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Fistulotomy In Real Time


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#1 Elzo

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Posted 15 February 2009 - 12:19 AM

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Hello everyone -

I'm new to this site and thought I'd share my fistulotomy experience in 'real time'...in Taipei, Taiwan.

Background: early October 2008 had a mysterious stomach virus that gave me diarrhea for 1 week. A week later, I inadvertently showered 'too close' up my rectum and felt a 'tingly' sensation. The next day after cycling for 50 minutes felt a sore pea-sized lump just above the anus that got sorer over the next week. A CRS saw it and said it was a 'perianal abcess' that needed to be lanced. Unfortunately, it 'spontaneously burst' (much to my relief) before I could see him. I thought that he would welcome this as good news, but after 2 weeks of not healing he said a fistula had formed. From mid-October to February 2009 I saw different CRS who prescribed different (but similar) types of antibiotics which kept a yellow pus discharge at bay. They all said to 'wait 3-4 months' to see if the fistula would spontaneously heal - as it does in 10-30% of cases as I was told. One CRS thought I might have Crohn's Disease and that the antibiotics could heal the fistula in that case. Other CRS dismissed the diagnosis of Crohn's given lack of other symptomology. All CRS agreed that surgery was necessary if no healing within 3-4 months.

My advice in retrospect: 1) go to the best CRS/hospital right off the bat when you've got the perianal abscess 2) do NOT allow the abscess to spontaneously burst - let the CRS lance it (they try to burst it 'outwards' - spontaneous bursting can burst in both directions causing the fistula - this was NOT told to me by the first CRS) 3) Get adequate coverage with AB at the start to maximize your chance of the drained abscess healing without forming a fistula - do NOT let doctors con you by saying: "AB do not cure abscesses"...this statement is true in itself but a doctor who says this is ignoring the fact that a burst abscess or fistula has no chance of healing if it is infected (infected tissue cannot granulize). Insist on getting full AB coverage for the first 1-2 months

January - February 2009 I met with 4 CRS at top hospitals in Taipei to discuss surgery. First CRS laughed at me and said to come back in another 3 months. He prescribed a minimal amount of AB and as he left the room said I may get 3 or 4 more perianal abscesses before I'm done. I didn't go back to him. Second CRS said he thought I had Crohn's disease given the 'aggressive' look of my fistula. He wouldn't look me in the eye as he talked. He stuck some metal probe up my fistula that sent me through the roof. He said I should delay surgery. I didn't go back. Third CRS had a tremendous amount of experience but just laughed at me when I asked questions - he denied any risk of fistula surgery. I asked him point blank: "On the internet I have read that there is a risk of incontinence after fistula surgery. Is this correct?" He laughed. "There is no risk." I asked him to describe the procedure. He said: "Cutting." I felt this was suspicious and didn't return. Finally, I went to the best hospital in Taiwan (NTU Hospital) and met their CRS. He was friendly and explained both the risks and procedure to my satisfaction. I decided to go with him.

THis past Tuesday I went in for a fistulotomy. He said he wouldn't know which procedure would be employed (lay open or seton) until I was under anaesthetic. After the surgery I was informed I had a 'simple fistula' and that it had been lain open. He said he also abraded the area to get rid of any necrotized or infected tissue. There was quite a bit of discomfort after the anesthesia wore off - somewhat akin to the feeling of having fallen and scraped your knee on the pavement, but having this on the anus - and quite a lot of pinkish drainage, though no outright dark blood. I went home on Wednesday (two days ago) and told to stay off work until next week. I was told to use sitz bath with iodine 2x day (and after every stool). I was given stool softeners and aspirin.

While I was very impressed with the overall professionalism at NTU Hospital and the CRS so far; it is early days yet, but so far have experienced no incontinence...a few other surgeons (non-CRS) said that it is all to do with "surgical skill and experience"...so pick someone with lots of experience and "good hands"...I also believe trust and openness is important too. My doctor instilled trust. The NTU nurses also had tremendous knowledge about fistulas which impressed me and the NTU hospital is cleaner and better organized than the rest.

From Tuesday to Thursday there was quite a bit of discharge and moderate pain - I could bear the pain but it was distracting. As I said, it was like a feeling of a skinned knee or elbow, but on the anus. I felt that low grade painkillers such as aspirin or Tylenol made life a bit easier, but if I didn't have pain killers I could bear it.

