Good Luck! When is your surgery?

Hi All,
I had the fistulotomy on Nov 15th (slightly less than 48 hrs ago). I did not talk to the surgeon but she told my wife that it was "slightly more than a superficial" fistula but no muscle was involved. She also removed the skin tag that had developed due to the AF. I had the first BM yesterday morning. I guess I was scared of the BM and maybe overdid the laxative thing (had milk of magnesia, stool softener, prune juice, prunes and mostly high figer diet) -- the result was 3-4 loose BMs yesterday. But none were very painful. Today I am puling back on laxative and also have a better idea of how much to take if I need to in coming days.
I have been alternating the hydrocodon and regular tylenol (500mg) for pain at approximately 6 hrs each. Mainly want to avoid the hyrdocodon for fear of constipating.
There is still bloody discharge - more of it from the site of the excised skin tag (which was probably 1cm). Still quite a bit of pain and while can walk around the house, not able to sit for more than few minutes. Not all positions of lying down are also comfortable.
I am assuming this is all normal given it is less than 48hrs after the surgery still.
How long do you think the pain medicines might be needed? It is clear that right now I cannot go alone on tylenol itself. The hydrocodon is needed as well.
Had 3-4 sitz baths yesterday just in warm water since the surgeon said that should be sufficient and those are very relaxing.
do you guys think adding epsom salt to sitz bath will help with healing? Also will it help to put an antibiotic ointment (like Neosporin) to the site where they removed the skin tag or even other incision sites.
I will keep you guys posted.

Do you have any packing? I would personally refrain from applying any ointment to the incision sites unless the doctor said it's okay. I use epsom salts in my sitz baths, although some nurses have said not to (not sure why?). One nurse recommended using regular sea salt. I find the epsom salts soothing.
I took the pain killers for 3 days but then got constipated. After that horrible 3rd day, I started only taking the pain killers prior to my packing changes as it really was too painful without. I was prescribed percocet (sometimes I miss that "la la land feeling" :)). Regular tylenol didn't really do anything for me, so I just didn't bother taking it at all. I was probably off pain meds fully 2 weeks post-surgery. While taking them, I drank 10+ glasses of water and ate lots of fibre-rich food. I also took a senokot laxative pills and stool softeners daily even when I thought I probably didn't need them. I wasn't taking them earlier - which resulted in the constipation. When constipated, I actually ended up taking the milk of magnesia, prune juice, softeners just like you and it eventually worked :)

Hi Diamond,
thanks for your quick reply. Sorry for my naive question: what is packing? where do you get it (walgreen, cvs?) and what is it used for?
I will try epsom salt as I have read that many people on this forum have tried it post surgery.
Yeah...water is my good friend these days...I am drinking so much these days....have never drank that much before. Maybe not drinking enough water in the past caused the AF and all the follow up issues.
Thank you all for your advice and supportive words.

Hi LT,
Great to hear you got the Fistulomy over and done with.....that seemed so quick!...Yes, you're on your way to recovery!
What you are going through right now seems totally normal. Don't forget it wasn't just the Fistula they dealt with but a skin tag too, so you're inevitably going to be in a bit more pain and recovery a little more uncomfortable for a while. ...you're dealing with two issues rather than just one.
I think skin tag removal is a little more painful than a fistulomy so you may need to keep on top of the painkillers for 2 -3 weeks but you'll know when you start feeling better. Just keep on top of the painkillers that are currently working for you, not the codeine based ones - which constipate!
The blood is totally normal still at that stage. Obviously, if it worsens or intensifies, you need to get back to a GP. Like you say, it'll probably be coming from the external site...That's what I had too.....
Honestly, as for the pain and your inability to get comfortable, that's sounding pretty normal too! Just get as comfy as you can and keep the pressure off the bottom for a few days. It will get better!
As for the packing, it might be that your CRS decided not to pack it at all, so perhaps just get that confirmed...I had an initial gauze placed in the wound but was told it didn't need changing and it fell out the evening after anyway! There's a few of us that didn't actually get the wound "packed" on this site, so I'd say possibly just check. Did you get any after-care information?....
KEEP up with the baths - really soothing and help the healing. I too experimented with Epson Salts/ Dead Sea Minerals. I'm not sure if they really helped or not! Hard to say, but the Dead Sea salts are extremely relaxing!....
Diamond is spot on when she says don't apply any external ointments. The wound is still open and particularly susceptible to infection at this stage. Don't apply anything to the open wound that might risk any chance of infection. It needs to dry up first. I was strongly advised not to apply anything external to the area for the first few weeks.
As far as your stools go, do what works for you at this stage. Soft soft soft is what you want but try to get the balance between too much and too little. You don't want to encourage runny stools either. I found lots of soft tinned fruits/ baked beans/ soft fruits/ soups/ soft veggies/ brown rice particularly helpful and tons of water.
I continued to take 2 doses of Lactulose every day and a large tablespoon of Extra Virgin Olive Oil every night to keep things soft my end!
Here's to your continuing recovery ! Keep us posted.

