I have a history of low transverse fistulectomy and I'm experiencing slight burning, what should I do?

Post-Fistulotomy Burning Sensation Management

For slight burning after low transsphincteric fistulotomy, apply topical lidocaine for symptom relief while monitoring closely for signs of recurrence, but understand that any future fistula recurrence absolutely requires sphincter-preserving approaches only—never repeat fistulotomy. 1, 2

Immediate Symptom Management

Topical lidocaine can temporarily relieve minor perianal pain and burning, though a transient burning sensation may occur upon initial application that generally disappears in several days. 3

Lidocaine Application Guidelines

• Use only on intact healed skin, not on cut, irritated or swollen areas 3
• Avoid contact with mucous membranes 3
• Discontinue if condition worsens, redness develops, or symptoms persist beyond 7 days 3
• Do not apply local heat or bandaging over the treated area 3

Critical Warning Signs Requiring Urgent Evaluation

Stop any anal sexual activity immediately and seek urgent colorectal surgery evaluation if you develop: 1, 4

• New perianal pain, swelling, or drainage suggesting abscess formation 1, 4
• Increased tenderness or induration around the prior surgical site 4
• Any purulent discharge from the perianal area 5

Early abscess drainage with seton placement prevents complex fistula formation—waiting allows simple abscesses to evolve into complex recurrent fistulas. 1

Understanding Your Elevated Risk Profile

Your prior fistulotomy history dramatically increases risk from any future procedures, making repeat sphincterotomy dangerous and potentially catastrophic for continence. 1, 2

Why This Matters

• Simple fistulotomy carries a baseline 10-20% risk of continence disturbances 2, 4
• For someone engaging in receptive anal intercourse, any degree of incontinence becomes functionally devastating to quality of life 1, 4
• Prior fistulotomy is an absolute contraindication to repeat fistulotomy 2

Treatment Algorithm If Fistula Recurs

If recurrence develops, the only acceptable approaches are: 1, 2

1. First-line: Loose non-cutting seton placement

   • Maintains drainage through the sphincter complex ending in the internal opening 1, 2
   • Can achieve fistula closure in 13.6-100% of cases as definitive treatment 1, 2
   • Allows inflammation to subside without additional sphincter damage 2

2. Second-line: LIFT procedure (ligation of intersphincteric fistula tract)

   • Consider only if seton drainage fails 1, 2
   • Preserves sphincter function 5

3. Never acceptable: Cutting setons

   • Result in 57% incontinence rate from progressive sphincter transection 1, 2

Common Pitfalls to Avoid

Do not assume that because your original fistula was "low transsphincteric" that future recurrence could be safely treated with another fistulotomy—this would likely cause permanent incontinence. 1, 4

Aggressive probing to define any suspected tract causes iatrogenic complications and must be avoided. 5, 2

Aggressive dilation causes permanent sphincter injury and must not be performed. 1, 2

When Anal Sex Can Resume Safely

You can engage in anal sex only if: 4

• The fistula tract is completely healed with no drainage, induration, or tenderness on examination 4
• There are no signs of recurrent abscess or active inflammation 4
• You demonstrate adequate sphincter tone on digital rectal examination 4

You must accept that any fistula recurrence would require sphincter-preserving approaches only, never repeat fistulotomy. 4

Monitoring Protocol

Monitor continuously for: 1, 4

• Any new perianal pain, swelling, or drainage 1, 4
• Changes in the anatomical deformity from your prior surgery 4
• Any difficulty with continence that could signal sphincter compromise 2, 4

If any new symptoms develop, you require urgent colorectal surgery evaluation to drain any abscess before it creates a complex recurrent fistula. 1, 4