On Friday the pain suddenly lessened considerably and discharge has decreased to mucous/serum. I've had a each day, but these passed without incident. The only thing that has me a bit concerned is a periodic itchy serum that is secreted almost like sweat and coats my buttocks. It has a slight odor to it, but I simply shower it off and soak in the sitz bath. The CRS assured me that the discharge is a normal process and that this area of the body is actually quite resistant to infection. It still worries me though since an abscess (and infected gland) is what started this whole process. I remain on the lookout for yellow pus, but so far haven't detected any (it tends to be itchier, yellower and smellier than serum).

I had a look at the wound - at first it appeared that it had not been sutured. There was quite an ominous purple gaping crevasse where the small fistula used to be. I noticed that the CRS also removed other hemorroidal tissue as well. The wound looks like it should be causing a tremendous amount of pain but the wound itself is no longer painful at all - the 'scraped knee' sensation is gone. The only discomfort is associated with a sense of swelling with the discharge. Later I felt a sharp pin prick which concerned me and then noticed that some of the dissolving sutures were starting to poke through from the site where the fistula opening had been. One suture end was about 2 inches long; I carefully snipped it so it wouldn't catch on my underwear, but didn't attempt to remove the suture (should never attempt to remove sutures unless by doctor).

I wear feminine pads each day (same as my GF!) and find these are great in not only capturing discharge but providing a great way to examine the amount and consistency of the discharge to alert about a) blood (only pinkish ooze, no dark blood) :( infection (only yellowish, slightly smelling serum, no smelly yellow pus)

I went walking each day for at least 30 minutes and it felt fine. Yesterday, I went a bit further in the park and sat through a movie - later this caused aching and discharge. I felt I had found my limit and will ease off today. I noticed that the aching and discharge seem to go hand in hand...I believe the aching comes from swelling caused by discharge. I notice when I shower off the discharge, the aching subsides. The sitz bathes offer some relief but I notice that sitting too long in them also promotes swelling and aching. There seems to be a cycle throughout the day of discharge, swelling, aching, showering, relief. At the moment as I write this, there is no discharge or swelling.

The doctor said I can move around within the limits of my pain, but no strenuous activity until I see him next Friday and no biking at least for another month. I will play it conservatively until Friday and will see him sooner if necessary.

Next post will be after my meeting with CRS.

Hope this helps!


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#2 raim

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Posted 17 February 2009 - 10:05 AM

look forward to hearing what your doctor says and how your healing progresses!

#3 Elzo

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Posted 19 February 2009 - 08:55 AM

Today is Post-Op Day 8 (Thursday, February 19) and met the CRS today....

Here's what has transpired since my last post last weekend...from Sunday to Tuesday, I continued to experience a tremendous burning sensation and swelling feeling along one side of my buttocks, NOT near the surgery site....this was alleviated by simply showering. In the last few days, both serum/discharge have decreased and the swelling and burning pain have subsided almost completely! The CRS wasn't sure, but we both surmised that this might have been a histamine reaction of the serum discharge...he wasn't concerned so long as the discomfort decreased with showering. He was primarily concerned that there wasn't a) pain with the fistula surgery site (minimal or none) :( pain in my abdomen (none) c) pain defecating (minimal or none) d) increase in discharge or blood (none).

I should also add two other corrections since my last post. I had surmised that my CRS must've taken off hemarroidal tissue (thus indicating the burning sensation on my inner buttocks)...however, he swore that he did not! It was odd...before the surgery I had various hemarroidal swellings but after they have all but disappeared! My only thought is that the hemarroids may been generally inflamed with infection over the past 5 months...now the infection is gone and the swellings have decreased. At any rate, apart from the fistulotomy, my bum looks quite a lot smoother and nicer after the surgery and can't pinpoint the reason. Maybe it simply looks better shaven!

Secondly, I mentioned that I had been plagued by stitches poking out and irritating my bum. This may have also contributed to the burning sensation on my inner buttocks and increased serum discharge. I also said that I had taken care not to remove them, but had to trim them from time to time (as they were catching on my underwear). Unfortunately while trimming one long thread (sticking out about 2 inches) yesterday I inadvertently pulled out the whole stitch! However, it came out rather easily and there was only a tiny drop of blood. The CRS was unconcerned - he said it was likely they were ready to come out.

