Anal Surgery - Royal Free Hampstead NHS Trust

Discomfort and pain is to be expected
although a local anaesthetic is
routinely used for pain relief during the
operation. Ask your nurse if you need
any more and ensure you take some
before the local anaesthetic wears off.
You should take your painkillers
regularly at home but avoid codeine as
it causes constipation. Warm baths are
soothing, and can help the anus to
relax which may ease the pain.
You should expect to have your
bowels open within one to three days
and this may be uncomfortable at first.
Some bleeding is possible. Try to eat a
high fibre diet (plenty of fruit,
vegetables, cereals, wholemeal bread
etc) and drink at least 10-12 cups of
water daily. Feel free to use a laxative
to help your bowels open comfortably if
you wish. You should try not to avoid
passing faeces as this may result in
constipation. Wash the anus carefully
with warm water after each time you
go to the toilet, and dry gently. Do not
use any fragranced soaps whilst you
are sore as this may irritate the anus
further.
The anaesthetic will make you clumsy,
slow and forgetful for about 24 hours.
This happens even if you feel all right.
You will also feel tired and ‘run down’
for a couple of days. You should avoid
any strenuous exercise or heavy lifting.
You can resume driving after 48 hours
as long as you are able to perform an
emergency stop comfortably.
POSSIBLE COMPLICATIONS
If you develop any of the following, go
to see your GP, nearest A&E or call us
(numbers on front of leaflet) or NHS
Direct (0845 4647) for advice:
• Increasing pain, redness,
swelling or discharge
• Develop a high temperature.
• Severe bleeding
• Constipation for more than three
days despite using a laxative
(these can be purchased over
the counter)
• Difficulty in passing urine
Your named nurse:
© Day surgery unit / Patient
information programme 2008
www.royalfree.nhs.uk
Anal Surgery
Day Surgery Unit
3rd floor
DSU Nurses: 020 7830 2665
Appointments: 020 7830 2710
Monday-Friday 7am-8pm (24hrs)
Saturday-Sunday 8am-6pm
This leaflet gives information about
care after having anal examination or
surgery. It is intended as a general
guide, and should never take the place
of the individual advice your surgeon
has given you. You will have the
chance to ask more questions when
the doctor goes through the consent
form with you on the day of the
procedure.

PROCEDURES
You may have one or more of the
following common procedures – you
should discuss them with your doctor:
Enema First, you may be given an
enema to empty the rectum before
surgery.
Anal examination (EUA): Next, the
doctor examines the anal region using
a special instrument to decide what (if
any) operation is best for you.
Excision (cutting out) of
polyps/warts/skin tags: These will
be examined and removed.
Dissolvable stitches may be inserted.
Anal fistula + fistulotomy
An anal fistula is an abnormal
connection between the back passage
(anal canal) and the opening to the
outer skin surrounding the anus. On
the surface of the skin around the
anus, one or more of the fistula ends
may be seen as holes, which tunnel
down into the back passage.
An anal fistula is usually the result of a
previous abscess, which does not heal
properly. An anal fistula is rarely a
serious condition, but it usually
requires surgery which involves
opening and excision of this tunnel. It
maybe left open to heal and may
require regular dressings by your GP
practice nurse. The healing process
normally takes about 2-6 weeks.
More complex fistulas may be
operated on in several stages, and
sometimes a rubber sling (a ‘seton’) is
left in the track to help drainage of any
infected material. Your surgeon will
discuss any other options with you.
It is rare for a fistula to heal without
surgery
Anal fissure + sphincterotomy
An anal fissure is a small tear of your
skin just inside the opening of your
anus. It is common in people of all
ages, but is most common in
teenagers and young adults.
They can be very painful, especially
when opening your bowels (passing
faeces). They can be very upsetting
but are very rarely serious. The fissure
may bleed a little and stain the toilet
paper with bright red blood after
opening your bowels.
An anal fissure will usually heal on its
own, but this often takes several
weeks. The fissure may not heal and
may become chronic. This is because
the blood supply may be reduced to
the skin of your anus due to the
muscles tightening in response to the
pain, so preventing healing.
Sometimes an ointment is prescribed
(steroid/local anaesthetic/glyceryl
trinitrate (GTN)) for treatment.
Sometimes the muscle is stretched
under general anaesthetic.
Some people require a minor surgical
operation to cure a chronic anal
fissure. The most commonly used
operation to treat anal fissures is an
internal sphincterotomy (cutting the
internal anal muscle). This procedure
is carried out in hospital under general
anaesthetic. Surgery is very effective,
but carries a small risk of some degree
of incontinence (of faeces or wind),
although this may improve with time.
The healing process normally takes
about 2-4 weeks.
AFTER THE OPERATION
You will be able to eat and drink
straight away once on the ward. You
will normally have a dressing in place
around the entrance of the anus. This
is to control any bleeding in the area.
The dressing may sometimes be inside
the anus, which may feel strange and
possibly rather uncomfortable. It may
also feel that you want to open your
bowels (although you are not likely to
do so). You may need to wear a pad to
prevent soiling of your clothes as some
bleeding is to be expected.