At a glance
A fistulotomy is a surgical procedure where the fistula tunnel is cut open and laid flat so it can heal from the inside out. It is one of the most common treatments for simpler anal fistulas.
After the procedure, you will have an open wound that heals gradually over several weeks. This page covers what people commonly experience during recovery, what tends to help, and when to seek care.
What the procedure involves
During a fistulotomy, the surgeon opens the full length of the fistula tunnel, creating a flat, open wound where the tunnel used to be. This is typically done under general or regional anaesthesia as a day case — many people go home the same day.
The wound is left open on purpose. It heals from the bottom up, which helps prevent the tunnel from reforming.
The first week
The first few days are typically the most uncomfortable. People commonly report:
- Moderate to significant pain, especially during and after bowel movements
- Some bleeding or discharge on dressings, which is normal
- Swelling and tenderness around the wound area
- Fatigue from the anaesthesia and the body beginning to heal
- Anxiety about the first bowel movement — this is very common
Most people take at least a few days off work. Some need a week or more depending on the nature of their job.
Wound care and packing
- Your surgical team may pack the wound initially or leave it open with a dressing
- If packing is used, you may need it changed by a nurse, sometimes daily in the early days
- Dressing changes become less frequent as the wound progresses
- Some people find packing changes uncomfortable — it is okay to ask about pain relief before changes
- Keeping the wound clean is important. Gentle rinsing after bowel movements helps
Pain and bowel movements
- The first bowel movement after surgery can be daunting, but most people find it more manageable than expected
- Stool softeners are commonly recommended to keep stools soft and reduce strain
- Pain typically peaks in the first week and gradually improves over the following two to four weeks
- Some people report aching or stinging that lingers for a short time after each bowel movement, even several weeks into recovery
What tends to help
- Sitz baths — warm water soaks for 10 to 15 minutes after bowel movements and a few times a day. Many people report this as the single most helpful thing during recovery.
- Fiber and hydration — keeping stools soft reduces pain during bowel movements. Psyllium husk and increased water intake are commonly used.
- Pain relief as directed — take what your doctor has recommended. Staying ahead of pain rather than waiting for it to become severe tends to work better.
- Gentle movement — short walks can help with general recovery and reduce the risk of constipation. Avoid heavy lifting or strenuous exercise until cleared.
- Loose clothing and breathable pads — comfort around the wound area matters during the healing weeks.
What tends to make things worse
- Constipation and straining — this is one of the biggest risks to healing
- Sitting for prolonged periods, especially on hard surfaces
- Skipping dressing changes or wound cleaning
- Returning to strenuous activity too soon
- Not drinking enough water, particularly if taking fiber supplements
- Ignoring worsening symptoms and hoping they resolve on their own
Talking to your doctor
During recovery, keep track of:
- How the wound looks at each dressing change — is it getting smaller over time?
- Your pain levels and whether they are improving, stable, or worsening
- Any changes in drainage — colour, smell, or amount
- Your bowel movements — frequency, consistency, and comfort level
- Any new symptoms like fever or increasing swelling
Healing is not always a straight line. Some weeks may feel like more progress than others. That is normal.
If you experience severe pain, heavy bleeding, fever, or symptoms that concern you, seek medical care.