The CRS said the following about my bum on Post-Op Day 8:

1) "It is healing according to my projections. It's on course"
2) "The wound is still open, but is closing and healing"
3) "Come back to visit me one month later (March 19)"
4) "In the meantime, no strenuous exercise, do not get sweat on the area - if you do, wash or sponge off (using baby wipes) immediately to avoid risk of infection, continue 2X sitz baths (with 1.5 mL iodine each sitting) daily, drink lots of water, adequate rest, shower and sitz bath after defecating if possible, shower or wipe (using baby wipes) whenever your bum feels 'slippery' with discharge or serum"

When he examined it today he pressed on it with a Q-tip and that hurt for a second.

He had few concerns about it and said it is a very very common condition, a very simple surgery for him and he's done countless of these surgeries. He said that none of his past patients have had to return to his clinic after the 2nd follow-up visit.

I don't feel any real pain or discomfort, discharge has decreased to a small amount, feel a LOT better after the stitches came out. However, there is an odd 'tight' sensation when I contract my anal ring - it reminds me of the same tight 'salty' sensation after soaking in a hot springs....I'm wondering if this has to do with my 2-3 times daily sitz baths with iodine...the iodine may be causing this slight aggravation. Otherwise no other pain or discomfort. My bowels are loose, but that is because I've been drinking vegetable/fruit/egg smoothies each day.

Tomorrow I'm due to go back to work for the first time. The CRS told me to sit on an inflatable 'donut' for the next month.

That's about it - I'll check in again after March 19 or if something comes up in the meantime. I'm eager to get back to exercising and bike riding, but I'll follow his conservative directions and will do more walking in the meantime. Since Post-Op Day 1, I have walked at least for 30 minutes to an hour each day and this was recommended.

E

#4 Elzo

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Posted 19 March 2009 - 08:02 PM

Here is an update on the progress of my healing wound 38 days post-fistulotomy (laying open). My last visit was on February 19. My CRS told me to come back 1 month later (today). He said:

1) would is showing good granulization, but still wound is open
2) still some drainage (yellowish pus)

He said that:

- I would be permitted to engage in exercise and sweat (including weight-training, yoga and running), but should shower immediately after
- I would not be permitted to sit on a bicycle seat for more than 10 minutes at this time. I would have to come back 1 month later to confirm (April 16). Basically, full riding should only be resumed when wound is fully granulized. He said this will take some time but will eventually occur
- bright red colour of wound site is 'normal' shows healthy granulization
- yellow pus around along wound tract is 'normal' and will gradually subside. It is NOT a sign that there is residual internal infection (which is what I feared)
- wound is healing 'bottom up' and this is normal (that is, scar tissue filling from the valley floor up. Eventually the wound valley will 'flatten out' - the wound does NOT heal by the valley sides fusing together)
- funny 'incomplete' feeling of something stuck up my anus after defecating is 'normal' during wound healing process. It has been gradually subsiding.
- continue to do sitz baths twice a day
- continue to drink lots of water and have high fibre diet
- continue to sit on inflatable donut cushion at work

So it's on track with healing process, but not out of the woods yet. Having said that, I can barely notice the wound these days and it does not interfere at all in my daily life EXCEPT that I cannot ride a bicycle in a seated position for more than 10 minutes. There is occasionally a slight salty stinging feeling from the sitz baths (water a bit too hot maybe, iodine irritating a bit), but this is only occasional now and not a major concern.

Another update April 16 when I see the CRS at least once more.

E

#5 bradd774

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Posted 31 March 2009 - 02:30 AM

Elzo, we must be mysteriously linked somehow (see my posting on a different topic below) - at the same time as you (more or less) i had the exact same symptoms, exact same abscess size/location, exact same fistula surgery (he even said it was "simple"), and going through exact same healing process. I however, am on day 7 of the fistulotomy, and seem to be in the same place you were 40 or so days ago.

So no one knows how I got this, Crohn's tests have all been negative - but let me ask you this. When you had that bout of Diarrhea, did you feel that that the area that you developed the abscess was sore/roughed up from all the activity? I believe that's how mine was caused --- and wouldn't you think that would rule out Crohn's (for perhaps both of us) since there was a physical force acting on the area from the outside (and not the inside as Crohn's would be)? It's quite uncanny how similar our situations are, or maybe these things happen all the time.... let me know how things are healing! My first stich just came out today ;-)

http://www.ibsgroup....mp;#entry735131

Hi, here's my story wondering if there's any similar situations out there.

