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Rectal Fistulotomy


A rectal fistulotomy is surgery to heal a fistula near your anus. A rectal fistula is a tunnel-like wound that forms next to your anus, often after you have an abscess (pus buildup under your skin). It spreads from inside your rectum to the skin surface near your anus. A rectal fistulotomy opens and drains the rectal fistula. The wound heals by filling in with scar tissue so the fistula does not come back or form an abscess. Your healthcare provider may also drain an abscess during your surgery.



  • Pain medicine: You may be given medicine to take away or decrease pain. Do not wait until the pain is severe before you take your medicine.
  • Stool softeners: This medicine makes it easier for you to pass a bowel movement. You may need this medicine to treat or prevent constipation.
  • Antibiotics: This medicine will help fight or prevent an infection. Take your antibiotics until they are gone, even if you feel better.
  • Take your medicine as directed: Call your healthcare provider if you think your medicine is not helping or if you have side effects. Tell him if you are taking any vitamins, herbs, or other medicines. Keep a list of the medicines you take. Include the amounts and when and why you take them. Bring the list of the pill bottles to follow-up visits.

Follow up with your healthcare provider or surgeon every 2 to 3 weeks as directed:

You will need to be watched closely after surgery to make sure you do not get sepsis. This is a dangerous blood infection caused by bacteria that can be life-threatening. You may also need to have your seton removed after your surgery. Keep all your follow-up appointments. Write down your questions so you remember to ask them during your visits. Your wound should heal within 4 weeks for a minor fistula or 16 weeks for a complex fistula.


  • Follow nutrition recommendations: Drink only clear fluids until you start passing bowel movements again. Ask when you may eat regular foods. Eat high-fiber foods once your healthcare provider says it is okay. Examples of high-fiber foods are fruit and whole grains.
  • Limit your activity as directed: Ask when you can return to your normal activities.
  • Do not smoke: Smoking may slow your healing process.
  • Care for your wound: Remove any bandages near your anus the next day. You may have some gauze inside your rectum that will fall out on its own or be removed by your healthcare provider. Clean the area as directed.
  • Take sitz baths: Sit in a sitz bath or take tub baths in warm water. Do this 3 to 4 times each day for 15 to 20 minutes each time, or as directed. A sitz bath is a clean pan that holds warm water and fits in your toilet bowl. Sitz baths help keep your wound clean and may ease your pain.
  • Avoid constipation: Do not stop yourself from having a bowel movement. This may cause constipation. Drink plenty of water. This will help your bowel movements stay soft and make them easier to pass. Exercise also helps your digestive system work better so you avoid constipation.

Contact your healthcare provider or surgeon if:

  • You have nausea and vomiting and cannot drink liquids.
  • You urinate less often than you normally do.
  • You have pain when you urinate. This may mean you have a urinary tract infection.
  • You have more bleeding, swelling, or pain than you were told to expect.
  • You have a fever.
  • You become constipated.
  • You have pus or blood that drains from your wound and does not stop, or your wound is not healing as it should.
  • You have stool drainage that does not stop or you cannot control your bowel movements or gas.
  • You have questions or concerns about your condition or care.

Seek care immediately or call 911 if:

  • You are not able to pass urine within 8 hours after your surgery.
  • You have increasing pain, redness, and swelling on skin near your anus.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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