Discharge information for patients Fistula plug for anal fistula

What is an anal fistula? An anal fistula is an abnormal opening between the internal anal canal and the exterior skin of the body near the anus. An anal fistula is usually caused by an anal abscess, an infectionfilled cavity occurring in the underlying tissues of the anal canal. Unless it is very small, an abscess can only heal by the pus draining either by the abscess bursting or being opened surgically. When the wound heals, a fistula may persist long-term. It is important to remember that while not all anal abscesses result in fistulas, a large proportion of them do. Symptom s such as pain, discomfort, swelling and tenderness are common, other symptoms from the abscess include drainage of pus, fluid or liquid stool. There are different types of fistulas, some can be a simple tunnel linking your anus and skin and some can be complex network of tracts that branch off in different directions. Many fistulas run through the sphincter muscles. These muscles surround the anus and are responsible for maintaining bowel control (continence). Surgery is usually necessary to treat an anal fistula as very few heal by themselves. The primary aim of surgery is to heal the fistula while avoiding damage to the sphincter muscles. The type of surgery you have will depend on the position of your fistula and whether it is classed as simple or complex. Your surgeon will be able to explain the procedure to you in more detail. Today you have had your fistula plugged. The treatment involves a specially designed plug which is inserted into the fistula and stitched into place. The plug is a conical-shaped device made from pig connective tissue with the pig s cells removed. The tissue communicates with your body, signaling surrounding tissue to grow across and into the plug, allowing your body to restore itself. Anal fistula The doctor locates the inside opening of the fistula using a fistula probe and irrigates the tract. Anal fistula plug The plug is pulled into the inside opening. The doctor notes where the plug enters the primary opening and cuts the plug to size. It is unlikely that fecal incontinence will occur as the placement of the anal fistula plug does not require cutting the anal sphincters. Stitches are used to keep the plug in place, but the external opening is left open so the fistula can continue to drain. New tissue then grows around the plug to heal it. 1 2 3 Rectum The inside opening is closed by suturing the top tissue layers over the plug s head. The exterior opening is not closed to allow for drainage. The tip of the plug is trimmed at skin level. 1 2

What to expect? Sexual intercourse The plugged fistula will initially continue to drain as before - do not worry, this is a normal process. Drainage can occur for up 12 weeks after the procedure as the plug is incorporated and the fistula tract is closed. If the fistula continues to drain it does not mean that the procedure has not worked. Please follow these instructions: Expect to be uncomfortable and experience a certain amount of pain and discomfort. Pain will most likely settle with mild analgesia such as paracetamol and Ibuprofen. Shower standing up and bathe the area with water try not to use soap or shower gel to this area. Do not lift any items over 10lbs (5kg) for four weeks. No exercise beyond gentle walk for two weeks. Avoid exercise and strenuous activity for four weeks. Use stool softeners for two weeks. Remember to eat a lot of fibre and drink plenty of water. This is especially important whilst the wound heals, as constipation may interfere with healing. Try to avoid using any creams to the wound area. Do not use topical steroids such as Preparation H. If there is a lot of discharge please seek advice, contact details are on page 5. You should abstain from sexual intercourse and not put anything into your vagina or rectum, including tampons, for six weeks after the procedure. Risk of complications All procedures carry some risks. For a fistula plug procedure the risks include: Infection Inflammation of the surrounding tissue Hardening of the surrounding tissue Abscess reoccurrence A pocket of clear fluid forming around the fistula tract this is called a seroma. The plug pokes out of the fistula tract The plug falls out Reoccurrence of fistula If you have any concerns, please do not wait for your follow up appointment. You will be given contact details on discharge to ring for advice, including the colorectal nurses number. Stitches Dissolvable stitches (sutures) are used. There is no need to have these removed, your body will absorb them over the following few weeks. Antibiotics You may be sent home with a course of antibiotics - please complete the course prescribed. For specific instructions following a general anaesthetic, information about taking pain relief and emergency contact numbers will be given to you from the ward that you are discharged from. 3 4

Follow up The colorectal nurses usually like to see you in 2 weeks following the procedure, for assessment. Your nurse will advise you if this is any different. Your follow up appointment will be sent through the post. If problems arise please contact the colorectal nurses or district nurses. Outside of working hours, please contact you re GP or the ward from which you were discharged from for advice. Notes Colorectal Nurse 0161 206 1249 5 6

G17111509W. Design Services Salford Royal NHS Foundation Trust All Rights Reserved 2017 This document MUST NOT be photocopied Information Leaflet Control Policy: Unique Identifier: SURG52(17) Review Date: January 2020 For further information on this leaflet, it s references and sources used, please contact 0161 206 1249. Copies of this leaflet are available in other formats (for example, large print or easyread) upon request. Alternative formats may also be available via www. srft.nhs.uk/for-patients/patient-leaflets/ If you need this information leaflet translated, please telephone: In accordance with the Equality Act we will make reasonable adjustments to enable individuals with disabilities to access this service. Please contact the service/clinic you are attending by phone or email prior to your appointment to discuss your requirements. Interpreters are available for both verbal and non-verbal (e.g. British Sign Language) languages, on request. Please contact the service/clinic you are visiting to request this. or Email: InterpretationandTrans@srft.nhs.uk Salford Royal operates a smoke-free policy. For advice on stopping smoking contact the Hospital Specialist Stop Smoking Service on 0161 206 1779 This is a teaching hospital which plays an important role in the training of future doctors. The part patients play in this process is essential to make sure that we produce the right quality doctors for all of our futures. If at any time you would prefer not to have students present please inform the doctor or nurses and this will not affect your care in anyway. Salford Royal NHS Foundation Trust Stott Lane, Salford, Manchester, M6 8HD Telephone 0161 789 7373 www.srft.nhs.uk If you would like to become a Foundation Trust Member please visit: www.srft.nhs.uk/ for-members If you have any suggestions as to how this document could be improved in the future then please visit: http://www.srft.nhs.uk/ for-patients