Sept 08: had some stomach cramps, later that week had about 25 BM's each day for two/three days. Stool tests showed Clostridium difficile.
Oct 08: was on Flagyl, seemed to help, a couple days getting off of it, had the same episode as before.
Nov 08: Had a colonoscopy, found a small bengign polyp, nothing else. Found some inflammation, suspected colitis, but biopsies turned out negative
Nov 08: A bump started to grow near the anus, was an abscess
Nov 08: GI ordered more tests (Barium Xray), turned out negative for Crohn's or Colitis
Nov 08: Had the bump lanced
Jan 09: Area still hurt after BM, went on Flagyl again, it worked, but then the pain came back after the meds ended
Mar 23rd 09: Really tired of the pain from the incision (pus, stinging, itching), had a fisulotomy
Mar 23rd 09: Surgeon said it was a "low-level" fistula that was basically cut into a groove, rectal area stictched up.

I guess my purpose of posting this is:

1) Is there anyone out there who hasn't been diagnosed with Crohn's or Colitis that would get such a thing? The GI was willing to bet the farm that I had Crohn's, but they couldn't find anything, AND, I didn't have any symptoms since the 2nd Oct 08 episode (other than the abscess/fistula of course)
2) I have to say I so far (knock on wood) am pretty darn happy with the decision to have the surgery. Sure there's pain (it's only been 3 days), but it wasn't as bad as I thought. In fact, I never had to take the pain meds (double knock on wood). So anyone who is not sure what to do - have the surgery!

-Brad

#6 bradd774

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Posted 31 March 2009 - 02:33 AM

If you don't mind me asking how old are you? I'm mid-30's male.... wonder if certain age groups are more prone.

#7 bradd774

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Posted 31 March 2009 - 02:34 AM

I also have to add - I had hardly ANY pain after the surgery. I took one OcyContin pill, just in case, and nothing ever hurt. Strange that you had the same experience....

#8 Elzo

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Posted 31 March 2009 - 03:36 AM

Hi Brad -

I got your messages - sorry, I rarely check this board unless I come back from a CRS visit (next one April 16)...

Yes, it's interesting that we are in the same boat and similar timeline. It's good to know we are not alone! I must admit, the whole process before during and after surgery is something else - it doesn't necessarily go according to injuries in other parts of the body.

I'm glad to hear things are healing. To answer your questions:

- none of the CRS I visited (except one who thought it might be a possibility because of the 'aggressive abscess') thought I had Crohn's since I haven't had any of the symptomology before or since (except for 3-4 days of extreme diarrhea). But Crohns' can only be ruled out completely with a battery of tests which I haven't taken. It's only unlikely I have Crohn's.
- I believe that since the abscess formed within a week or so of the diarrhea session it might have had something to do with that. But the strongest memory I have is after a bike ride I put a shower nozzle too close to my anus and hard showered a bit of the rectum. I could feel an abrasion and 'zinging' feeling which didn't go away until I felt a 'bump' form the next day...the zinging feeling remained until the abscess burst a week or so later. I believe it's a combination of the massive diarrhea and the shower abrading the rectum (which I'll never do again!) - but can't be certain
- I'm in my early 40s and male. I have been constantly on my bike for the past 25 years (which may also contribute)

As of today (almost 50 days after surgery), there few symptoms, virtually no discharge. However, it is still tender to sit riding for more than 10 minutes so it is not completely healed yet. But so far, so good. I'll get final confirmation in a few weeks from the CRS about when I can get back to bike riding.

Although everything has gone relatively smoothly, the time, expense, inconvenience and hassle and just thinking about it constantly for 6 months - I hope that I don't have to go through it all again, but I suppose things could be a lot worse.

I hope you're healing goes smoothly - getting the stitches out was the first positive sign for me!

Good luck,

E

#9 forthestars

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Posted 19 April 2009 - 09:13 PM

Elzo, your post is really helping me deal with my fistula problem.

I have an odd situation where, last March (a year ago) I took a course of antibiotics which caused diarrhea for me. I was having about 4/5 BM's a day. This subsided but I was left with wind and sof t stools, i am down to just 2 BM's a day now but one of these is usually softer than they used to be.

I've had blood tests and stool tests but nothing was found. In september last year I started cycling 2 hours a week, and lifting weights. The cylcing was on indoor bikes that really hurt my ass every time! It's interesting you mention you do this too as I started to get an abscess, which turned to a fistula. Doctor said they are not related to cycling or weights but It's strange I seem to be hearing a lot of people with it. The nurse did say that most of the people they get in with fistulas are young men my age...strange.


