Hello Everyone,
A little background first....I am a 39 year old male living in the Charleston, SC area.  I am scheduled to get a surgery done for what my surgeon thinks is a fistula.  My story starts about 3 years ago when I had a perianal abcsess form.  This abscess formed (not coincidentally) a week or 2 after a HORRIBLE 2 week bout of diarrhea.  Never found out what caused the diarrhea.  Anyways, my general doctor made an appointment to go see a Colo-Rectal Surgical Specialist and he lanced it under Local Anasthesia.  It seemed to heal back fine.
About a year later I had another abscess form, but on the right side of my butt cheek near the anus.  Went in and had this one lanced by a different surgeon, but in the same practice.  The guy I had the first time around I really liked, the 2nd guy, not so much.  The second guy just seemed like he was in a big hurry and was in and out without answering any of my questions.
Fast forward about 17-18 months later and I had another smaller abscess form on the left side (where my initial one was).  Once again, went and got it lanced.  This was at the beginning of June of this year.  Everything seemed to be going fine with healing, but then about 2 months later (beginning of August....couple of weeks ago) I began feeling the lump come back.  This was my "Oh Sh*t" moment.  Went in, got it lanced again, but my surgeon (back to the guy I like) said because it reoccurred so quickly, the I probably have a fistula.  
He said that he would like to knock me out and go in to fix the issue.  He said he is pretty sure it is a Simple Fistula because he could feel a track right under my skin,  but won't know for sure until he "gets in there."  So about a week and a half ago, I set up the surgery for the 27th, which is two days from now.
I have been going through my periods of being anxious and nervous, and then half my moments of calmness, knowing that I have to go through with it in order to have a chance of getting rid of these issues.  I believe my initial abscess was caused from the diarrhea 3 years ago, probably causing an infective anal gland.  I have been taking various probiotics, vitamins, etc over the past 3 years, but if a fistula is there, that means junk can still flow into that area.
There are three things, I am most anxious about......
1. Being put under.  I have had it done for a couple of surgeries in the past, but it has been about 20 years since my last time.
2. The possibility of getting a seton.  I think I am much more prepared for a simple fistulotomy and having it laid open.  I keep thinking of this just being a larger version of getting my abscesses lanced which I handled pretty well.  I just pray that these things are simple.  
3. Giving myself 2 enemas before the surgery.  Never done one before, so just the unknown factor is freaking me out a little.  I bought 2 Fleet Enemas from CVS a couple of days ago....the surgeon's office said they all pretty much do the same thing.  I went for the smaller versions (4.5 ounces) compared to the larger ones (8 ounces).  They are both saline.
I have a Sitz Bath on order from Amazon that is supposed to get here tomorrow, but I also have a decent soaking tub that I may use more often.  Just wanted to be prepared.
One other thing that worries me too, is not so much the first BM, but the clean up afterwards!     Any advice is welcome on this one....I have wet wipes, but not sure if I am going to want to be rubbing anywhere near that area.
Thanks for listening.....hope all goes well!

Hey there - So glad you reached out on here.. where people actually understand what you're going through! I'm sure you'll get lots of good advice. Not sure if you've read my story - but long story short, one recurring abscess - doc thought it was probably a fistula .... a lot of wasted time given our not so very efficient healthcare system here.. second abscess formed while waiting around .. turns out I had 2 fistula tracts with one internal opening. I've had 3 surgeries to date as one of the tracts went through muscle. Surgery 1 - both tracts were laid open, draining seton placed in the one going through muscle. Surgery 2 - both tracts were opened up again and a second seton placed, turns out the simpler tract had healed over too quickly and was still communicating with the other tract/opening. Surgery 3 - this took place 11 days ago, both setons were removed and the rest of the area laid out. First surgery was in Oct last year, second surgery in April and last one this month.
And now to address your questions:
1. I had never been put under and I was terrified. It's really not that bad - I had some issues my first time where I apparently tried to get up off the operating table while they were putting me under. I assume this was due to my own awful anxiety (I'm a very anxious individual in general). The next two times were very simple and straightforward. Before being put under the last time, I was actually given about 6 pills - pain killers and anti-inflammatory drugs. I believe this drug cocktail put me in a la-la land mood and I really wasn't too worried going in. So personally, I think this is the least of your worries. The doctor/hospital will most likely do all the necessary pre-op tests - if you have any questions or are still anxious you can ask during your pre-op appointment. Not sure if you've had that already or it could happen on the day of your surgery. I've also heard that you can ask for anti-anxiety meds if needed.
2. I would say the seton isn't a big issue either. It sounds like your fistula is very superficial - especially if the doc can feel it through your skin - so I would assume you most likely won't need one. Mine was definitely very deep inside as I had 2 MRIs to try to give the surgeon an idea of what she was dealing with. If you do get a seton, keep in mind it's not there forever and it's only real purpose to ensure that you don't heal over and close up too quickly while trapping infection inside. That is what happened to me after the first surgery which is why they placed the second seton in. Living with a seton isn't bad at all - it's just annoying as you'll have drainage but most times you won't notice it's there. You may have some discomfort sitting depending on the exact location but nothing compared to the pain from an infected abscess! The first 4-5 days post fistulotomy will be the most painful, but once again nothing compared to an abscess. They will also give you pain meds for a reason - use them as needed! Depending on how deep your opening will be - you may need packing. Over here, they send a nurse daily to pack the wound.
3. I've only had an enema twice (evening and morning) for a different doc - she needed me to do it prior to a sigmoidoscopy which all really turned out to be a big waste of time in my case. I actually didn't need an enema for any of my surgeries - I think that it really does depend on the doc. Having gone through it though, it's really not that bad. I am very squeamish so I had my husband administer it - just make sure you're near a toilet. You'll just get a sudden urge to go - but nothing to be afraid of. If you have major anxiety about this - perhaps you can ask if a nurse at the hospital can administer it?
My sitz bath has been my best friend for the 3+ years I've been dealing with this. The sitz bath is easier to keep clean and sanitized.. I usually spray mine with lysol between uses and then rinse it out with hot water. I also use sea salt in the water when soaking. I've tried epsom salts as well but it's my understanding that sea salt has more healing powers.
Ahhh the post BM clean up :) Don't rub - pat! If you don't already have one - get a hand held shower (my other best friend). Depending on the exact position of your incision it may be very difficult to wipe clean. I take a couple of sitz baths and rinse off with the hand held shower post BM. I assume you will end up on strong pain meds post-op ..these have constipating effects so make sure you drink lots of water, eat lots of fibre (apples are great) and take any stool softeners you've been prescribed. After the first surgery I didn't think I needed stool softeners or laxatives as I'm always so regular - but I paid the price on day 5 post-surgery :) When out and about, baby wipes are wonderful. I would recommend
Post surgery try to maintain a healthy diet. I take vitamin C and eat lots of protein and veggies.
Any other questions - feel free to reach out to me!

