What do we mean when we tell you to ‘floss your fistula?’
An anal fistula is a longer term complication after an anal abscess. It may occur in15% of patients who are unlucky enough to experience an anal abscess. Once your abscess has either popped or been surgically lanced by a surgeon, a permanent tract can remain under the skin. It may be that you are left with what looks like a small boil at the site of your previous abscess. This can either lie dormant (i.e never go away) or it may leak fluid ( usually a bit of mucus and poo mixed in). Some poor souls experience regular eruptions of infection that may feel similar to your original abscess.
It is a very difficult condition to live with and for a surgeon, a very tricky condition to treat. The anal sphincter muscle is usually integrally involved with the tract under the skin. Most of us are not keen to simply cut into your sphincter to clean the area out. This may risk your continence in the longer term.
Anal fistula flossing is a really good option. You may never have heard of it before. It might not be something you want but be patient……it can help preserve your anal sphincter in the longer term!.
Your surgeon is likely to offer you an MRI scan to look at your unique fistula anatomy followed by your first fistula operation. This operation is offered routinely @TheMcCarthyClinic under local anaesthetic or wide awake surgery. The fistula tract will be cleaned out and the superficial areas fully removed. We will whittle your tract down to your anal sphincter and then insert a stitch that looks very similar to dental floss. It will be a loose sling around in the fistula tract and almost certainly will contain anal sphincter muscle.
We will ask you to start ‘flossing your fistula’ within 2-3 days of your operation. This is best done in the following way;
- squat down in the shower or bath
- give the anal surgery site a very vigorous clean with a shower head and try get your finger in the wound to clean out (finger digitate)
- feel for the stitch which will have a knot tying it in a circle.
- move the stitch back and forth similar to flossing motion. Try not to pull hard as it may cause pain or snap.
- Floss several times then wash the area afterwards.
The purpose of anal flossing is just like with teeth – removal of debris that can trap in the tract and cause infection.
After several months of flossing, the body will heal the cavity around the tract and the tract will start to become more superficial. After your surgeon is happy with progress the second fistula surgery can be offered which will hopefully definitively remove the fistula tract.
Brace yourself! For some patient the process may take a bit longer – smokers (try your hardest to stop!), those with immunosuppressant conditions and those with inflammatory bowel disease.