Do I have a fistula? How is surgery going to be like?

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Re: Do I have a fistula? How is surgery going to be like?

Postby owieher » 21 Jul 2012, 00:01

^^ I don't know much either, but what symptoms could you describe?
I've only read about actual surgery should take care of it?
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Re: Do I have a fistula? How is surgery going to be like?

Postby Ever the Optimist » 21 Jul 2012, 11:44

Hi Owie,
I am 4 weeks post-fistulomy and honestly, it's not been that bad!...As Afalumni says it's a 15-20 minute procedure and I'm so glad I had it...no more cycle of inflamed fistula, soreness, itchiness, pain, pus and then calm for a few days leading to then another pus-filling lump!.....It was all bearable but glad it's gone!
My symptoms were as described and the thing looked like a small fleshy lump with a hole right under it (about 1cm long) I had an abcess (to date MORE painful than the fistula or post-op surgery period) that burst at home in March and the fistula followed a week or so later.
Fistulas RARELY heal themselves as the other posters have advised and you will need straight-forward surgery to get rid of the irritating thing. It is also quite possible that the fistula has derived from the original incision site.
Good luck with your appointment in August...not too far off now and even if they confirm it as a fistula, from what I've read, it's easier to deal with than a fissure and less painful...Actual surgery is 95% successful if the fistula is a superficial and simple case, so be reassured!
Zowie, it sounds like your CRS just suspects a fistula at this stage and is doing exactly the same as my CRS did - Providing you with all the alternative options for treatment DEPENDING on the state of the fistula. They will only be able to confirm exactly how superficial or deep it is under the EUA and then fix it accordingly so I wouldn't start getting too anxious at the mo with all the options....I was told all about the setons etc too...(which is a simple piece of thread/ stitch they put through the fistula tract to allow it to drain completely)...
It turned out mine was very superficial (through the skin only) and nowhere near the sphincter, so in my case, they simply "deroofed" the tunnel so it can heal from the inside out. I had a couple of stitches, which is supposed to assist the healing, which have now gone.
Mine never bothered me to a great extent either so hoping yours is also superficial and you won't even need any of the treatments you've been advised.
Like I said these all have to be discussed with you because they will only be able to tell for certain once they investigate it under EUA and you have to consent prior to that in case they do need to put it a seton or flap.....
Good luck to you all. Keep this updated!
I'm still a bit sore even now post BM's for a while.....but week by week, it does seem to be getting better. I was also advised 6-8 weeks for full recovery, so fingers crossed for all of us :)
Chronic Fissure diagnosed December 2011
Healed by Diltiazem around Feb 2013
Anal Fistula followed burst abscess in June 2012
2 internal troublesome piles remain & suspected, but undiagnosed, ongoing Levator Ani type symptoms & flare-ups
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Re: Do I have a fistula? How is surgery going to be like?

Postby zowie » 21 Jul 2012, 11:56

It's SO good to hear from someone whose been there! I'm curious what your before symptoms were. Did you have to do the seton? Is that done surgically? I'm kind of afraid to go ahead with the EUA and have something done that's irreversible in case I want a second opinion, you know? I like my doctor but just met him and have no idea how good he is... I was so freaked out and scared when I saw him it was hard to take anything in. Not easy for a girl with a male doctor with the sort of thing. : /
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Re: Do I have a fistula? How is surgery going to be like?

Postby Ever the Optimist » 21 Jul 2012, 13:36

Hi Zowie,
It is great when someone knows exactly what you're going through isn't it? Reassuring....
My sympons before was a small hardish lump with like a fleshy raised bit underneath the lump with a hole in it about 1 cm in width. The lump would get inflamed and painful and then pus would expel from the hole underneath it. It was inflamed, sore, itchy and painful at this point and I'd keep gently pushing on it with baby wipes to expel the pus and put a hot showerhead on it a few times to keep it clean, get some pain relief as I think the pus made the area itchy. It would go down after a couple of days and then the cycle would build up again ( actually probably over 3 weeks)....It was uncomfortable and a bit painful when inflamed but I could live with it.
I didn't need a seton because the fistula (luckily) was small, superficial and easy just to deroof (the first preferred of the healing treatments)...If it's "deeper" and cuts through the sphincter, they put in a seton because there's a greater risk of incontinence if they have to cut into the muscle. It's all done surgically and under anaesthetic. From what I've researched, some setons are like silk threads and some like rubber bands. Most people notice them initially and then just get used to them. This lets all the pus drain out and then the seton either falls out or is removed if the CRS is convinced it's drained and healing OK. ..
You need to go ahead with the EUA. If there is no fistula, they won't do anything necessarily anyway. If it needs treating (and the sooner you get it done, the better) they will treat it.
If in any doubt always get a second opinion, but I'm sure as a CRS has recommended this course of action, he will have a pretty good suspicion of what's going on.
IMO, I'd just go with the EUA and prepare yourself for treatment if they think you need it.
Honestly, a simple fistula is really easy to treat and if you leave it, fistulas can form several tracts and become more complicated. Treatment then can take months, in some cases, years, as they will need to deal with it "bit by bit"....
My CRS was male and I'm female too and he was good and don't forget they deal with lots of people (and girls) with these issues!! ...
I know it's all horrible and scarey but honestly, just get it sorted, post op it's really not that bad...just a few weeks of some soreness and popping the Ibruprofen, but at least, you're fixing the problem and moving on to being better again.
Feel free to contact me with any worries....
I've been in your position and know how stressful it all is and happy to share my experience with you anytime :)
Chronic Fissure diagnosed December 2011
Healed by Diltiazem around Feb 2013
Anal Fistula followed burst abscess in June 2012
2 internal troublesome piles remain & suspected, but undiagnosed, ongoing Levator Ani type symptoms & flare-ups
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Re: Do I have a fistula? How is surgery going to be like?

