After many years dealing with recurring AF, I can say with some certainty that I appear to be healed following surgery. I told myself I would keep this account short, but as always, it's gotten quite long. Thank you ahead of time for reading and I hope this helps you as you are considering your options.
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It took over a decade to get a solid diagnosis for AF, and thankfully it was only the last year or so that I was dealing with the worst of it. Initially I just noticed some bleeding and skin tags, which at the time I thought were hemorrhoids. They were a little embarrassing but not painful. About 5 years later, as I developed IBS and my Endometriosis got worse, I also noticed that the bleeding was accompanied by a sharp pain. Again, the flares only last a few days at a time and a little neosporin was enough to get make it go away (mea culpa on the neosporin, I didn't know any better).
Eventually I saw a gastroenterologist for my digestive pain and brought up the bleeding and pain. She assured me it was just hemorrhoids and gave me a prescription for steroid cream, which was never as helpful as the neosporin. Cue about a year and a half ago, I get a full blown flare-up, while on vacation no less (not cool). It was so painful all I wanted to do was lay in bed and cry. I used so many over the counter items and tried to get through it. Then about 2-3 weeks later it went away. I hoped that was the end of it, but a month later it came back for another 2 weeks.
I researched and learned about AF and found a colorectal surgeon who confirmed that's what I had. We tried a couple different nitro cream formulations over the next 9 months, but while it would go away for a few weeks or a month at a time, it always came back, to varying degrees of discomfort. We finally decided on surgery, but then I got cold feet and decided to wait it out a little longer to see if it could heal on its own. Then AF ruined ANOTHER vacation and that was it for me. I scheduled my surgery as soon as I returned.
Going into it, I was very scared. I read so many journal abstracts about incidence of incontinence, levels of incontinence, risk factors, and so on and so on. It was frustrating because the literature all differs. By and large the incidence of catastrophic incontinence is incredibly low (35yo female, no prior vaginal deliveries), but it's still a scary possibility. I was also very hesitant because my flare ups always ended. They always came back, but they rarely lasted more than a week or two. I kept reasoning that maybe it was better to live with this than to put myself at risk. After surgery I felt better about my decision when the surgeon told my husband that the fissure was very long and probably would never have healed on its own.
My surgery was a four-in-one: LIS, Hemorrhoidectomy, tag removal, and fissurectomy. The fissurectomy was a day-of surprise, as my doctor hadn't discussed that prior. I remembered some of the horror stories from others on this forum and was so worried, but am now really glad I had it done as well - the scarring on the edges of the AF probably wouldn't have allowed it to heal all the way.
I'm not going to lie to you, my recovery was awful. It was one of the hardest things I have ever done, but now that it's behind me (...sorry) I'm so happy I went through it. Suggestion, if you aren't sure whether anesthesia makes you nauseated, get a prescription for an anti-nausea med to use right after surgery. I didn't get one until it was too late and couldn't keep my pain meds down, and the full post-surgical pain was unbelievable. On meds it was eventually bearable.
You are supposed to have regular, bulky-but-soft bowel movements as soon as you can, at least once a day. This was impossible for me, possibly due to my IBS. My digestion gave up completely for a couple weeks, and I worried about my healing but in the end everything worked out. I also experienced issues with my stitches. My body seemed to reject them, they pulled and hurt, and they came out much earlier than they should have. A visit to my Dr after 5-6 days post-op he confirmed that they should have stayed in longer, but that continuing to use the nitro cream was enough to heal up, and it was - though I did get a new skin tag out of the ordeal, surgical souvenir.
It took about a week before I felt like I hadn't made a horrible, horrible mistake. It took 2.5 weeks before I could sit like a normal person, albeit on a nice cushion. I bought a Purple brand seat cushion that was amazing, but by about 3 - 3.5 weeks I didn't really even need it anymore. About 4 weeks post-op I was back in my spinning class. If a tiny, hard bike seat isn't the ultimate test, I don't know what is.
The best part, no lasting change in continence. Fecal continence was normal a day or two after surgery, but I did require some extra cleaning after BMs for a couple months. Flatal continence was back to normal about a month later, and honestly was just a silent issue. :)
Has everything been perfect since? No. I had irritation, itching, and some aching/pain from the scarring for a several months. (Balneol was really helpful after my nitro was finished.) I was on constant lookout for fistula and keyhole deformity until my 12-week post-op appt. Luckily, I had neither of those. Now 9 months later, I still occasionally get a pang of pain, always fleeting, and maybe a little bleeding here and there around the margins of the incision. My IBS complicates everything, so I don't think things will ever be perfect. But the important thing is, when a painful moment arises, my body can heal it up now. All in all, that area feels better than it has in over a decade and I'm so thankful I finally got the help I needed.
I hope this helps you. I probably won't check back very often, so I apologize if I don't respond to comments, but wanted to provide my account before leaving this forum for good. My heart is with all of you dealing with this. Don't be afraid to get help and make sure to visit a proper colorectal surgeon if you can. It took forever for me to get an appt, but in the end it made all the difference for me.