HI ETO,
nice to hear from you....having discovered this forum recently, I am now checking up on the postings very regularly. It is really great and I hope I can help others similar to how I am getting advice from you all.
Yeah...it seems they did not pack in my case also. I had a pretty thick dressing after the surgery which they said can be removed next morning before shower and that is what I did. After that they had adviced just to use feminine liner to capture the bloody discharge and that is what I am doing.
I will heed your and diamond's advice and not apply anything external.
The surgeon had said to avoid prolonged sitting initially and I agree since it is uncomfortable. But what about standing? I am finding that standing is not uncomfortable (in fact I am typing this while standing ...for the last few months, I have placed my computer on the kitchen counter and have gotten adjusted to working that way...with all the discomfort of fistula, standing was lot better than sitting). Did they ever tell you on any restrictions on standing? Are long periods of standing bad in any way during the healing process?

Packing would be gauze that's placed inside the wound. I had a very deep incision so I have a nurse who comes by and cleans the wound and changes the packing (gauze strip) inside it on a daily basis. I believe the purpose of it is to ensure that the wound heals from the inside out. If your wound isn't too deep you may not have any - if you have packing inside, you would probably know by now. It eventually falls out (especially after a bm).
Rest, rest, rest as much as possible! I really do think it helps with healing. I'm also taking vitamin C and zinc supplements.
Hope you'll continue to heal well!

Thanks Diamond.
Yes...my plan is to rest a lot. Have taken this and next week off and will try to take easy as much as possible.
It is 4th day post-op now ...the pain has become better but still there. There is also bleeding as getting captured on the liner and since this morning a little bit of itching. I am hoping this is all still normal part of wound healing.

lordtrinity,
Just wanted to pop in and wish you all the best in your recovery. I just wanted to support what Diamond said above about nutrients while healing. Vitamin C, zinc, and either a mixed carotene supplement or lots of colorful foods like yams, bell peppers, carrots that give good sources of carotenoids will really help promote healing. Also, making sure you have a good source of protein like fish in your diet. These are things you can do with your diet to not only speed healing, but also support yourbody in the various stages it goes through in healing.
As far as standing for too long, it's probably a balance between doing what feels most comfortable for you, and making sure you aren't in any one position for too long. Too much standing for too long a period also puts stress on the anal area.
Congratulations on making the difficult decision to have surgery, and for being on the road now to recovery. once these initial days are over, and the healing stages are progressing out of the inflammatory phase, it's going to be smooth sailing really quickly from there with very steady and noticeable improvement.
And you're in great hands here with ETO and Diamond for support and info.
Again, Wishing you all the best in your recovery!

The bleeding and itching is typically normal. I'm almost 5 weeks post surgery and I still have some blood. Within that first week, I actually had a few scares with gushing blood - my nurse said that it's normal. Just keep an eye for anything that looks like pus - or smell funny. I think smelly stuff is what you should be most concerned with.
Itching is normal too - I have lots of itching and tingling as the wounds are healing.