Hi there,

First of all: So glad I found this forum and that it's still active! I have had a difficult time finding anyone who has even heard of this, much less experienced it. So it's good not to feel alone!

I'm five days post-op. My CRS originally thought the fistula was a simple one, but upon surgery determined it would be best to perform a staged fistulotomy. So, I have the open fistulotomy wound as well as a seton. She said after six weeks we can go back in and finish, or I could wait until the summer ends and get in a little bit of activity.

I'd love to hear from you about any of the following:

1) Has anyone here experienced a staged fistulotomy? What was your recovery like? I know each recovery is different, but it would be great to set some expectations.
2) What was your scarring like? Any tips for making that process smoother? I'm an avid hiker and want to be sure I can hike as much as I want!
3) Any women out there who have had babies vaginally after a fistulotomy? What was your experience?

Welcome fistulugh! There is likely someone who will pop along who has had this experience. Also, it's not uncommon so if you search "seton" you'll come up with many posts. Be sure to check out the success stories and diaries as well if you haven't.

I had a simple fistulotomy. I've talk to my OBGYN about it and she has never been considered about me giving birth vaginally in the future. I *think* if I remember correctly if you have Crohn's they are more cautious about vaginal births in those who have had fistulas. However, my CRS told me that after the repair is completed & healed for non-Crohn's fistulas the recurrence is very low. So I don't foresee any concerns. :)
Welcome again and wishing you well as you heal!

Figured I would come back in here an update this, just in case anyone searches for "staged fistula" and they end up here.

So, a little background, about 15 months ago, I got an anal abscess that burst on its own. I had it drained twice in the doctor's office, underwent a few rounds of antibiotics, then ended up in a dermatologist's office because doc thought it may actually be a cyst, since it wasn't healing. Two attempts at removing the "cyst" later, they sent me to a general surgeon who, through a stroke of luck, had performed fistulotomies in the past and knew what it was the moment he saw it. He referred me to an excellent colonorectal surgeon. No Chrons diagnosis; my CRS was actually pretty unconcerned after I talked to her about my BM, history, etc.

She performed a staged fistulotomy a little over 6 weeks ago. My fistula was a single track, long, deep, and somewhat complex because it intercepted the sphincter and a full fistulotomy could have affected about 20% of my muscle. She placed a seton to allow the fistula to continue to drain while the wound healed. I was surprised by the size of the wound and thought I'd made a terrible mistake. I definitely cried about it the first day when it had all the dried blood in it and I thought it was just the grossest thing I'd ever seen. TMI? haha

To answer some of my questions from above:

1) I thought I would be in a lot more pain. The first couple of days were painful but after that I just used ibuprofen (along with some Prilosec OTC to help my stomach), sitz baths, and ice packs to keep swelling down and discomfort at bay. Baths and ice packs were probably the biggest helps for immediate pain relief!

I took 2 days off work then just worked from home, mostly laying down on my couch. Returned to work (I have a standing desk) 2 weeks post-op, basically as soon as I could just clean up with wipes without irritating wound after BM.

My wound is completely healed and both my CRS and I decided to wait until the end of summer to do the other half. Meantime, she told me I can return to normal activity. I started hiking and doing yoga about 2 weeks ago and felt fine!

2) My scar healed nicely; it's smooth and about 1.5"x1/4".

3) I asked my CRS about this and she said that it should hold up just fine to a normal, low-risk vaginal birth, but like any tearing, unusually fast or slow labor is a concern.

My CRS has suggested performing another fistulotomy, with the option for endoanal advancement flap or a LIFT. She says she prefers not to do cutting setons because they extend the pain that a patient goes through. Her concern for the second fistulotomy, however, is that I just can't seem to figure out how to make my sphincter squeeze. Like, I just have no idea how. I know I can because I can control when I pass gas or BM but I can't, er, demonstrate it for her.

So, if anyone is reading this: any tips for becoming aware of your pelvic floor would be much appreciated! I'm almost ready to see a PT for it just so I can get my surgeon comfortable with moving forward with fistulotomy.