Hello, Iam 30y/o male from Ontario Canada, Cambridge area. I currently have a horseshoe fistula that I developed 10 yeasr ago when I got a absess, I had that absess lanced and drained by my CRS whom my GP refered me to when I complained about the absess. The absess was drained and everything was going well untill I devoloped another tract on the opposite side of my sphincter. This tract was not at all painfull infact i didnt even know it was there untill my Crs pointed it out.I have been dealing with these over the last 10years and jus squeezing and draining them myself but just when I thought they were gone my original has become absess again and is Very painful. This time Im thinking of getting the fistulectomy surgery that my CRS said I would need to fix the issue 10 years ago. Iam very worried about doing this surgery as Ive heard its very painful, but Iam most worried about the possible incontinence and the possibility of another surgery. He said it would be not much more painful then the absess was, that he does the surgery with no dressing as thats "old school" and that he has never had issues with incontinence. Has anyone had this surgery done, how was the recovery and have they had issues with incontinence? Wish I would have done the surgery the fist time as now both my parents have devoloped stage 5 bowel cancer and Iam taking care of them while they are doing their Chemo treatments. But we do all share the same CRS. Any info or words related to this procedure woulld be great.
Thanks
Trevor

Hi Trevor - I'm so sorry you are suffering and I'm very sorry about your parents. I really hope they recover and that you all enjoy excellent health very soon.
I'm also in Ontario and I had a fistulotomy June 27th. I developed a small abscess and a superficial fistula at the incision site of an LIS I had in May. The LIS fixed my fissure, but, unfortunately, abscesses are possible complications of an LIS. I'm glad I did both surgeries, though, because I now feel that I am healing and not just coping with pain. I have not had any problems with incontinence of any sort from either surgery (I can hold stool, even loose stool, and I can hold gas).
The fistulotomy was not as bad as I thought it would be, but the first week is pretty rough. There is pain and swelling for a while. In my experience, the second week gets better, but recovery is pretty up and down for about a month, so I would really recommend that you get help looking after your parents for at least the first week, and ideally for a month, if you can manage that.
Has your CRS investigated the cause of your abscesses and fistulas? I'm wondering if it is a good idea to rule out underlying conditions like Crohns. It's my understanding that such conditions can make healing very difficult and meds are often needed to achieve remission and full healing from surgery. Also, I've read that setons are a better option for treating fistulas for people with Crohns - hopefully Paulspain can chime in, since he knows an awful lot about all this. I think the level of risk associated with a fistulotomy depends on how much muscle is cut. If there is very little muscle involved, then the risk of incontinence is quite low, but if there is a good amount of muscle involved then the risk is higher. It's a good idea to put some of these questions to your CRS, and ask him how many of these surgeries he's done and what his success and complication rates are.
There are quite a number of threads here that describe fistulotomies, so you should get some good information about how the surgery goes.
I really hope you find relief very soon! :)

Hey there,
I have had 2 fistula surgeries and LIS, and I have no problems with incontinence. In a competent surgeon's hands I would say the risk of it is minimal.
My recovery wasn't fun, but it wasn't unbearable! As Hope says, the first weekk is the worst.

Hey guys thanks for the quick replies! I can see in the future this site will be very uplifting for me as I cope with the surgery, I have decided to do the fistulectomy and finally be rid of these horrible things. I have had 2 colonoscopys since the initial bout 8-10years ago and have been told I do not have chrons or any bowel desease. When these things devoloped I was quite a bit over weight and had issues with constipation. Now up untill this flair up, I had been working out and have lost over 70lbs and now Im in great shape and have no issues with constipation as I have changed my diet. This has made the doctor think there is very little chance of reoccurance... and I dont think the pain of the surgery can be that much worse then the last absess was and it will be nice not to stain my underwear with pus and blood anymore. I have lately just dealt with both parents coming out of surgery as they both had bowel resections, I guess now its my turn. Dont spend the night at my house its crazy lol.

Aw, you have a lot to deal with at the moment. I hope you can get the surgery done quickly and be on the path to healing very soon.
We will do our best to help you after surgery! There are a few good things to know beforehand that will make recovery easier.
1. Stay on top of the pain. Afterwads you will feel wonderful because you have local anaesthetic in your butt. When it wears off, it is a HUGE SHOCK!! If you take painkillers whenever you are allowed to, this will really help.
2. Get your stool softener regime perfected before surgery, then up them a bit afterwards to compensate for the constipating pain meds.
3 Use a shower spray instead of wiping afterwards.
I'm sure everyone will chime in with more suggestions before your surgery!

