Hello everyone,
Just like to share my experience all the way from Hong Kong.
I had an anal fissure after having BBQ and KFC. I remember having fresh blood after BM on the 16th of December. I didn't really pay attention to it and everything. It turns out to be so much pain on Christmas day and Boxing Day I had to return to HK from a Macau trip and rush to an A and E. I thought it would be an abscess as it was hard and palpable at the interior of the anal canal.
The physician attended me perform a protoscopy (painful) looking at it and said it was just a fissure. I asked him 3 times and he still said he was a fissure. He gave me all these KMNO4 sitz bath and these corticosteroid cream. This diagnosis totally delayed of me having an Incision and Drainage.
The next few days was really painful and I started having these shivers (probably sepsis). I didn't really wanted to go to the A and E again to be dismissed. Until I feel these throbbing pain and spasms that my wife dragged me to the A and E again. This time they are sure it's a full blown abscess and admit me for I and D.
I and D was performed on the New Year 2019. Pain was alleviated and for the next week or so I had wound packing from the community nurse. That was one painful procedure with questionable necessity. For the next 4 weeks, I have these healing process and wound pain that was really troublesome. On and off, pus just doesn't reside no matter how much I tried to wash the wound with alcohol, chlorhexidine. It just doesn't feel right. After a visit to the Out patient clinic for my perianal abscess, the phycisian said it's healing fine but you just never know it would turn in to a fistula.
I was happy about the progress and all and the next follow up is 8 weeks later. For the next few weeks, wound discharge just coming back and forth and won't stop until a hard swollen tissue was form under the wound. I thought it could just be a scar tissue but the pain just won't go away. After a few more visit to a normal clinical office and the A and E questioning about a fistula, I had enough and bought some Curam (1g Augmentin) for a week course. The pain did subside but it started to form a round tubular structure around the wound. It would discharge after a while and the pain will subside. If poop gets in it, it would started to get inflamed and my groin area (lymph nodes) would get swollen.
I finally had enough and search for answers online. From a well healing wound to the possibility of a fistula, it really devastating. I looked for a General Surgeon online who advertise for conducting anal fistula. A specialist is a specialist and with just one digital rectal examination, he said it's a low fistula on Mid Feb. He said you could do a fistulectomy or not, it's up to you.
The thing with a fistula is that it's not that painful and it seems to be healing on some day but inflamed on the next if some poop gets in it. I also know it's going to turn in to an abscess anytime soon if I would take care of it. So I called the surgeon and schedule a Fistulectomy on the 2nd of March, 2019. I had General Anesthesia and the surgery lasted for half an hour. It's really like a nap and the only pain I encountered was the needle injecting the Anesthetic. The surgeon reassured my fistula was low and he performed a simple fistulotomy so it shouldn't be a concern.
The next day I unpacked the dressing and there was no external wound. Probably cuz my external opening is near to the anal verge. There was some blood and all but it was a concern. The only concern was I still felt a hard palpable tissue underneath the fistula opening. Does it meant it's not cleared or potential missed secondary tract of the fistula? I immediately called my surgeon and he said it's just scar tissue. Of course, all of us with these procedures has lost faith in any doctors and still questioned whether what he said was true.
So here is my diary for post-op till today.
Post op day 1. Sunday. Pus and blood was observed with feeling of something leaking out the whole night. The scar tissue is still inflamed with pus coming out.
Post op day 2. After walking at a partk for the whole morning, heavy blood stain was observed. Pus was not observed afterward. But whenever there was BM, the scar seems to be more swollen. Sitz bath was performed. There is no more feeling of pushing of pus from the wound the night of Post op day 2.
Post op day 3. The feeling was better today. Some serum or little pus was still observed in the wound. Blood was not appeared. The wound from the scar tissue is still hard but it may want to close with the internal anal verge. Sitz bath was continued to prevent premature closure of the wound.
Post op day 4. Wound pus yellowish is seeping throughout the day. The wound is still open. Underneath is a swollen area that seems like a scar tissue. The wound would increase in sepage if some poop sticks onto the opening. Let's hope the wound would not close prematurly and the scar tissue subside in swollen as the wound closes.
Post op day 5. Discharge seems to go down at night. The wound is starting to close and merge. Pain and stinging feeling after BM. The scar tissue underneath is softer and seems to be less inflamed as the wound closes. Yellowish brownish discharge was still observed especially when the wound gets dirty.
Anyways, I would like to share a few things here after all these.
1. If you suspect to have an abscess, get incision and drainage in A and E ASAP. Fistula wouldn't likely to be formed if you get it done earlier.
2. Perianal abscess usually heals quickly. If there is any recurrent infection or recurrent abscess, it's 90% that it's going to be a fistula. Get professional help ASAP.
3. If you have a fistula diagnosed (especially a low one), get it done ASAP. I got mine done in 3 months after I and D of an abscess and it's healing nicely now.
4. If all these have to mean something, all these suffering is our body trying to tell all of us to start losing weight and get a healthy diet.
5. A fistula track is formed most likely due to insufficient drainage by the abscess in the first go. Some muscles need to be cut and the I and D for abscess usually doesn't have a clean cut leading to a fistula.
6. MRI is not necessary if you have a simple fistula. Just get someone who done these procedures often and make sure they deal of the internal opening and clear the infection from the gland with sufficient drainage.
7. Pus (yellowish discharge) after surgery is normal depends on the size of the wound. It's really not a concern. However, make sure they leaks out and doesn't trapped in any tunnel or tracks when you touch it which makes it a recurrent issue. Massage your wound multiple times daily, sitz bath with salt is enough.
Anyways, I don't have much to share with people suffering from a high fistula. But the bring home messege is just it done ASAP to prevent it from getting complicated.
Good luck for all.