Hi everyone,

1st - awesome that this forum exists and it has been so helpful in my research. I think I have literally read everything related to my problem and I'm partially relieved to know what to expect and partially terrified!!

Anyway, I have had what I THINK is a Chronic Fissure for probably 10 years. In fact, I think I have had several over many years. Terrible diet, not enough water intake... I'm 28 years old now, but problems with going the bathroom have been going on for 10 years or more. I never said anything, mostly out of initial embarassment, but then when I would have a fissure they would bleed, sting, and then heal. Months would go by without issue, I would pass a hard stool, and then it would flare up again. So, over the course of a year I would probably have 2-3 flare ups that would last a few days and then dissipate. So in summary, it became "normal" for me. I think the other fissured have healed, but I'm left with two large sentinel piles in this area and no pain. On the opposite side, I have a larger sentinel pile where the current fissure is. Not much pain, but that's because I think it is chronic.

Anyway, in early December I developed an abscess. Hurt like hell, but I thought it was a hemorrhoid (never had one before) and after 4-5 days it spontaneously ruptured and drained. Instant relief! Because I thought it was a hemorrhoid, I let it go. But after another week it was still draining... so I started putting toilet paper between my cheeks to catch any pus and lived my life. It's not been about 8 weeks since the abscess developed and I'm still draining. After a BM, it will swell a bit but since the external opening is still there, it drains and doesn't get too painful. After it stops swelling, I have absolutely 0 pain. The (what I think is a) fistula will still drain a light yellow/green non-smelly pus continuously. It is right at the 6 oclock position, but on the right posterior side and only 1cm or less away from my asshole (sorry for the crudeness).

I am making a CRS appointment today to be examined for the first time - so all of this thus far is self-diagnosed. I am expecting to need at minimum a Fistulotomy.

If I have the fistulotomy, do I HAVE to have the LIS as well to cure the chronic fissure? I assume having them both at the same time is probably the best idea overall since I'll need a Fistulotomy at minimum anyway. The fissure is just to the left of the abscess/fistula at the posterior side, so I'm concerned having them both operated on will lead to complications during healing.

Anyone else have both at the same time? I've seen horror stories of recovery and also stories where people said it wasn't nearly as bad in recovery as they had thought it would be. I have a very high pain tolerance - love long tattoo sessions, the abscess was definitely painful but not unbearably painful until the night it ruptured. During a BM if I have an active Fissure, it's definitely painful but at this point I'm used to the pain.

I know there are hundreds of recovery stories here, but I just wanted to post my pre-exam experience and get anyone's thoughts that they may have now that I've learned so much and think I have a solid understanding of what is going on in my body.

I'm so scared of 4-6 weeks of recovery I'm OK with taking a week off of work, but I can't take more than that. How long were you all unable to drive for? I sit on a medicine ball at work all the time just because I like it better than a chair. I wonder if that would be easier on my bottom after surgery? I know 4-6 (or even weeks of recovery doesn't mean it will be painful and I'll be unable to function that entire time - I guess I'm also wondering how long you were all really out for the count for and couldn't live your life normally.

Thanks everyone

Hi everyone,

Little disappointed I never saw any replies. I had the fistulotomy surgery on Wednesday afternoon and it's now Saturday morning. In a lot of pain to be sure. Haven't had a BM yet and that's currently my biggest concern. I've taken miralax daily, eating high fiber and staying away from constipating foods. Drinking 5-6 32oz bottles of water a day. I can feel that I have to go, though it's not painful yet (at least pain from having to go to the bathroom.. the wound itself is still painful) but I'm afraid to push too much to go because of the pain. It honestly feels like my
anus is in more pain than the fistula site. My fistula was just to the right of the 6 o'clock position, only about a cm from the verge. The CRS used dissaolvable sutures after laying it open. I'm wondering if that's why I'm in more pain than some other people here.

Im really hoping for a positive turn soon. Right now I'm getting anxious that I can't seem to have a BM or even imagine how that could even be possible.

Post Op Day 3:

No sooner did I make that last post did I have a bowel movement!

I had to induce it. I knew I needed to go, so I mixed up a blender bottle of preworkout supplement. I normally drink this daily before workouts anyway for the last 2 years and it has the effect of making me need to go #2. If I drink it slowly, it's sort of like coffee in that about an hour into sipping it I could just barely push and then relax and it will just come out. This time was still a struggle due to the anal area swelling and being post op, but it worked. I pushed out a healthy amount of stool though it was more formed than I was trying for given the miralax I had taken daily up until that point. Stool was soft but they were well formed logs. I hoped I didn't do any damage because I did need to push but tried to be careful not to continuously strain.