Congratulations on losing so much weight!That's really impressive! I'm glad your parents are out of surgery and I'm glad you got checked for underlying conditions and that everything looks good.
I agree with all of Val's excellent advice. Definitely stay on top of the pain. It's easy to underestimate how much the butt will hurt just after surgery because everything is numb. Painkillers can constipate, though, so I recommend using Restoralax (that's what Miralax/Movicol is called up here in Canada - and it seems to be a favourite around here). Try to get your diet and stool softening routine sorted before the surgery and increase the stool softeners afterwards to compensate for the painmeds. Some folks have a back-up supply of Milk of Magnesia, just in case the first BM proves to be really stubborn.
If you have trouble cleaning with just a shower wand, you can get flushable wet-wipes, but not the kind that have alcohol and definitely not the scented ones. Go for the gentlest brand the store carries. You can also wet those down with warm water and *gently* dab the tender bottom.
Stay strong! Soon this will be just a distant memory! :D

Awww Hope & Val give the best advice! Bravo You Two xx
Trev, I hope everything goes quickly and smoothly on all counts!! Be strong and stick around for support! P.s don't let you doc push you around! You know your own body as your its own advocate! Stay strong Brother

I agree that Val and Hope have great advice. They helped me through my surgery. I had a fistulotomy around the same time as Hope (as well as a hemmroidectomy ...never know how to spell that and too lazy to look it up lol...and a skin tag removed). My muscle tone was a little weaker than the CRS would have liked, but I didn't have any problem with incontinence and just some issues with gas (not loud though lol). It has gotten better and better each week, so now it's rarely an issue. I just discovered Gas X too, so that was great! LOL I remember someone on here telling me to judge my progress by weeks rather than days, and that was great advice. It can be a bit up and down depending on your bm's any particular day, but all in all, it was not as bad as I feared.
I agree that the first week or two is the worst. I actually wasn't in too much pain laying around, mostly when I had to go to the bathroom or sit down. I was on bed rest the first week and light activity the next week (probably because I had three things done). Definitely drink a lot of water and try the miralax and stool softeners at first. I had some hard bms at first, and that was probably mostly my fault for not staying on top of the water when taking my pain killers. I got off of them as soon as possible.
It's not as bad as what you read online. I was literally scared out of my wits to have the surgery, but by the time the week before surgery came, I was ready to just get it over with! Everyone on here was such a great help. I am so glad it's behind me now. I still have some small issues here and there, but I feel so much better than pre-surgery. You will be just fine and coming on this site will give you lots of good advice and encouragement.

p.s. Not sure if this will work for you or not, but I use some 4x4 gauze that I fold and tuck between my cheeks to help with any possible drainage etc. It works like a charm for the location of my fistula/surgery. That might help you too in regards to the staining of the underwear.

I just had a fistulotomy this past friday, and all the above advice is great. Anyone who hasn't tried the non stick gauze pads, they are a must have right after surgery. Nobody wants to peal gauze pad out of a wound thats just another stinging pain you don' need.
So far everything is going well whish I had done this years ago when the problem first was noticed. Originally I had started out with what I had thought was a hemmroid when I went to my regular doctor he thought the same thing and prescribed me suppositories. What a mistake that was I never felt so much pain in my life afterwards, apparently whatever it was the suppositories infected and turned it into an abcess. After being in so much pain I wanted to cry for 2 days and not being able to pass a bowl after prune juice and stool softners I went to see a general surgeon. He let me know that I had a abcess and that if not cut open and taken care of correctly it would turn into a fistula. The surgeon also let me know he wouldn't be able to take care of it for 2 weeks, I was in so much pain I said what can you do now, and he said he could take a needle and drain it on the spot with no anesthesia or numbing. I told him go ahead nothing could hurt more that the pain I was in at the time. As soon as the doc popped it I was so relieved, but what a smell it left, I am guessing all the bacteria and puss from the abcess. All was well after the draining I went home had the biggest BM of a lifetime and went on about my life. Couple months later while at the gym working out I felt this pain that I could best describe as someone pinching one side of my butt hole. After dealing with this pain for a couple years I finally decided to see someone who specializes in this area. I found a CRS recommended by a co worker. I had my first appt. with him 9//29 and finally went through and had the surgery on 10/7. I have to say the pinching pain finally went away. Obviously I have pain from the surgery but it feels so good to have the other pain gone.