I am on day 13 since my fistula was laid open. My CRS is so relaxed he didnt give me antibiotic after surgery ( he said he wouldnt then he didnt!) , he just gave me two wound pads, told me to soak it, and no packing!...and sent me home.

I am in no pain but like you, I do have this weird yellowy(sometimes slightly browner after BM) mucous, it smells slightly, particular after a bowel movement. i am also finding small particles of faecal matter in it sometimes, I am scared this was a residual infection, i went to the nurse 3 days after who said it was a "brilliant wound". But even 13 days later I still am getting yellow discharge, but I am in no pain at all now , its just slightly itchy like you said.

Showering it all regularly is the key i think,

My follow up is not until May 19th, so i just feel like I am constantly worried like maybe it is infected and I'm not realising!

It' weird how we are all conditioned to assume that yellow mucous is infection, if it is not then I wonder what this is ?

I have searched online and it seems to be a normal thing, Oh well. I am glad your post settled my mind slightly...and I hope this is the end of this story for me ! it really is an unpleasant thing to have...

The worst part is i really wanted to get a good body by March 2009, but I had to stop everything in November and now I'm scared to do it again!

#10 Elzo

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Posted 17 May 2009 - 07:09 AM

Dear "For The Stars"


I'm glad to hear things are going well from your post - the yellow mucous I was told (and found out) is a normal part of the discharge. For a few weeks after the surgery things are quite 'weird'...it doesn't necessarily go according to common-sense...bear in mind that for most CRS this is a SIMPLE surgery...my CRS does 10-20 per month!...if you just hang in their and keep the faith...and do EXACTLY as the CRS recommends in terms of bathing, rest, exercise etc. I believe things should be fine...good luck with it!

I'm now at Post-Op 96 Days.

Near the end of April 2009 my CRS saw me for the last time and said that my scar had healed sufficiently that I would be able to cycle a maximum of 10 km per day until the middle of May. Then I would be able to cycle without restriction. Recent developments:

- It feels like it is 98% healed. Scar has nearly fully filled in (from bottom to top of the wound valley) but I feel that the scar tissue is still soft and not as strong as surrounding area yet. That may take quite some time (maybe up to a year?)
- Able to cycle ‘sitting down’ without restriction. The first few times I tried cycling ‘sitting down’ within 10km limit resulted in a ‘raw feeling’ but this was eased with sitz baths
- Very slight discharge persists, but only notice by touch and does not show up on feminine pads
- Still do sitz baths daily (with Epsom salts now, not iodine any more). My CRS said I should continue to do sitz baths going forward as part of long term therapeutic benefits (he didn’t say when I should stop doing sitz baths)....I like them and read the paper while doing them.
- Generally I now pay more attention to hygiene; I do not use toilet paper anymore; instead, I use baby wipes and showers. I wash my hands as every opportunity (without being obsessive about it).

This problem started at the end of September 2008 with the formation of an anal abscess and has taken almost eight months to overcome. Would I have done anything differently? I would have had a CRS lance my anal abscess rather than let it burst on its own back in October 2008. Other than that, I think everything has gone fairly smoothly and the decision to get fistula surgery was a correct one. I'm glad I went to an experienced and caring CRS.

Good luck everyone! Glad I could help a few by relating my experience...especially the recovery...not much is on the web otherwise. If you have any questions, feel free to e-mail me personally. I may not be on this site again for a while.

Best Regards,

E

#11 Billy222

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Posted 01 January 2010 - 08:21 PM

