Frequently Asked Questions

Question: What will the integrity of the sphincter muscle be like over time?

Answer: This depends on events of delivery. If the sphincter muscle has been injured with a 3rd/4th degree tear, the patient may suffer pudendal nerve neuropathy, which is an injury to the nerve of the anal sphincter. Each case is different. You would be best to discuss this with your doctor.

As you age it is not possible to predict what each patient's continence will be like as other events such as menopause influence this. We do know that incontinence is more common in women, principally due to childbirth and that delivery events such as a tear, forceps, large babies are risk factors for anal sphincter injury, nerve injury or both.

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Question: Soiling - what are some of the management options?

Answer:

• Modifying your diet - you will need to seek advice from a dietician
• Physiotherapy using Biofeedback
• Use of medication e.g. Loperamide, Imodium, Lomotil, taken orally
• More surgery
• A Stoma (extreme)

Question: What level of pain can I expect from a fistula repair? Will it be similar to post birth pain?

Answer: Pain is only relative to pain relief. Pain is subjective and all patients are different. It is amazing how people differ. Some people seem to get very little pain and for others it is terrible. Unfortunately there is no good answer to this.

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Question: I have a stoma and have had my fistula repaired. How can the doctor tell if the fistula has completely healed prior to closure of the stoma?

Answer: In order to check this an EUA (Examination Under Anaesthetic) can be performed. This involves having a look while patient is under general anaesthetic and use of a probe to ensure no connection however tiny between the vaginal and rectal walls. Some surgeons choose to have another colorectal surgeon or gynaecologist assist during the operation thereby providing an additional expert opinion.

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Question: Once a fistula repair is successful, is it possible a patient may suffer short or long term any or all of the following:

Answer: Yes to varying degrees you may suffer the following;

• Soiling (incontinence)
• Bleeding - this may be due to scar tissue, raw areas (due to incontinence) or distortion of anus
• Pain - due to raw area or scar tissue
• Urgency to defaecate

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Question: Am I able to have another baby?

Answer: There is little risk of obtaining a fistula through pregnancy, however discuss your options with your obstetrician about having an Elective Caesarean Section as opposed to another vaginal delivery. You would need to weigh up compromising any repair of a recto-vaginal fistula with another vaginal delivery. You have the final decision.

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Question: Is continence physiotherapy best started after a successful repair or can a patient help themselves by strengthening the pelvic floor earlier?

Answer: Early physiotherapy may help alleviate incontinence if associated with a sphincter defect. Theoretically physiotherapy helps increase the local tissue blood flow and therefore promote healing.

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Question: What about Pain Relief?

Answer: As part of your pre-op consultation you should discuss pain relief options with your doctor or anaesthetist. Pain relief is important, it enables patients to start to ambulate sooner thereby avoiding some post-op complications. Several methods of pain relief will be offered either via PCA (Patient Controlled Analgesia), epidural, injection and orally. You may receive by injection pethidine or morphine then you may be moved onto oral pain relief.

Don't be afraid to voice how you are feeling. Please don't think you have to put up with pain, you should ask for pain relief when necessary, you are the best judge of how you are feeling. Everyone is different.