Dear all,

I thought I'd register and write a post to say thank you for sharing what you've been through with fissures / fistulas -- it's been really reassuring to read people's success stories, and to hear that other people have been going through similar things to me, and to see how generous and supportive all the other members of this forum are. In case it helps to reassure or inform anyone else, I'll describe what happened to me too. I'd imagine that a lot of it will be familiar to pretty much everyone here!

In 2009 I started to have pain around my back passage -- I think it followed on from a serious bout of diarrhoea, though I can't quite remember -- pain which was particularly bad when I laughed, or coughed, or walked downstairs -- anything that involved tensing the area even a little. It got more and more severe until it was almost unbearable. Sometimes, for no reason, the whole area would seize up and clench uncontrollably -- it was excruciating. Once when I was lying in bed in the middle of the night it happened unexpectedly and I was so shocked, and in so much pain, that I screamed; a couple of minutes later I heard a knock on the front door -- my neighbours had heard -- but I was in too much pain to go answer them.

I had initially thought that it was a haemorrhoid and would go away on its own. When it started to bleed (a lot) I went to the doctor, who told me that it was an anal fissure, 'very acute' -- i.e. new, temporary, and likely to go away soon -- and prescribed me some kind of pain relief cream and suppositories. She also suggested that it looked infected, although she didn't seem too worried about it, and other doctors I've spoken to have suggested that it's very unlikely that it was.

The cream helped a little; the suppositories were impossible to get in! I gave up on them almost immediately. The bleeding got worse for a little while, then much worse -- at one point, after a bowel movement, the blood was just pouring freely into the toilet -- but over the next few days the pain started to go away. When I went back for a checkup the doctor said that it was healing, but noted some 'granular tissue' around the wound -- I think an early sign that it was not healing properly, but rather becoming chronic.

Over the next few years I had occasional discomfort there, occasional bleeding, and noticed a sort of bump had formed by the exit -- after some searching online I assumed that this was the 'skin tag' that accompanies a chronic fissure. Sometimes this felt slightly swollen and painful; sometimes it was very itchy. Although I worried about it a bit sometimes, it never made a huge difference to my day-to-day life. I just tried never to strain when using the toilet. Sometimes that's unavoidable, though, I guess, and whenever I did, or whenever my diet suddenly changed for whatever reason -- if I was travelling, say -- there would be blood on the toilet paper the next day.

Earlier this year the area became more painful again. It was never as bad as it was in 2009, which I assumed was down to the fact that chronic fissures are generally meant to be less painful than acute ones, but it didn't stop bleeding. On the contrary: the bump felt painful and swollen, more painful and swollen each day until, every three or four days, there would be a large amount of blood and other fluid on the paper after a bowel movement. The bump would seem smaller and less painful after that. The area was also quite itchy and damp feeling, and I began (upsettingly!) to notice some damp stains in my underwear. All this, combined with the constant low-level discomfort served to put me in a pretty terrible mood, pretty much all the time. Because it would bleed, feel a little better, then bleed again, I thought that it was a fissure that was healing a little, then tearing again, then healing a little -- every time I saw blood again I felt wretched, like no matter how careful I was it would never heal.

I went to my doctor, who suggested that it was the fissure opening again. First we treated it with a simple pain relief cream, then with a more powerful nitroglycerin ointment that I had to, er, 'insert' with my finger, and which gave me migraines. It's supposed to relax the muscles and increase blood flow there to promote healing. Things seemed to improve a little; but I was worried that the blood and seepage seemed to be coming from the painful bump, rather than any recognisable fissure, and, after some searching around on the internet, I came to think that it must be a fistula -- the increasing pain sporadically relieved by release of blood and pus seemed in particular to be a really clear sign.

I was crushed! I was reading surgical manuals and the websites of colorectal surgeons pretty much all day every day -- I'd never had surgery before and I was really worried about it. But I was equally stressed out by the prospect of continuing to have the pain and blood and discharge indefinitely. And I was incredibly worried that it would turn out to be the complex kind of fistula that necessitates a lot of different treatments over a long time. My heart goes out to the people on this board who have had that experience -- I really hope that you're doing well, and admire your toughness and bravery. I've read so many stories online now of people who finally get the treatment that works, even for very difficult cases -- I'm sure that a good result is around the corner for you too.

