Hello,

Its been a long time since i was on the forum, and something happened re not being able to access the site. I managed to create another email address and reregister, but for future reference how do i contact a board administrator i couldn't work this out?

Good news - had botox for fissure last May, and all is well and fissure gone!!!! Hoorah!!!!! Healing was fine, used bathing and raw coconut oil. I had a bit of difficulty containing wind for awhile, but that's settled down now, and worth it for the fissure to be gone.

Dilemma - Ive had a anal fistula for about 10 yrs, and had surgery in the past which hasnt worked. I lived with it for many years and it even closed over superficially for awhile, but since the Botox it opened up the fistula again....it has settled a bit and I wonder whether to just manage this condition rather than have more surgery. Ive already had a few surgery including a lateral sphinterotomy 15 yrs ago for fissure, so i am worried about loosing my continence given that ive had a few surgeries already. Are the benefits worth the risks or not ? And is a seton more uncomfortable than just living with the fistula? Pease help.........

I think your CRS is the best to determine the integrity of the sphincter muscle, they afterall know that business the best. I had a general doctor do my follow up because I was far away from my CRS and in the middle of moving. His wife had a fistulotomy in the 80's, and while the procedure is mostly the same the surgical tools, techniques and skills are 100000x improved. He was living in the 80's mentally speaking, when checking me out and telling me horror stories of how I'd have flatulence for life no matter what and more. This was all based off his personal experience with his wife, who just happened to be a fistulotomy patient in his proctology (CRS) rotation just out of med school.

My CRS had NONE of these concerns for me. I have had no problems in regards to the worries the doctor who checked my incision out had. This is because the ability to do these surgeries guided well in the hands of good CRS doctors comes with much, much lower risks than they used to... Due to ultrasounds and so on that they can perform when under general anesthesia. It makes determining how much muscle to cut much easier... Good doctors will stage the surgery with those setons to carefully manage any risks to the best of their abilities. I think we have come a long way, thankfully!
Regarding the seton, I did not have one but only hear they can can be uncomfortable. It depends on the person, just like recovery even from a simple fistulotomy can be. I could have waited 6 months for surgery until after I moved and completed the clinic rotations of my masters degree. But I risked the small chance of it becoming more complex. People told me based on my personality that living with it would weigh heavy on me.
If you feel you can manage it and live life happily. I don't see any reason to feel pushed into the surgery. But if you decide to get the procedure done know you have the support of everyone here. Wishing you the best.

Hello I have had a seton and now have just a drain and the seton is a lot more comfortable than the drain. As far as not having surgery and just trying to manage it hopefully you can I tried just managing mine for 6 years then Aug 2013 it go really abcessed and have been dealing with surgeries and drains since and nothing has worked. My doctor said i have a huge cavity and i believe its from me letting it go so long. So in the last 11 months I have had 2 fistulotomies, a seton , s different mushroom drain catheters, the LIFT procedure and advance flap procedure which all have failed. So when I go back and see my Dr. on the 8th I am going to talk to him about getting a temporary colostomy bag because if it wasn't for having to have bowel movements I believe this would have healed by now thats when the pain really starts is after bowel movements because mine comes out of places its not suppose to because of the fistula. I have the best colo rectal Dr in the St Louis region and I have no crohns or anything just the fistula so I would have it looked at because I would hate for anyone else to go through the pain that I have in the last 11 months and not to mention missing a total of 12 weeks of work so far. Take care and hope all works out for you.

Hello both of you. Many thanks for your helpful replies.

Manitourose - Im glad things have worked out for you. Tll it sounds like things have been extremely difficult for you in terms of trying to find a way to heal. I hope something starts to work for you soon.