Hi, I'm also new to this site. I found it on what I thought would be a vain search for answers regarding my current predicament. I'm a 32 year old male and reside in the US. In early September of 09 I went out with some friends and ended up having 2 beers. I woke up the next morning feeling like I had consumed an entire bottle of liquor myself! I was constantly going bm (maybe 8 times a day). I thought maybe I had a touch of the stomach flu so I didn't give it much thought. The next day while in the shower I noticed a small lump outside of my anus. I thought it was a hemmroid and went so far as to buy anti inflammatory cream. Needless to say it didn't work. As the weeks went on it got bigger and I decided to go see my doc. He said it was a perianal abscess and that I would have to take warm baths to get it to burst on it's own. He also gave me a prescription for augmentin, which I had never taken before. It was literally on the drive home from the doctors that the abscess burst- disgusting!! But I was happy to have some relief from the pain. I began taking the augmentin and immediately felt worse from the horrific GI side effects. These included diarhea, stomach cramps, and severe nausea. I called the doc and told him that I was having these awful side effects- he told me I should just tough it out for a week and that should do it. So that's just what i did. Fast forward to late October of 09 and I'm supposed to fly to Virginia for the weekend. I had been off the augmentin for 2 weeks and still the nausea and belly pain had not lessened. And to top that off, my abscess was still draining on a daily basis. It ruined my trip to be feeling this way. It worsened it even more to not understand what exactly was wrong with me.
After I returned home I was tested and was found negative for C Diff, and parasites. That was when my dic decided because he couldn't figure out what was wrong with me, that he'd ignore my situation and my questions. I took it upon myself to do some online research and discovered that if an abscess drains for longer than 2 weeks that it had most likely formed into a fistula.
It was then that I changed primary physicians and started going to my girlfriend's doctor, a nice man with some years of experience. He confirmed that it appeared to be a fistula, but that i would need to see a GI doc in order to get it evaluated and repaired. He prescribed me flagyl for any infection and sent me on my way. This was good news and bad news for me. I was glad to have a diagnosis for the fistula, but the main reason I had gone in was for the severe belly pain, which I was certain was tied to the fistula somehow.
The belly pain worsened and after 2 days on the flagyl I began to have small seizures associated with the pain. I thought I was dying. My poor girlfriend didn't know what to do for me, so we went to the ER where they basically shrugged their shoulders and sent me home that same night after a CT scan revealed it wasn't appendicitis. They gave me a script for vicodin, and I almost flipped out on them when they told me the most common side effects are belly pain and nausea! I could barely walk back to the car that night but I got in and we went home. I was having seizures all night with being doubled over in belly pain. I finally got to sleep at 4am, but woke back up around 7am in agonizing pain. We went straight back to the hospital and I demanded they admit me until they found out what was wrong with me!
4 days later I had been through every test imaginible that they could throw at my GI tract. I had a colonoscopy, an endoscopy, and an ultrasound (to check for gallstones) and the only thing the tests found was that my stomach was enflammed with "mild gastritis". If this was mild I don't want to even think about what moderate or severe would feel like!! My symptoms seemed to be subsiding and they sent me home to be on a bland diet. This was late November. Again, I did a little online detective work and discovered that not only does augmentin actually cause gastritis in many people, but the drug flagyl causes severe neurological side effects in persons who are allergic to it: namely seizures and numbness of the extremeties!! I stopped taking the flagyl on my own 2 days after getting out of the hospital and the seizures have not come back. I still need to maintain a very bland diet until my gastritis is under control, but that's the least of my problems at this point.
It was when I was in the hospital that I met my CRS who did my colonoscopy. We spoke about scheduling a fistulotomy for early February, as I'm supposed to go to Ireland with my girlfriend in mid January for two weeks. However, after giving it some careful thought, I decided I'd rather just get it over with now than risk it becoming infected and being laid up in a hospital overseas. I went in for my fistulotomy on Dec 30th and the doc said it was shallow enough that I didn't need to yet a seton put in. It is now Jan 1st and the pain isn't as bad as I thought it would be. Even the first dreaded bowel movement wasn't bad at all. You just have to remember that it's very swollen down there and things are just going to feel weird for a little while I suppose.
One of the main reasons I wanted to share my story on this board was that you guys had mentioned that you were physically active and then had experienced flu like symptoms before you came down with your abscesses. That's just what happened to me! I went to the gym every day and ran 3 miles before lifting weights for a half hour or so. I'm not sure if there's any correlation here, and I'm just going to throw my shame out the window, but I shave downstairs both front and back. It might be possible, I think, that maybe I nicked myself with a razor while shaving and then when I went to the gym and I sat down in someone elses sweat. That seriously the only thing I can think of that might offer any explanation.
So here I am... me and my sore bum. My stomach is feeling better every day and I'm hoping my fistulotomy will heal enough to allow me to go to Ireland in a couple weeks. I'm taking my sitz baths after every bm, though I just have them with plain water- no iodine or salts. Wouldn't salts hurt? So if anyone can offer me any sage advice on either fistulotomy recovery or gastritis treatment, please respond. It took me months to find this site & I'm SO glad I did!!