Afterwards I was in the worst pain post op yet. The actual BM wasn't that bad (worse psychologically) but the burning and stinging afterward for hours was rough. I showered immediately, but it didn't help the burning/itching. I changed the gauze pad I have between my buttocks twice that evening and finally when I came home, i decided to try a sitz bath in the tub. I had not done any sitz baths yet because my CRS used sutures and he specializes in fistula, and specifically told me I don't need to sitz just shower but could sitz if it helped my pain. I didn't want to bother with the tub they gave me at the hospital as my bathtub was just easier but until that point was just worried about any organisms in the bathtub getting into the wound area but I'm probably over-thinking it. Anyway - so much relief! I was in the tub thinking this is the first time I can't even feel it.

Afterwards, dry appropriately and apply lidocaine topical with a gauze between my butt and take some more Tylenol.

Post op Day 4:

Repeat the sitz bath in the morning along with lidocaine and Tylenol - It is still uncomfortable but not unbearable and slowly getting better with time. I've read Day 4-7 seems to be when others see a marked turn for the better so I'm hoping to wake up tomorrow morning Day 5 with more relief. I was going to go back to work tomorrow but my boss offered to let me work from home. I will do that for 2 more days, then return Wednesday (1 week post op) if I feel I can sit continuously

Hi I don't have much advice to give as I have fissures not a fistula.
Again I can't really help with the BMs as I struggle to keep mine anything other than liquid...but I did over do my IBS and crohns meds after my LIS and had 3 days of very firm almost constipated BMs and rang my surgeon in a panic and he told me not to worry too much.
I just wanted to let you know that your posts are being read its just there are way more people with fissures on here. Please keep posting as I know that often people cone on desperate for info about fistulas.
I'm sure that you will improve day by day, that area is super sensitive and some of us myself included take longer to recover but it does get better.
Sending positive thoughts

Thank you for the reply! I will continue to document here Day by day. I found the info I read here very helpful in self diagnoses and understanding what I was in for before seeing a CRS. I luckily do not have chrons or IBS and think my abscess started due to straining/constipation and then made worse the next day by the opposite, diarrhea. I have had fissures for some time on and off, but am confident it was due to diet and lifestyle not the disorder or disease. Since I have been paying attention, fissures have healed up on their own (even the one I thought was chronic). It is aggravated right now because it's right next to the fistula incision and since they have to spread and tape you during fistulotomy, I'm sure it probably re-tore a bit.

The funny thing is my pain seems to be coming from a combination of the sutures due to fistulotomy and the site of the old fissure, NOT the fistula tract itself. I've felt it with a gauze pad between while cleaning and it's really not painful. Hoping that the fissure heals back up (if that pain is coming from there like I seem to think) within a few days as they usually do and then I can return to normal life while the fistula heals.

I have no problem with the high maintenance of sitz baths, changing gauze, applying lidocaine, etc but the pain/itching/burning is driving me crazy. Luckily it seems to happen less frequently and I can now go a few hours with little to no pain.

I should also say, because I was afraid of getting constipated from pain medication, I never took the hydrocodone prescribed to me, only Tylenol and ointment. I have many tattoos though and a high pain tolerance, so it could just be me. My mother is a retired RN and my surgery was in her old hospital and recovery was her floor. I was given VIP treatment from her nurse friends, so that was at least a little nice

I don't think I documented here what happened after the surgery (same day). They told me I had to urinate before they would let me go home. I wish they just said we want you to urinate instead of HAVE to, because then I got inside my own head and no matter what I could not pee. My bladder was full from 2 bags of IV and 4 glasses of water/ice. It hurt so bad, but I couldn't relax my urinary muscle to empty my bladder. Finally I said - someone get me Mountain Dew! Halfway down a 20oz bottle and the caffeine helped. I peed just enough for them to let me leave and by the time I got home I went again. By that evening my bladder was empty and the pain was only post surgerical and not bladder pressure! That was honestly the scariest most frightening part of the whole ordeal.

Day 5 post op

Luckily my boss offered to let me work from home all week which is a huge relief. I can work, I just can't sit straight up and I still need to clean multiple times a day so this is for the best.

