Anal Fistula Surgery

• Persistent or intermittent discharge of pus, blood or fluid near the anus
• A small opening or pimple-like spot in the skin around the anus
• Pain and swelling around the anus, often worse before discharge
• Skin irritation, itching or soreness from leaking fluid
• Recurrent anal abscesses that keep coming back in the same place
• An unpleasant smell from the discharge
• A feeling of a lump or tenderness near the back passage
• Occasional fever or feeling generally unwell during a flare-up

The great majority of anal fistulas begin with infection of the small glands inside the anal canal. When one of these glands becomes blocked and infected it forms an abscess; as the abscess drains, a tunnel can be left connecting the gland to the skin surface, and this becomes the fistula. Because the original gland remains, the tunnel keeps producing discharge and tends not to heal spontaneously.

Most fistulas are therefore described as cryptoglandular, meaning they arise from these anal glands. A minority are linked to underlying conditions such as Crohn's disease, previous surgery or radiotherapy, tuberculosis, or trauma to the area. Mr Hussain will consider whether any such factor is present, as this can influence both the treatment approach and the likelihood of recurrence.

Diagnosis usually begins with a careful history and a gentle examination of the area, during which Mr Hussain looks for the external opening, feels for the track and assesses any tenderness or swelling. In many cases the diagnosis can be made clinically, but understanding the exact course of the tunnel and its relationship to the sphincter muscles is essential before planning surgery.

To map the fistula accurately, an MRI scan of the pelvis is often arranged, as it provides detailed images of the track and any hidden side branches without discomfort. An examination under anaesthetic may also be performed, allowing the track to be probed directly and the internal opening identified. These steps help Mr Hussain choose a technique that clears the fistula while preserving continence.

At your consultation Mr Hussain takes a history and gently examines the area, looking for the external opening and feeling the track. Because the exact path of the fistula in relation to the sphincter muscles determines the safest treatment, he often arranges an MRI scan of the pelvis to map it accurately, and may plan an examination under anaesthetic to probe the track directly.

Fistula surgery is carried out under anaesthetic, usually as a day case, and the technique is chosen specifically to protect your bowel control. If there is an active abscess it is drained first to settle the infection, with definitive surgery planned as a separate step. Afterwards the wound is often left to heal naturally from the inside, and Mr Hussain's team gives you clear wound-care instructions and arranges follow-up.

Recovery depends on the technique used. After a simple fistulotomy or seton placement, most people go home the same day and can return to light activities within a few days, with many back at work within one to two weeks. The wound is usually left open to heal naturally from the inside out, which can take several weeks; keeping the area clean is the cornerstone of healing.

Aftercare typically involves regular warm baths or showers, gentle cleaning after bowel movements, and wearing a small dressing or pad while there is discharge. A high-fibre diet and good fluid intake keep stools soft and comfortable. Mr Hussain provides clear wound-care guidance and arranges follow-up to check that healing is progressing and the fistula has not recurred. More complex flap or LIFT procedures may involve a slightly longer recovery and a period of reduced activity.