#12 Fistula

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Posted 19 October 2010 - 11:51 AM

This was very helpful - I'm amazed by how little information there is regarding recovery. My surgeon is a friend of mine - and I feel like I am in the dark.

I am 6 days post-op.

I first noticed a fibrous line in my perianal area in 2007/2008 (emanating away from the anus). No swelling or drainage. It was sort of concerning because it was firm and unusual. Eventually went to a CRS who wasn't sure of what it might be. Had a MRI in 2008 - radiologist determined that it might be an infected anal gland. CRS was rather unresponsive, and I just lived with it... Unfortunately, it began change in size. Swelling a bit and then shrinking. Eventually, I felt drainage into the anal cavity. I could feel the pathway. Discharge ranged from light brownish to cloudy pinkish. Once, dark blood. It was never particularly noticeable unless I really pressed on it. I dealt with this for about 3 years!!!! What an idiot. This was mostly due to my concern about the CRS I initially visited (turns out he was a D.O. quack). Also, I knew it would have a huge impact on athletics and was avoiding the inevitable. Eventually, the swelling began to become uncomfortable and drainage was erratic - which was concerning. I feared a big abscess at an inopportune time (like traveling) - and visited my surgeon friend. He diagnosed perianal fistula and recommended fistulotomy.

I was on the table in three days. General anesthesia. The surgery and post op was not that uncomfortable. No need for pain pills. In fact, I went to Walmart Post Op day 3 (decided to ride an electric cart). I have been very mobile - but try to sit in comfortable padded chairs as much as possible. Fortunately, I can work from home.

I was most shocked by the gaping unsutured wound. WOW! That was a bit unexpected. The fistula canal is cut open (leaving a 3cm open incision from the anus) and the abscess cavity is removed (leaving a large 4cm diameter hole in the glute). This sounds horrible and it looks horrible. One day post op, I removed the gauze with clean tweezers and pulled the packing from the abscess cavity. No significant pain. The fistula cavity was packed with gauze gel that is intended to dissolve over time. I wish I had known that... It was a pain to remove as it disintegrated easily. Interesting to see my muscle up there. The wound requires very attentive care... I had no idea - and the posts above were very instructive as to what to expect. There is some discomfort but not a lot of pain.

I have been wearing sanitary napkins - which are perfect for absorbing drainage and keeping the area clean. I go through several a day. Here's a suggestion - place the napkin in your briefs and get it positioned right. Then, and this is the trick, put an athletic supporter on over your briefs. This presses the pad close and keeps it in place. I tried to go one night without the jock, and it was not good. Drainage appears dark on the back of the pad. Sometimes it was rather heavy (meaning the pad was heavy). No significant blood. Some goopy residue. No significant odor. I am on antibiotics (flagyl and something else). Thank God for those. I am surprised that there is no topical spray - that would make me feel more secure. No iodine prescription for sitz baths either. I will talk to the surgeon about this next week and let you know what I learn.

Bowel Movements - didn't have one until day 3. Didn't really want to - but it turns out not to be that bad. I am now having several a day. Take the stool softeners and stay on a diet that encourages softness. I have been pressing a folded up wet wipe on the wound during the movements. I hate the thought of feces in the area and it seems to help. I try to close the fistula wound and press up on the abscess wound. I think the pressure helps give me confidence to press and completely void the colon. This minimizes the number of BMs and reduces strain on the wound. Of course, I shower afterwards. The hand held showerhead is very helpful because it allows me to direct the stream in the wound area and seems to clean it out thoroughly. I have not been taking sitz baths - favoring longer showers with some decent water flow through the area. Amazingly, this is not uncomfortable at all.

Looking back, I wish I had attacked the problem back in 2007 when it first started. Waiting led to a larger abscess and larger wound. Don't wait - get it fixed!!!

I was hoping for a recovery in 3 to 4 weeks - but from the earlier posts, it appears that this is more of a multi-month process. I hope this was helpful.

#13 inferno

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Posted 20 February 2011 - 06:51 PM

So is it true that yellowish pus is expected after a fistulotomy. Had my surgery on Tuesday and today I started getting some yellowish slimy stuff on the gauze. Slight odor, nothing too horrifying but noticeable. Increased itching to. Just nervous now after having the fistula.

