Hi fellow fistula sufferers

Preamble: I went to hospital a few weeks ago, for my first botox injection for a fissure. It turned out the fissure is actually a fistula (posterior midline, "12 o'clock"). I was sent home without botox. The CRS surgeon had seen this 'thing' in January (after a junior doctor had said it looked like a fistula), and disagreed with the junior doc, diagnosing fissure (I believe he now thinks - saving face? - it has 'become' a fistula). So many months later of weird pain and useless/exacerbating application of GTN, diltiazem and emollients by myself (now stopped), I actually believe the CRS surgeon was most likely wrong right from the off - mainly cos of the new weird feeling I had from back then, and various embarrassing indications (e.g. gas passing thru this mysterious 'fissure'). So, with my confidence levels in him quite low, I am now on his waiting list for examination under anaesthetic and fistulotomy.

Day to day pain is bearable. In fact, sometimes absolutely fine. I seem to have 2 kinds of days...

(...Bear in mind, I take one sachet of Movicol at breakfast; eat a high fibre diet, but I don't necessarily steer clear of sugary stuff, caffeine or alcohol. No red meat, very little white flour.)

First kind of day: I will go to poop in the morning. It will be a bit 'urgent' and will end liquidy. Then I will bathe, but very soon feel burning inside. I am guessing some poop has inflamed or even entered the internal anal-canal opening of the fistula. If I sit (say at work) for hours after this morning poop I will get this dull throbbing pain and burning, and need to take ibuprofen, paracetamol etc. I DO remember fissure pain however, and it doesn't compare. If I dab with a baby wipe/tissue paper later in the day there will be small amount of yellow-green discharge. I do not think I have an infection though. Still, this kind of day is a bit annoying

Second kind of day: I avoid the morning poop, go to work, come back later, and avoid pooping till evening or last thing at night. Even tho I will have drunk lots of water in the day the poop comes out feeling harder and better formed. It almost tickles. All quite satisfying. BUT, wiping (or dabbing) there will be some blood! Never nice to see, but no pain.

So the choice between my two regimes seems to be soft, liquid poop and stinging.
Harder, better formed stools (still soft), and blood.

Unsurprisingly, sensation-wise I prefer the second but it does take some willpower not to rush to the toilet during the day when I get the urge (Movicol-inspired too).

Anyone else experienced similar, or think I might be missing something, could try a different approach, until I get my operation?

Sounds like you are doing a lot to take care of yourself Benny Lee. From my own experience with a fistula I can't say what else to do. I think you are doing well!
I'm so sorry you had the experience you did with the doctor. I am somewhat surprised how much they miss but at the same time I'm not. Perhaps these things hide, or look closed up.. I don't know. My 1st CRS said "it looks like a fistula, but isn't". What ??? Called him a week later and described the same symptoms that I did in the office and he then said "yep likely a fistula". So I feel your pain on that one.

Are they doing an exam under anesthesia and then later doing surgery? Or will they operate as they find the fistula tract while under? How long is the waiting list usually?

Hang in there, it will get better! Those fistula mystery pains will subside. :)

Thanks for the kind words Manitourose. I think the waiting list at my NHS hospital shouldn't be more than 8 weeks or so, but I guess my problem has been first I was a patient who wanted LIS for fissure, then I got scared and wanted botox, then LIS again - now I know it's fistula, I have a new problem for them to fix with, I guess, a bit more involved. This is a problem which started December/January (after a long kind of 'leading up to it' in autumn with me mistakenly over-using pile suppositories and old tube of GTN - uurgh!), so coupled with my anxious indecision on matters, and a godlike distant CRS (who may be a great chap for all I know), I'm languishing appointment-less! Though have just rang and they haven't got a date for me yet that's all.
I don't know whether it's because I've been sitting a bit more recently, but the fistula ache seems to be slightly more ache-y. Still only mildly painful, but I guess my anxious side just imagines new 'tracts' forming (though they're probably not as I imagine that might hurt a lot more).
Anyway, I have informed my workplace I may be having an 'embarrassing' operation soon, with at least two weeks off needed after. I feel like sitting on a pillow at my work desk, like I do at my desk at home!
Manitourose, I expect you mean the 'mystery pains' will subside after surgery? Looking at some of your posts, you've had surgery, how was it, and also ("First World question") how much did it inconvenience your life?