surprise chronic fissure and fistulotomy

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surprise chronic fissure and fistulotomy

Postby woeisme » 21 Jun 2019, 02:39

I am almost 12 hours post-op and thought I would share my story as I have been reading this forum for 6 months and stories of healing have brought me hope! I am hoping my journey helps someone out there!

I was diagnosed with Type A flu in late December 2018. After a week of diarrhea, I was on the mend. Then I developed a stomach bug that saddled me with diarrhea for another 3 days about 1 week after healing from the flu. All of that loose stool lead to (what I thought) was an acute fissure or hemorrhoids. I had a fissure back in 2011 and knew how to treat it (sitz baths, ibuprofen, etc.) and have had hemorrhoid flare ups monthly, so I began my healing journey without seeing a doctor. By the end of January 2019 I knew I needed to see someone as it wasn't getting better. I made an appointment with a GI doc that specializes in removing internal hemorrhoids painlessly. As he was conducting his exam he found a very big fissure. He prescribed nitro cream and I thought my healing would begin!

2 weeks later we found my mother dead. She hadn't been sick-one day she was walking her dog and working as a nurse and the next day she was dead on her bathroom floor. She was only 67. The shock and despair were overwhelming. Trying to plan her funeral with my siblings put my daily sitz baths on hold. This was the middle of February. The first week of March I had my follow-up appointment with the GI doc but by this time I was so much worse than when I started the nitro at the end of January. I had extreme anal swelling, constant throbbing and stabbing pains, could barely walk, couldn't sleep, was waking up nightly with heavy sweating. If I had been of sound mind I would've noticed that these symptoms are classic for infection. But, since I was heavy into grieving my mom's death I wasn't focusing on my tush health. I had to cancel my appointment with the GI doc and tell him that he couldn't even do an internal exam I was so swollen. He wrote another prescription for nitro (which, I had wrongly assumed I developed a reaction to) and I searched online for other cures. I had always taken stool softeners, but added in miralax, put coconut oil in my baths and on my tush prior to BMs, ordered online "cures" (pranicura, medihoney, etc.). Most of these eased the pain, but nothing worked long term.

By Mid March 2019 I knew I needed to see a colorectal surgeon and get diltiazem. I scheduled an appointment and taking one look at my external rectum my CRS prescribed antibiotics and diltiazem. Within 48 hours of starting the antibiotics, I was like a different person! I could walk, pass gas without crying, poo freely-I thought I was cured! My fissure pain was now nonexistent! I took two rounds of antibiotics and saw him 3 weeks later. I marched in his office sure I was cured! No fissure pain. No leaking anything from my rectum. I was confident I would get a clean bill of health! My swollen rectum had reduced enough for him to see that I had an infected fissure-likely a fistula had formed-and I would need surgery (a fistulotomy or seton) to clean it all out.

I was devastated! I had no pain-no fissure or fistula pain. It took me all of April and half of May to wrap my head around getting surgery. With my mom recently dying, I just couldn't imagine having to get that awful surgery without her help! I am a stay at home mom to 4 kids under 10-how could I manage without her! Halfway through May I knew I needed to get the surgery done. I had read enough stories to know fistulas don't go away on their own and had started having some minor leakage from my fissure/fistula.

I just had my fistulotomy 12 hours ago! My CRS said that my fistula tract was super low and superficial, almost no muscle involvement, and little infection-all good things! He opened my rectum horizontally below my external fissure/fistula opening. During my initial consultation he discussed how this would be like a modified LIS that would not only clean out the fistula, but also allow the fissure to heal. I didn't speak to him directly after surgery but he spoke with my sister who is also a doctor. He was surprised how big my internal fissure still was and how much scar tissue was attached to it. He cut out all the old scar tissue, deroofed the tract and cleaned out the tiny infection, and sent me on my way.

