Anal Fistulotomy: What to Expect at Home

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Your Recovery

You may be worried about having a bowel movement after your surgery. You will likely have some pain and bleeding with bowel movements for the first 1 to 2 weeks. You can make your bowel movements less painful by getting enough fibre and fluids, and using stool softeners or laxatives. Sitting in warm water (sitz bath) after bowel movements will also help.

You may notice a small amount of pus or blood draining from the opening of your fistula. This is normal in the days after your surgery. You can put a gauze pad over the opening of the fistula to absorb the drainage, if needed.

Most people can go back to work and their normal routine 1 to 2 weeks after surgery. It will probably take several weeks to several months for your fistula to completely heal. This depends on the size of your fistula and how much surgery you had.

This care sheet gives you a general idea about how long it will take for you to recover. But each person recovers at a different pace. Follow the steps below to get better as quickly as possible.

How can you care for yourself at home?

Activity

  • Rest when you feel tired. Getting enough sleep will help you recover.
  • Try to walk each day. Start by walking a little more than you did the day before. Bit by bit, increase the amount you walk. Walking boosts blood flow and helps prevent pneumonia and constipation.
  • You may drive when you are no longer taking pain medicine and can quickly move your foot from the gas pedal to the brake. You must also be able to sit comfortably for a long period of time, even if you do not plan to go far. You might get caught in traffic.
  • Most people are able to return to work within 1 to 2 weeks after surgery.
  • Shower or take baths as usual. Pat your anal area dry with a towel when you are done.

Diet

  • You can eat your normal diet. If your stomach is upset, try bland, low-fat foods like plain rice, broiled chicken, toast, and yogurt.
  • Drink plenty of fluids (unless your doctor tells you not to).
  • Include high-fibre foods, such as fruits, vegetables, beans, and whole grains, in your diet each day.
  • You may notice that your bowel movements are not regular right after your surgery. This is common. Try to avoid constipation and straining with bowel movements. You may want to take a fibre supplement every day. If you have not had a bowel movement after a couple of days, ask your doctor about taking a mild laxative.

Medicines

  • Your doctor will tell you if and when you can restart your medicines. He or she will also give you instructions about taking any new medicines.
  • If you take blood thinners, such as warfarin (Coumadin), clopidogrel (Plavix), or aspirin, be sure to talk to your doctor. He or she will tell you if and when to start taking those medicines again. Make sure that you understand exactly what your doctor wants you to do.
  • Be safe with medicines. Take pain medicines exactly as directed.
    • If the doctor gave you a prescription medicine for pain, take it as prescribed.
    • If you are not taking a prescription pain medicine, take an over-the-counter medicine such as acetaminophen (Tylenol), ibuprofen (Advil, Motrin), or naproxen (Aleve). Read and follow all instructions on the label.
    • Do not take two or more pain medicines at the same time unless the doctor told you to. Many pain medicines have acetaminophen, which is Tylenol. Too much acetaminophen (Tylenol) can be harmful.
  • If your doctor prescribed antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics.
  • If you think your pain medicine is making you sick to your stomach:
    • Take your medicine after meals (unless your doctor has told you not to).
    • Ask your doctor for a different pain medicine.

Incision care

  • You may have gauze and bandages over the opening of your fistula, and you may have a string coming from the fistula. Your doctor will tell you how to take care of these.
  • After a bowel movement, use a baby wipe or take a shower or sitz bath to gently clean the anal area.

Other instructions

  • Place a maxi pad or gauze in your underwear to absorb drainage from your fistula while it heals.
  • Sit in 8 to 10 centimetres of warm water (sitz bath) for 15 to 20 minutes. Then pat the area dry. Do this as long as you have pain in your anal area.
  • Apply ice several times a day for 10 to 20 minutes at a time. Put a thin cloth between your skin and the ice.
  • Support your feet with a small step stool when you sit on the toilet. This helps flex your hips and places your pelvis in a squatting position. This can make bowel movements easier after surgery.
  • Try lying on your stomach with a pillow under your hips to decrease swelling.

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor or nurse call line if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.

When should you call for help?

Call 911 anytime you think you may need emergency care. For example, call if:

  • You passed out (lost consciousness).
  • You have sudden chest pain and shortness of breath, or you cough up blood.
  • You have severe belly pain.

Call your doctor or nurse call line now or seek immediate medical care if:

  • You have bleeding from your anus that soaks 2 or more large gauze pads.
  • You have pain that does not get better after you take your pain medicine.
  • You have signs of infection, such as:
    • Increased pain, swelling, warmth, or redness.
    • Red streaks leading from the wound.
    • Swollen lymph nodes in your groin.
    • A fever.
  • You have stool that leaks from your anus or you cannot control when you have a bowel movement.

Watch closely for any changes in your health, and be sure to contact your doctor or nurse call line if:

  • You do not have a bowel movement after taking a laxative.

Where can you learn more?

Go to https://www.healthwise.net/patientEd

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