I went back to the doctor to ask if, after all, it might not be a fissure but rather a fistula. He referred me to a colorectal surgeon who quickly identified it as a fistula (although he could not find the inner entrance of the tract) after a very short and painless examination. We scheduled an examination under anaesthetic for three weeks later: the plan was to find the inner entrance, lay it open if it was subcutaneous or passed through just a very little part of the sphincter muscle; or, if the entrance was high or the tract was too complex to lay open, to put in a seton and schedule another surgery several months down the road, when the tract had 'matured' (i.e. dried up and healed a little, with any blind tracts closing up). The surgeon suggested that the fistula had formed as the earlier fissure healed -- that rather than healing from the deepest part of the wound upwards, it had instead healed over at the top, leaving an open tract underneath that was prone to infection. This explained the discharge of blood and pus -- there was an open wound or irritated fistula tract under there, even after the fissure closed.

I was still very stressed out -- I spent the intervening weeks obsessively reading up on how the surgery works, surgical outcomes, the likelihood that it was one kind of fistula or another, etc. I found a lot of horror stories online. I was particularly worried about the prospect of incontinence. It's listed as a potential side-effect of any fistulotomy that cuts through the muscle fibres of the sphincter -- and the majority of fistulas pass through the sphincter to at least some extent. There's reassuring news there, though, for anyone who has to go through that. In the course of reading various surgical papers I saw that a huge majority of people who have fistuolotomies report back that they're very glad they had the operation -- far and away the most common response to post-operative surveys is that their quality of life has improved. And one of the surgical manuals that I read suggested that 'incontinence' nearly always means the occasional bit of gas, and very rare minor skid mark in underwear -- probably a tradeoff that most people would be willing to make for relief from their other symptoms. And, by the sound of things, quite a rare tradeoff anyway. Other treatments -- e.g. the fibrin plug, LIFT, etc. -- seem to have slightly lower success rates, but when I asked my surgeon about this he said the variety of options meant that, over time, you'd pretty much always be able to find something that helped.

For the weeks up to the examination / surgery I drank as much water and ate as much fibre as I could -- didn't seem to make much difference to my bowel movements, I guess because I've always tried to have a pretty good diet. On the last day before going to hospital I had to stop eating six hours before the procedure, and stop drinking two hours before. The hospital portion itself was a breeze -- meetings with the nurse, anaesthetist, and surgeon; cannula in, then general anaesthetic and I was out like a light.

When I woke up I couldn't believe that it was all over -- it seemed so quick. A nurse told me that it had, after all, been a low and simple fistula, about a centimeter long, and that they had been able to lay open surgically. At this point there was no pain at all. I was rolled back to the ward, where they made sure that I could eat, drink, and urinate, then took the cannula out and said I was free to go. There was a bit of worry about the fact that I was still bleeding from my backside -- a medium sized bloodstain on the bed when I got up -- but they said that it was perfectly normal, that I could keep a piece of sterile gauze between my ass cheeks to stanch any bleeding, and that it would probably stop within 48 hours. No weightlifting or riding bikes until after my followup consultation -- a month from now! -- and 'make sure not to get constipated' -- and that was it.

The car ride home was uncomfortable -- the local anaesthetic was beginning to wear off. They'd given me three kinds of painkillers to take, including a rather serious one called Meptid, in case it got worse. I was worried it would get really painful during the night, but it didn't -- uncomfortable rolling over, and in the morning there was a tiny bit of blood in the sheets, and of course I slept pretty badly, but overall it wasn't too difficult.



That was yesterday -- this brings me up to the present, apart from two last things. One is bowel movements. I was told I'd 'open my bowels' some time 1-3 days after the operation. It's the following day now, and I'm in no pain at all, but sitting down on the toilet is a little uncomfortable, and the thought of actually having a BM while there's a large open wound in my sphincter is stressing me out. So every half hour or so I go and sit down briefly on the toilet in case I could just effortlessly 'go', but nothing's coming out so far … Other people have suggested that this won't be as painful as I think. I'm loading up on prunes just to speed things along. But I'm still worried.


The other thing is to wish you all good luck! My fissure was incredibly painful, and even after it healed it continued to cause me a lot of worry. I was very stressed about the fistula, worried that it would just become a part of my life indefinitely, and then, after that, worried about the surgery -- that it would be painful, or leave me with reduced continence. While I'm tired today, I also feel huge relief that the problem has been taken care of. I'm looking forward to being free of discomfort and worry -- there's just a few weeks of rest and healing now while the wound closes. Thank you again to everyone here who helped set my mind at ease by telling their stories, and good luck!!!

What a fabulous story - thank you so much for sharing it. I'm sure that it will be very helpful to those who come later and are as worried (naturally!) as you were.

I hope that your first BM comes soon, and proves to be as easy as we all hope.

Thank you very much! I just read your story -- good grief, what a lot of trouble you went through -- how wonderful that you've found such a happy ending!