Wow.....thanks for the extensive recap! I go in tomorrow for the procedure, so hopefully it all will go quickly and well. I think I am definitely going o ask for some sort of anti anxiety when I get in, but sounds as though everything is going to move quickly. Have to be at the office by 10:15am and surgery is at 11:15am. My surgeon said if it is a simple fistula then the actual surgery may only be 20 minutes or so. If it turns out to be more complex, then it could be upwards of an hour. I guess I won't know the difference though! :D 
Thanks again for the advice.....now that I think of it, I think I may be more nervous about the enemas than the surgery. Imagine that!

Done. Just got home......whole procedure was 20 minutes. Surgeon just cut it open. Can't feel anything right now because he numbed it up pretty well, but we shall see once the local wears off. I was prescribed some new pain meds that are supposed to be non-constipating, so that is awesome if it works. They are so new that he said to check before filling because some insurance companies don't cover yet. Mine does cover but still running $27 out of pocket. Also getting Flagyl and a muscle relaxer. They also gave me a topical muscle relaxer and topical pain cream.....definitely using that before a BM! Hopefully everything goes well.

One other question......should you take a warm, soaking bath the night that you had the surgery done or wait until the next morning?

I had written you a long msg this morning and I just realized it disappeared :(
Glad to hear your surgery wasn't complicated. You'll hopefully be back to normal in no time!
I assume you don't have any packing in the wound? Had it been dressed in any way? I would definitely wait until the next day before taking a bath or even a shower. I believe I waited at least 24 hours in each case.

Hey so wonderful u had ur surgery done and u will be glad that u got it done. As diamond gave u most of the info. just want to say happy healing n eat lot of fruits :) n fiber
Kathy

oh yes - drink lots of water :) forgot to mention that!

Thanks for the comments everyone.  I actually did take a sitz last night and then showered off the area.  Only reason I did this was that at one point I thought I had gas, but when I went to pass it, I thought a little extra came out into the gauze.  :oops: 
I wanted to make sure I had a clear area before bed, so decided to change the gauze over and start fresh.  Gauze definitely had some blood, but also had what I guess is the most disgusting puss I have ever seen.  Almost a jelly like consistency....sorry to be graphic, but did everyone else have this?  It was disgusting.  At that point, I was glad I was changing everything out.
Still no BM, but had a lot of gurgling and gas going on.  Still fretting the first BM a little, but know it is better for it to come than not to.
The side of my bum that had the procedure is pretty swollen, but I am assuming this is normal considering what I had done.
Pain is still manageable and have not taken any of my serious pain meds yet, although I did take a Naproxen (muscle relaxer) and my first Flagyl last night before bed.
That is pretty much where I am right now......and it has not even been 24 hours yet from when I had the surgery done.  Need to go start pounding that water!

I think that was the right decision if there was a possibility of the gauze being "dirty".
I have seen pus like that before - not recently, but possibly after the first surgery ..and definitely before any of the surgeries. It's probably just the wound draining. Keep an eye on the state of the discharge - blood is a good sign, pus isn't. Also, make sure nothing smells funny - that's usually a sign of an infection. I would say swelling is normal. After this last surgery, I had a substantial amount of swelling for about 2 days post-surgery.
It's interesting that you've been prescribed Flagyl - most people seem to be prescribed antibiotics but I've never been! Even my nurses are surprised. Don't know what the reason is.  
I try to drink 10 glasses of water a day. The other thing that's been my saving grace is a smoothie every morning ...the melange of fruits and chia seeds gets my bowels moving. You can check out my other post (titled something along the lines of "positivity" :)) Don't fret too much about the BM - I'm guilty of having stressed myself out completely about it..and I think that made things worse. It may take 48 hours before you get your first BM .. especially since you had used an enema prior to surgery and already cleared things out.