I am starting to think (based on his words of what my fissure looked like internally) that what I had been treating for years as hemorrhoid pain was actually a chronic fissure. I had one in 2011 and a skin tag removed in 2015. Once a month for a week I would need to take hemorrhoid suppositories to deal with irritation, pain, and swelling in the area. I will be interested when I call his office to see how long he thinks I have been suffering from this fissure.

I am hopeful that my recovery is smooth-having to keep the fistula tract clean and open so it heals from this inside down-is my number one goal. I am worried that him "tidying up" the fissure will lead to the return of spasms and the pooping glass feeling. I will keep this diary as a running update on how my healing is going!
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Re: surprise chronic fissure and fistulotomy

Postby patience_and_healing » 21 Jun 2019, 10:56

You are incredibly brave and resilient! I hope your recovery goes smoothly and you can say goodbye to bum pain forever.
8/16-12/16: Fissure due to antibiotics
5/17: Botox to sphincter, fissure healed
9/19: Trigger point injections and pudendal nerve block
11/19: Botox to pelvic floor
8/20: Botox to pelvic floor in new location.
Currently in pelvic physical therapy
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Re: surprise chronic fissure and fistulotomy

Postby woeisme » 22 Jun 2019, 18:14

Thank you patience_and_healing! I hope so too!

Day 1: Woke up at 2:00 am after having fallen asleep at 10 pm. Wasn't really the pain that woke me up, but I took a tylenol anyway. Nursed my daughter who was awake and then wrote my first diary entry. Took a couple sitz baths, making sure to really swish out the wound. I didn't have a BM in the morning, but my stomach was very upset (I think due to all the anesthesia and pain meds). By 8:00 am I was exhausted. The surgery center had given me a steroid in my IV sedation and I think it had finally wore off by that time. I crashed hard. Slept from 10:00am-1:00pm. My husband brought home my two younger kids and I nursed my youngest down for a nap, took another sitz bath and went back to sleep. Woke up by 3:00 and felt marginally better. I was able to play outside with my youngest two for 1/2 hour. My husband picked them up again and took them out of the house by 5:00-had another bath, ate a little more (I had some chicken breast and some salad), put my kids to bed by 9:00. Then had my first post surgery BM! It wasn't as terrible as I thought it would be (imagine your worst fissure pain as a 10-this was a .5-1). I had it in my sitz bath, rinsed off with my perianal bottle, then jumped in the bath. Took another tylenol and went to bed by 9:30

Day 2: Woke up at 4:00-felt so much better! No more zombie like sleepiness! I must've overdid it on my miralax, magnesium citrate, and prunes because I proceeded to have 3 more BMs this morning. None of them were super painful, however I did have more pronounced drainage following each of the BMs. I followed the same procedure each time (perianal bottle rinse, followed by tub soak). Was able to clean the kitchen and fold a ton of laundry. Had some guests stop by at 10:00 am and proceeded to entertain them until 1:00 when I politely informed them it was time for me to soak and nap! I was definitely tired and feeling sore. Was able to rest from 1:30-3:00. Woke up feeling much better. Had an early dinner of chicken breast and salad, took another bath, and here I am.

I have only taken hydrocodone twice (once in the surgery center and the first night to help me fall asleep). Other than those two, I have been alternating ibuprofen and tylenol every 4 hours. I am hoping that I continue to feel better (however, I know that most people feel a spike in their pain on day 4-5, so I am prepared for that). I have been eating my regular diet-I usually eat very low carb as I am a Type 1 Diabetic, mostly salads, chicken, greek yogurt, fresh veggies, etc. Overall this experience has been WAY less traumatizing than I had anticipated. I know I read that repeatedly on this site, but it is true. It is the terror of not knowing what will happen and what your recovery will look like that paralyzed me from making the choice to get the fistulotomy. I am remaining optimistic that I will continue on this path of healing.
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Re: surprise chronic fissure and fistulotomy

Postby Tryingtorelax » 02 Jul 2019, 20:55

Woeisme, how are you doing now? I hope all is well.
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