Postby owieher » 22 Jul 2012, 00:24

Thanks for the post. I was curious what type of testing they do for fistulas? Do they x-ray? CT scan?
I'm afraid my wound might close by then, so I wanted to know what tests are possible in detecting it, as well as how big / small it might be.
Thanks. These posts by you folks mean a lot.
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Re: Do I have a fistula? How is surgery going to be like?

Postby Ever the Optimist » 22 Jul 2012, 03:25

Hi Owie,
TBH, I'm not 100% sure on alternative methods for testing the state of the fistula. I think sometimes some CRS' use an MRI scan for diagnosis but I was advised that the best and most accurate way of knowing is for them to perform an examination under anaesthetic, which means they knock you out and then have a good look whilst you are asleep!....Even if the wound were to close by then ( and assuming) it is a fistula, they would be able to determine the appropriate course of action anyway. If it is a fistula, I'm not sure the hole would close completely anyway...It might be at this stage, they would prescribe you anti-biotics to see if they can clear any infection and let it heal up by itself but this is rare for a fistula to completely heal this way - it generally needs surgical intervention. They tried this approach with me initially and although the anti-biotics stopped the pussing and calmed down the inflammation for a bit, the lump bit never went away and it went back to it's old cycle again. Surgery had to be done to get rid of it all...
Whatever..., just persist that you want it checked out properly and treated accordingly!
Good luck with it all :)
Chronic Fissure diagnosed December 2011
Healed by Diltiazem around Feb 2013
Anal Fistula followed burst abscess in June 2012
2 internal troublesome piles remain & suspected, but undiagnosed, ongoing Levator Ani type symptoms & flare-ups
Ever the Optimist
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Re: Do I have a fistula? How is surgery going to be like?

Postby owieher » 24 Jul 2012, 21:59

It is my understanding that this is a general anesthesia (sleep) procedure? I've never had general anesthesia, nor any surgery of this stature.
As my appointment day comes closer, I can't help but to worry about how they are going to find this tunnel/ hole, or what the diagnose will be.
I can go about my daily activity.
Would someone go in detail in terms of what are some possible methods, especially if my hole is rather small from a visual stand point? I dunno how to explain this anxiety, it's as if I know I have to do this operation, but just living out this nightmare.
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Re: Do I have a fistula? How is surgery going to be like?

Postby Ever the Optimist » 26 Jul 2012, 01:08

Owie,
Yes a EUA is simply an investigation of your bottom under anaesthetic. It's very quick, painless and all done whilst you are asleep. NOTHING to worry about. I've now had 3 in my lifetime and they are a breeze.... The anaesthetic might make you feel a bit tired and not with it for 24 hours after, in which they recommend no driving or anything requiring full concentration. Normally they give you a local anaesthetic with it, which acts as a pain relief to that area for a good few hours too. It's really nothing to worry about.
It's so natural to get worried and stressed and anxious about it all but it's all done very quickly and you are taking action to get it all healed once and for all. That in itself, I found incredibly reasssuring!
An experienced CRS will know exactly what they are looking for, how to deal with it and will act accordingly, so don't worry about that hole. To me, it sounds like a simple fistula and they are so treatable. Read Thisfissurecankissmybutt's account or Sue UK for further reassurance as they've just had the same ops recently.
My fistula never stopped me in going about my daily activities as normal either and I had a few days off work post recovery but getting back to normal.
Please trust in your CRS, go with the EUA and try to stop stressing yourself out about it. They will sort that hole out for you!! It feels like a nightmare but it's all straightforward, lots of people have fistulas and a simple op will help you get rid of it all and mean you no longer have to worry about it.
Good luck :)
Chronic Fissure diagnosed December 2011
Healed by Diltiazem around Feb 2013
Anal Fistula followed burst abscess in June 2012
2 internal troublesome piles remain & suspected, but undiagnosed, ongoing Levator Ani type symptoms & flare-ups
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Re: Do I have a fistula? How is surgery going to be like?

Postby thisfissurecankissmybutt » 26 Jul 2012, 05:58

Owie:
EVO is absolutely correct - an EUA is really not a big deal at all.
I had an EUA in June and that is when my CRS confirmed my superficial fistula. Once you are under anesthesia, your CRS can have a good look around without worrying about you being uncomfortable. An experienced CRS will immediately be able to tell what is going on down there. If the fistula is superficial (which it sounds like yours may be), it is an easy diagnosis and an easy surgical fix. If the fistula is not superficial, your CRS may order a CT scan or MRI to see exactly where the fistula tracts are before surgery.
I would also strongly recommend you read EVO's posts:
http://anal-fissure.org/t5024-3rd-day-post-fistulotomy
Her posts REALY helped me in the days leading up to my recent surgery for fistula repair and LIS.
Good luck!
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Re: Do I have a fistula? How is surgery going to be like?

Postby owieher » 02 Aug 2012, 19:30

So I dreaded this day, for about 2-3 weeks. I finally saw the CRS, and got the examination. Being probed that way was pretty painful, odd, and scary. I feel stretched.
I told him about my abscess a few months ago, and the wound re-opening. He said he did not find evidence of any fistula, but saw that I had hemorrhoids. He told me, he'll do the rubber band technique. I freaked out and started to panic.
He told me, he didn't want to just cut around for the fistula.
So, now I had the band on the roids, and my butt hole feels weird. My legs are weak and it feels like I have to go to the bathroom.
Would someone chime in.
Thanks.
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