I didn't sleep well last night at all. Maybe 3 hours of sleep. The itching was insane alll night long. Througout the next day, it wasn't as itchy and started off fine. I drank miralax and had to go to the bathroom within 20 minutes - that was a surprise! It almost just ran out of me but that is a good thing that it was so soft. I find when I have a BM, I can't get it all out. I will pass a decent amount without straining but then I feel pressure on the area like there is more and it's RIGHT there, but I don't want to strain to get it out. So I would clean up and move on, but experience lots of pressure which felt like it was behind the wound (leftover stool I didn't pass). A couple hours later I planned to just to clean up and change gauze, but then surprise I had to go again! I passed another small amount and felt the pressure lessen up. Rest of the day felt a bit better albeit slightly itchy.

I'm still draining an awful lot and thought it would lessen by now. It easily fills a single guaze pad overnight (6-7 hours) with a fishy, pinkish color. I guess a mix of pus and some blood gives it that color. The center of the guaze which touches the wound is always darker and very "fishy" smelling.

More to come!

Day 6 post op

Today was THE best day so far. Almost no pain at all, if it did hit me it was a 1/10 and totally tolerable. Only took 2 sitz baths today and may do one more before bed, out of enjoyment more than necessity.

I didn't have a BM today, though I probably could have if I really wanted to. I generally only have a BM every other day, so this isn't too odd for me. I'll take miralax tonight and try to go in the morning. I just think taking a break from aggravating the area on a good day could only further promote healing, as long as I'm not forcibly retaining my stool.

Very light drainage today as well. Changed my guaze 3 times rather than the 6 or 7 in previous days.

Just to clarify, I'm a 28 y/o male in otherwise fine health. Active and exercise regularly up until now as well.

Another update tomorrow, when I will schedule the follow up with my CRS. He asked to see me 7-10 days after surgery, as opposed to 2-3 weeks that some people here have said. This might be because I'm on private health insurance as opposed to you lucky Brit's with national healthcare. :)

Day 7 post op

Forgot to call the doc today to setup my followup, but that's OK - all seems well and seems like most of the people on here waited a few weeks before follow up.

Took miralax last night and this morning woke up ready to go. I really don't like the feeling of miralax, but it does what it's supposed to do and makes going more regular and easy on the area. It just feels like the motions are turning and the stool is coming whether I want it to or not, and with a sore bum that needs time to prepare and relax that can be a little uncomfortable. The BM itself was only minorly discomforting, no sharp pain just a sore feeling.

It hurt for several hours later, until I finally took Tylenol and then it slowly dulled and went away completely. Not particularly itchy but again very sore. I notice after a BM I can't get every last bit out, given how soft it is. It's almost like a little bit remains at the end of the anus and since I just relaxed the muscles to go, they haven't fully constricted again yet or something, and a little bit slowly seeps out for a few hours making the area "annoying". I soaked twice and then it went away.

That's really the only event of the day, another update tomorrow.

Day 8 post op

Soaked last night before bed, it was really bothering me after being out for a few hours. I wouldn't call it a setback, because after a sitz bath I was fine. Woke up this morning and hanged gauze, surprised because now I'm seeing no more "pink" drainage (i.e. No more blood). Only brownish fluid which I've come to the conclusion now is wound exudate. It's funny because the last 2 days as my anal verge heals even more and becomes more comfortable and swelling keeps reducing, I can literally feel the exudate fluid draining from the fistula wound and my anus. It makes me think I'm leaking mass amounts of fluid, but it's really not. It was leaking in more volume the early days and I just couldn't feel it happening due to swelling and whatnot.

I haven't taken a sitz bath yet because I haven't been uncomfortable enough all day. The drainage is minimal and I've only dabbed with a wet wipe and changed gauze twice since waking up (it's 3pm) and I'm in virtually no pain unless I move quickly or something. Sitting in a chair straight up is still not comfortable and leads to aggravating the area, though.

This will probably be my last post for a while unless I experience a major setback. My followup with the CRS is on Tuesday (day 13 post op) and I'm not expecting anything other than "looks good to me", so pretty much uneventful.

If I don't come back after this, I will probably return in a few months once the area is 100% healed up just to give my feedback for any new sufferers. I don't think I would have psychologically gotten through this experience without this forum and I hope my post op diary helps out someone else going through this exhausting experience.

Until next time!

Hi. I'm 5 days post op and wondering how you are doing ?