Hi everyone,

I had a fistulotomy on January 7th (a little over 12 weeks ago) and it looks like it is nearly healed (there is some raw skin and wetness near the wound but no depth at all. I generally feel no pain, but for the past 3 days I've had some mild pain during my bowel movements, feeling like I was passing a hard stool even though I have been eating plenty of fiber. During the past few weeks I have had some tightening and loosening, tightening and loosening of the wound which appeared to coincide with increased closure and healing. I'm just curious if you think these pains are due to the healing getting close to the anus and this me feeling more tightness...or if you think there is a problem. There is no blood after these stools. It feels similar to internal hemorrhoid soreness but it appears to be coming from the part of my anus where the wound is. Should I be concerned? Again it isn't major pain at all...very minor (an ache) but anything at this point makes me concerned.

I'm only 2 weeks in. At the beginning I had zero pain during or after a bowel movement, but then I started having a bit of pain about 3-5 seconds after the movement was complete. But it goes away within in a couple minutes.

I'm not sure what is causing your pain, but if it goes away quickly I wouldn't worry too much. Odd things are happening down there, just watch for infection.

I posted this under another thread but it is applicable to both. Well perhaps I got a little too excited too early. My fistulotomy wound has completely healed, but there is a pretty good amount of aching pain coming from the area. Not sure why, it's been lasting for about 4 days now, it's worse when I have a bowel movement. Externally everything looks great, there isn't even a scar anymore and this was a pretty deep wound. I am worried it is recurring, but- 1.) I don't have Crohn's disease or any other IBD nor do I smoke, 2.) There is no pus, discharge or blood coming from my butt at all and there is no hole or bulge on the skin anywhere, 3.) There is no abscess and there is no fever...there is merely just pain. I wonder if this is the new skin being stretched when I BM? Or did the fistulotomy inadvertently cause a fissure? Or bad hemorrhoids? I'm visiting my surgeon tomorrow to figure out what the hell is going on. He has pretty poor bedside manners but I have confidence that he will know. I would assume a recurrent fistula would involve discharge and an abscess...or at the very least discharge or blood from my rectum. Everything LOOKS normal, it just hurts.

Maybe the fistula is ok, and there is no abscess, but there is pain from the opening of the fistula?

What's the actual difference between a fissure and the opening of the fistula? Aren't they pretty much the same (when the fistula is low down)? A fissure is a tear in the lining of the lower rectum, and a fistula is a hole thru that lining (and a tunnel leading from that hole to someone outside the body).

So my speculation is that even a healed fistula (as in no infection and abscess) can still give the pain of a fissure. But this is all just pure assumption.

Hi Calc,

A fistula is an actual tunnel from the rectum to the outer skin. Clearly this hasn't reformed for me yet, but I just fear it is in the process of reforming due to the pain. A fissure is much, much less of a serious problem unless it becomes chronic. I have a history of hemorrhoids in my family but no history of fistula or anal disease. My uncle did have a fistula with seton placement but it seemed to workout fine and he had no more problems with it. I don't have Crohn's or anything else, so I'm baffled as to why it would recur (unless my surgeon was incompetent, which with 24 years of experience as a rectal surgeon I doubt he is). Is it possible to have Crohn's with no symptoms (other than the abscess and subsequent fistula) and no genetic history? Just seems unlikely...plus my fistulotomy wound healed within 12 weeks, I don't think a Crohn's wound would have healed that quickly. When my abscess was drained initially (on Halloween 2014) my surgeon said there was no sign of a fistula, so it clearly formed after the fact.

What I am saying is that the internal fistula opening into the anus might be what's giving you the pain, since it is very much like a fissure.