At a glance
Fistula treatment decisions are more complex than many other colorectal procedures because the type of fistula, its path relative to the sphincter, and the presence or absence of active infection all influence which procedure is most appropriate. Having the right questions prepared helps you understand your options and feel confident in the plan.
About the fistula itself
- What type of fistula do I have? Simple or complex? How does it relate to the sphincter muscle?
- Has the full tract been mapped? Has imaging (MRI) been done to identify the complete path?
- Is there any active abscess that needs to be addressed first?
- Is there more than one tract? Complex fistulas with branching tracts may require different approaches.
About the recommended procedure
- Which procedure are you recommending and why? Fistulotomy, seton placement, advancement flap, FiLaC, LIFT, or another approach?
- Why this procedure over alternatives? What makes it the best option for your specific fistula?
- What is the success rate for this procedure with this type of fistula?
- What is the recurrence rate? How likely is it that the fistula will come back?
- Will this be done in one stage or multiple stages? Some fistulas require staged treatment — a seton first, then definitive surgery.
About continence
This is the question people find hardest to ask but most important to have answered.
- What is the risk of incontinence with the recommended procedure?
- What type of incontinence — gas, liquid, or solid?
- Is the risk temporary or permanent?
- Are there sphincter-sparing alternatives if continence preservation is my priority?
- How does my specific anatomy affect the continence risk?
About recovery
- How long will recovery take realistically? Not the best case — the typical case.
- What will the first two weeks look like? Pain levels, wound care, activity limitations.
- Will the wound be open or closed? Open wounds (secondary intention) take longer to heal.
- What wound care will I need to do at home? Sitz baths, packing changes, gauze.
- When can I return to work? Be specific about your type of work.
- When can I resume exercise, driving, and normal activities?
- What are the signs of complications I should watch for?
- When is my first follow-up appointment?
About the surgeon
- How many fistula procedures do you perform per year?
- What is your personal success rate with this procedure?
- Do you have a specialisation in fistula surgery? Some surgeons have a particular focus on complex fistula cases.
Practical questions
- Will I need someone to drive me home?
- What supplies should I have ready at home?
- Should I start stool softeners before the procedure?
- What should I eat and drink beforehand?
- How long should I plan to take off work?
Writing your questions down
Bring a written list. Appointment time is limited, and anxiety can make it hard to remember what you wanted to ask. If you cannot get through all your questions during the appointment, request a follow-up call or send the remaining questions to the clinic.