Trusted medical platform in Jordan
An anal fistula is an abnormal tunnel connecting the inside of the anal canal with the skin near the anus. In most cases it develops after an anal abscess whose track failed to close following drainage, leaving an internal opening in the canal that keeps feeding the tunnel. Typical symptoms are discharge of pus or yellowish fluid that stains underwear, fluctuating pain that builds before discharge and eases afterwards, recurrent swelling in the same place, and itching or irritation of the surrounding skin. It is important to understand that fistulas do not heal with antibiotics or with time alone, because the tunnel is lined with tissue that keeps it patent while discharge continues from its internal opening. Treatment is therefore fundamentally surgical, and it has a dual aim: healing the tract while preserving as much sphincter muscle as possible, since that muscle is what maintains control of stool and wind. Assessment is half the decision: identifying the internal opening, tracing the course of the tunnel, judging how much sphincter it crosses, and looking for side branches or secondary collections. Clinical examination comes first, and pelvic MRI or endoanal ultrasound may be requested, particularly for recurrent, multi-tract or high fistulas. Options vary with the anatomy. Fistulotomy suits superficial tracts that cross little muscle. A draining seton is a thread left in place for a period, either to drain safely or to divide treatment into stages. Sphincter-preserving procedures include an advancement flap from the rectal wall, ligation of the intersphincteric tract, or plugging or filling the tract, and are generally used when a substantial part of the muscle is crossed. The limits are explicit. No single procedure fits every fistula, and the equation is always between the chance of healing and the risk to continence: faster-healing operations usually divide more muscle, while sphincter-preserving techniques are safer for control but more likely to see the tract return, and treatment may need two or more stages, which is a plan rather than a failure. If the fistula is part of inflammatory bowel disease such as Crohn disease, surgery alone is not enough and is managed alongside treatment of the disease itself. Candidacy and the choice of procedure are determined by clinical examination and imaging, and the final decision is sometimes made during surgery under anaesthesia once the tract is clearly displayed.
The doctor inspects the perianal skin for the external opening or openings and performs a rectal examination and anoscopy in search of the internal opening. He asks about any previous abscess, about discharge and recurrent swelling, and about any leakage of stool or wind before treatment begins.
For recurrent, complex or high fistulas, or when inflammatory bowel disease is suspected, pelvic MRI or endoanal ultrasound is requested to map the tract, its branches and any collections. This imaging reduces surprises during surgery and helps define which procedure fits.
In theatre, after anaesthesia, the tract is explored with a gentle probe, the internal opening is precisely located and the amount of muscle crossed is judged. This step settles the choice of procedure definitively, since what can be seen under anaesthesia is far clearer than any clinic examination.
The chosen operation is carried out: fistulotomy for superficial tracts, a draining seton for safe drainage or to prepare a second stage, or a sphincter-preserving procedure such as an advancement flap, ligation of the intersphincteric tract or plugging, with cleaning of the tunnel and drainage of any side collection.
Daily care, sitz baths and how to handle a seton if one was placed are all explained. You are followed up to assess closure of the tract and continence, and if the plan is staged, the timing of the second stage is set. Where Crohn disease is present, the plan is coordinated with your gastroenterologist.
Give your doctor the full history: whether an anal abscess has ever been drained and when, and whether you have had previous operations in the area and how many, since a recurrent fistula is managed differently from a first one. State frankly whether you have any leakage of stool or wind or weak control before surgery, and whether you have had several deliveries or an obstetric tear, because this steers the choice towards sphincter-preserving techniques. Mention chronic diarrhoea, blood in the stool, weight loss or abdominal pain, as these may indicate inflammatory bowel disease that needs its own diagnosis. List your medicines, especially blood thinners, steroids, immune-modulating treatments and diabetes drugs, plus any allergies. Ask how long to fast and what anaesthetic is planned, arrange an escort and a day or more off work depending on the procedure, and ask directly whether the plan is one stage or more.
Take warm sitz baths in plain water several times a day and after every bowel motion, then dry the area gently, since moisture and friction delay healing. Wash with water after opening your bowels, use a clean dressing and change it as instructed, and expect yellowish or blood-stained discharge in the first days. If a draining seton is in place, do not pull it or try to remove it; clean around it as taught and keep your review appointments, because the timing of tightening or removing it is part of the treatment. Take painkillers and stool softeners as prescribed, drink enough water and increase fibre to avoid constipation and straining. Avoid heavy lifting, vigorous exercise and swimming pools until your doctor allows them. Monitor your control of wind and stool and report any change, however slight it seems. **Seek care immediately for fever or chills, returning throbbing pain and swelling, heavy or foul-smelling pus, bleeding that does not stop with pressure, inability to pass urine, new leakage of stool that was absent before the procedure, or spreading redness of the surrounding skin.**
Simple procedures usually take 20 to 45 minutes, while complex or staged fistulas may take up to about 90 minutes; most are day-case operations.
الدكتور داوود محمود داوود — استشاري جراحة السمنة والمناظير والجراحة العامة في الأردن، وحاصل على البورد الأردني في الجراحة العامة، وعضو في جمعية الجرّاحين الأردن…
There are currently 1 doctor profiles linked to Anal fistula treatment on ClinicsJo. Review the listed services and contact the practice to confirm availability with the doctor and branch you choose.
Start with an available doctor's profile and use the contact or booking options shown there. Confirm the service, practice location and appointment time with the clinic. If this list is empty, broaden your search using the directory links on this page.
Ask the practice for the current price and what it includes. A consultation fee shown on a profile is not necessarily the price of a procedure, tests or follow-up. Confirm any additional charges and insurance arrangements before your visit.
