Aftercare Instructions

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Many of us don’t get proper aftercare instructions after fistula surgery. A friend in my support group shared photos of her aftercare instructions, and they were so good that I had to type them up to share with all of you. I turned them into images so that they can be easily saved and shared from most platforms. Please feel free to save and share them!

Please note that these instructions aren’t perfect, just the best I have seen so far, and they won’t apply to everyone. If you are unsure about your aftercare, I urge you to call your surgeon’s office to have them answer any questions.

(All of this information comes from a handout by Alberta Health Services)

En Español:

Instrucciones de descarga despuès de la cirugìa anal

(Informacion crèdito a Alberta Health Services)

Cuidandando tu àrea anal

1. Toma un baño de asiento tres o cuatro veces al dìa. Limpia la bañera antes y despuès de su baño. No use aceites, baños de burbujas, lociones, o polvos en su àrea anal.

2. Es possible que tenga una secreciòn amarilla en sù àrea anal. Es posible que tambièn tenga sangre en la zona, especialmente despuès de movimientos intestinales.

3. No demore la evacuaciòn intestinal. Vacìa tus intestinos pronto cuando sientes la necesidad. No te sientes en el baño por mucho tiempo. Siempre toma un baño de asiento despuès de la ecvacuaciòn intestinal. Trata de no aser tension ni estreñirte.

4. Use una compresa frìa en la àrea anal para ayudar con el dolor.

5. NO se siente en una almohada en forma de rosquillas. Presionan sobrè la àrea que esta sanando.

 

En Español:

Instrucciones de descarga despuès de la cirugìa anal

(Informacion crèdito a Alberta Health Services)

Llama a su cirujano si tienes: 

* Escalofrìos o fiebre (temperatura sobre 38.5° C o 101.3° F)

* Estreñimiento que no mejora

* Dolor que no mejora con medicamentos

* Cuàgulos de sangre viniendo de la àrea anal

* Drenaje de la zona anal que huele mal

* Sangrando abudante (remojando una almohadilla gruesa en menos de una hora)

* Problemas pasando la orina

** llama 911 si tienes dolor repentino en el pecho o dificultad para respirar**

 

En Español:

Informaciòn de seguimiento para la cirugìa anal

Procedencia: Alberta Health Services

Movimiento intesinales despues de su cirugìa

  • Después de la cirugía, puedes contar con un poco de de dolor con su primer movimiento intestinal. No demore teniendo una evacuación intestinal. Esto solo hace que su materia fecal sea más dura y causa más dolor cuando eventualmente tenga una evacuación intestinal.
  • Toma medicamentos para el dolor 30 minutos antes de evacuacìon intestinal
  • Vacíe sus intestinos tan pronto como sienta la necesidad
  • No te sientes en el baño por largos períodos de tiempo. Esto puede causar presión, hinchazón y sangradura. Siéntate en el baño solo el tiempo que sea necesario para vaciar los intestinos. 
  • Toma un baño de asiento después de cada evacuación para limpiar y calmar su área anal.
  • Trata de no estreñirse o esforzarse con los deposiciones. Debe tener una evacuación intestinal el segundo día de la cirugía. Llama a su médico si está comiendo fibra exta o está tomando laxantes prescritos, y todavía está estreñido.

Cuando tù lleges a casa

  • Después de la cirugía, debe levantarse y hacer muchas caminatas cortas. Levantándose temprano ayuda a recuperar su fuerza, estimula buena circulación, ayuda a pasar gas y ayuda a que sus intestinos comiencen a funcionar. Cuando el dolor se comienza mejorar, aumente lentamente la distancia. Haga que alguien camine con usted hasta que esté firme en sus pies.
  • Puedes aumentar tus actividades como te sientas capaz.
  • Puedes volver a tus actividades ordinaro si no hay dolor.

Cuando llamar a su cirujano

  • Fiebre (temperatura sobre 38° C o 101.3° F
  • Dolor que no mejora con medicamentos
  • Problemas para orinar
  • Coágulos de sangre viniendo de su área anal
  • Estreñimiento que no mejora
  • Drenaje de la zona anal que huele mal
  • Sangrado abundante (remojando una almohadilla de gasa gruesa en menos de una hora)

Advancement Flap Surgery

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One of the most common surgeries available to close a fistula is called the advancement flap surgery. If you have a colorectal fistula, there is a good chance you will hear about this option somewhere down the line. I’ve sketched my own depiction of the surgery here:

What you are looking at is the fistula from the inside of the rectum. Simply put, the surgeon will cut a piece (or flap) of tissue near the fistula hole, and stretch it over the hole like a patch. Sutures are used to keep it in place.

Here are several questions you might want to ask your doctor before you decide to have the surgery:

1) What is the state of my tissue in that area? Is it in good shape for surgery? As we get older our tissue can weaken. If you have had multiple surgeries in that area, the tissue might not be in the best shape. Your doctor should know whether or not the tissue is good enough for a strong flap, but asking is always a good idea.

2) Am I clear of all infections? Any kind of infection can compromise healing. If you feel something might be “off,” have frequent diarrhea, or stomach cramps, ask your doctor to run some tests and stool samples. You know best what your body feels like when it’s healthy, so don’t be afraid to insist on lab work before going in for surgery.

3) What can I do after surgery to help the healing process? Ask your doctor about how to properly take your antibiotics and pain medications. Ask about what foods to eat, and what foods to avoid. It is very important to eat well after this surgery, and to be conscious of eating foods that will pass through the rectum easily.

4) How can I best manage my pain and physical discomfort after surgery? Every person is different, has different levels of pain, and different reactions to pain. This surgery can take time to recover fully from, and there will be at least a few days of serious discomfort and/or pain. It is important to prepare for this beforehand.

5) How should I keep the area clean? After surgery the area will be tender, there will be some bleeding, and keeping the area as clean as you can is important. (In this seton band article I give tips on keeping things clean)

According to most literature currently available, the advancement flap surgery has a success rate of about 70%. Many studies reported causes of failure were often due to the presence of Crohn’s Disease. I would advise that you not get too caught up in numbers. Do your research, talk to your doctor about concerns (don’t be embarrassed, colorectal surgeons have heard it ALL), and get a second opinion if necessary.

Best of luck to all of you on the fistula journey. As always, feel free to contact me with questions or comments. I will do my best to get back to you in a timely manner. Please remember that I am NOT a doctor, just someone who has lived through a 3 year fistula, and has accrued what I hope to be valuable knowledge and experience on the subject.

Leah R. Chatterjee