healing well. Washing You can wash the wound area as soon as the dressing has been removed. Soap and tap water are entirely adequate. Salted water is not necessary. How long in hospital? Usually after 2 or 3 days, when your bowels have opened, you will feel fit enough to leave hospital provided there is someone to look after you. Sick notes Please ask your surgeon for any sick notes or certificates that you may require. Driving You can drive as soon as you can drive safely without discomfort in the wound, i.e. after about 2 weeks. What about sex? You can restart sexual activities within 2 to 3 weeks, when the wound is comfortable enough. Work You should be able to return to light work within 2 weeks and a heavy job within 3 to 4 weeks. Complications Complications are seldom serious and are well known. The wound is always a bit moist for 3 to 6 weeks. There is likely to be a discharge of yellow matter and for a week or so even some dark blood. Opening your bowels becomes rapidly easier particularly if you take a laxative. Occasionally you may notice difficulty controlling the wind through your back passage. This improves after a day or two. The chance of the fistula coming back again is about 1 in 10. In general the operation is not particularly painful. But the final healing sometimes takes more than 8 weeks. You should, however, be able to return to work before the wound has healed. If you have any problems or queries, please ask the nurses or doctors. |
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