#14 fisto

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Posted 03 September 2011 - 10:53 PM

I had my fistulotomy done on 1 Aug and am still discharging a bit of blood and yellow pus in very small amount. Doctor told me it will probably be six weeks before this stops. The stiches have begun to drop out. interestingly enough I also had diarrhea before I had anal abscess and subsequently develop a fistula. Seeing a doctor early helps and I must admit I was pretty freaked out when I knew that my anus had to be cut out. But reading this forum help me made the decision to treat this as early as possible. Thanks to Elzo for providing the information.

#15 MissMel

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Posted 10 August 2012 - 07:56 PM

Hi everyone,
This is an outdated thread, but i noticed many of you have had a simple fistula and undergone a laid-open fistulotomy. I was hoping any of you could give an update of how you've recovered, after about 1 year? My Dr. believes I have a low simple fistula and require a fistulotomy, but isn't 100% sure until surgery. So many people with setons have had complications, but it sounds like many here with fistulotomies had success.
Thanks for all the detailed sharing, it really helps to be informed!
Mel

#16 alexphuongvu

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Posted 14 August 2012 - 05:52 PM

Hi everyone,
This is an outdated thread, but i noticed many of you have had a simple fistula and undergone a laid-open fistulotomy. I was hoping any of you could give an update of how you've recovered, after about 1 year? My Dr. believes I have a low simple fistula and require a fistulotomy, but isn't 100% sure until surgery. So many people with setons have had complications, but it sounds like many here with fistulotomies had success.
Thanks for all the detailed sharing, it really helps to be informed!
Mel



#17 alexphuongvu

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Posted 14 August 2012 - 06:05 PM

I had my fistulotomy in Feb of this year. So it's only been 6 months for me. My doctor said my fistula was superficial/simple also but he won't know if i need a seton until i go under. When i woke up from my surgery, the doctor said he found two fistulas and not just one. He almost put in the cutting seton for the deeper one but decided not to. I'm glad he didn't because of all the horror stories i heard about setons. There's pain the first couple days after surgery but not too bad. expect drainage for the first 30 days.Now, my surgery site has totally healed. My butt is back to normal.

I'm realy glad i went through with the surgery. The fistulas caused me a lot of anxiety and sleepless nights. When i was first diagnosed, i told the doctor there was no way in hell i will do the surgery. I saw and heard online how invasive and painfull it is and got scared.

#18 MissMel

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Posted 14 August 2012 - 11:52 PM

Hi Alex,
All healed in 6 months, that's great. So glad your Dr. found the 2nd fistula too, yikes. I know many ppl are having a hard time healing because of IBD/crohns, but I don't have that, thank goodness. And yea, no way in hell does anyone want to get surgery down there, but it's really good to hear that you are glad you chose it. It helps me to go ahead with surgery, I want to enjoy the upcoming holidays!
Mel

#19 alexphuongvu

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Posted 15 August 2012 - 03:24 PM

Hi Alex,
All healed in 6 months, that's great. So glad your Dr. found the 2nd fistula too, yikes. I know many ppl are having a hard time healing because of IBD/crohns, but I don't have that, thank goodness. And yea, no way in hell does anyone want to get surgery down there, but it's really good to hear that you are glad you chose it. It helps me to go ahead with surgery, I want to enjoy the upcoming holidays!
Mel

go to this link http://analfissure.e...-already-had-it . there's a lot of people in this forum who just had their surgery and they have regular updates obout post-op.

#20 MissMel

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Posted 21 August 2012 - 12:26 AM

Thanks Alex,
That forum was really helpful too, but i had to stop reading so much, i was freaking myself out.
I'd like to add my 2cents to the other helpful stories here...
My surgery for a low fistula went well, so far. I am 6 days post op. i peeked at myself and didnt see the "gaping wound" that everyone was talking about. My CRS stitched up my fistulotomy by what he called marsupialization, which I believe is why it's tidy back there. My wound is also right in the crack at 6 o clock, posterior, so its hard to see anyway and I haven't the stomache to get a flashlight at it.
Also, the surgery wasn't bad, in that I was given a sedative before the general anesthesia. I was expected to roll onto the operating table myself, which is why they didn't just knock me out in the waiting room like I asked. I just kept my eyes low when i entered the OR, rolled over, made some ridiculous drug-induced chit chat, and passed out in a few seconds.
I hope this will calm the nerves of anyone who is having surgery and/or fistulotomy for the first time.
Go see a specialist, ask about marsupialization (for fistulotomy, at least) and weigh your pros and cons. I wasn't sure what I was going to get (most likely fistulotomy or seton) but my CRS went over every option with me.
Mel





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