Hello everyone. Just wanted to write about my experience having a Fistulotomy and Hemorrhoidectomy. I read a lot before having the surgeries with various forums and found stories where people who wrote about their successful operations very helpful so I decided to share about my own experience.

I am a 28 year old man without any other health problems. At the beginning of May 2015, I had pain in my anal region. I have a history of hemorrhoids (runs in the family) so i thought this was just another hemorrhoid. I had it checked and the original diagnosis was a thrombosed external hemorrhoid. I was given some medication. Fast forward a month and a half later and the pain was still there. This time though, the bump in my anal region would burst with discharge everyday. Before bursting during the day, the pain was excruciating. After bursting, the pain would go away only to swell up later on (usually after a BM).

I went to a different doctor, this time a CRS who has done multiple operations for people in my family, and he said it was not a hemorrhoid, but it was an anal abscess that resulted in an anal fistula. He said the only option was surgery and that it looked very low so there was very little chance of incontinence. He was not completely sure and would only know on the day of surgery. So with much prayer, I decided to have the surgery ASAP. We decided on fixing my hemorrhoids as well. I have grade 3 hemorrhoids but they don't usually bother me and are not painful but since I was on the operating table, I might as well get it done as well.

So I was admitted to the hospital a day before my surgery. There I was given Castor Oil as a laxative. In a couple hours I had to start using the washroom and I probably went a total of 10 times that night to clear everything out. By this time my hemorrhoids had really swelled because of the constant bathroom trips, but I was assured it would be taken care of anyways during surgery. They also gave me an IV drip because I wasn't allowed to eat and they needed to rehydrate me due to the constant bathroom trips. The pre-op was probably the worst part of the whole surgery for me.

The next day, I was ready for surgery. They wheeled me into the operating room and gave me a spinal anesthesia. I expected the shot to hurt a lot more but it felt just like a normal injection. My lower body started to numb. Once it was completely numb, they put my legs up on a harness and I didn't even know it but I was put to sleep. Next thing I know, the anastheolegoist was telling me I was done. I didn't feel a thing during the operation that lasted 1 hour. I was wheeled into recovery where I felt really nauseous and wanted to throw up. Since I had not eaten anything, obviously I could not throw up anything. The nurse assured me that the nausea was normal and a result of the spinal anesthesia.

After I recovered I went back to my room, still feeling very nauseous. I was informed that the fistulotomy went very well and it was simple with only very little muscle cut. Praise God! Also, they fixed 3 hemorrhoids. They removed 2 while doing some banding on another one (Sorry can't remember the term). I was full of air when I got back to my room and I had not yet urinated. The resident informed me that my bladder was full and that I needed to urinate soon, but I just couldn't. I wanted to pass wind also but I couldn't so I asked if I could remove the gauze in my anal region. The nurses and residents all agreed I could so I took the gauze out (a little painful, just go slowly) and was finally able to pass wind and eventually urinate.

When I removed the gauze, something like hemorrhoids popped out and I thought I had new ones. I was really worry because I had called one of the residents and they checked it and said it was a hemorrhoid! I was worried and stressed because what was the whole point of the surgery if I still had these hemorrhoids. My wife also started crying because she was so confused and saw how scared I looked. After a sleepless night at the hospital, a senior resident came and inspected and said that it was just swelling and it was nothing to worry about.

Anyways, by this time, I was in a bit of pain but not so much. I was discharged after my surgeon came to see me and said everything looked good. I was sent home with instructions to take Senocat/Senna before bedtime, Flagyl antibiotics every 8 hours for 5 days, and Paracetamol as needed. I was instructed to do a sitz bath 3 times a day.

I was happy to go home and start my recovery. I planned to be off work at least 2 weeks and then I would see from there.

Week 1 (Day 1 − 7)

The most painful part of recovery are the Bowel movements, no doubt about that. After a bowel movement I would have a very stinging and raw feeling in my anus and have to rush to get in my sitz bath. On a scale of 1-10 the pain was about a 7. I know a lot of people use the thing you put on top of your toilet bowl for a sitz bath but what I use is a commode chair (I learned this from my father in law who had a hemorrhoidectomy). It's basically a toilet chair for people who can't make it to the toilet but if you're not on the heavy side, you can fill the bucket with warm water and sit on the commode chair dipping your butt in the bucket. This is more ideal as I can put this in an area of the house with more air circulation.

The first BM which I had on day 2 was not really that bad. It was only a little so there was minimal pain. My second BM a day later which had a lot more volume was more painful and so the sitz bath helped immensely. After the sitz bath, I would feel a lot better. I would have a sitz bath at least 3 times a day and whenever I felt like having one. This helps the area keep clean and heal. My wife would also boil guava leaves for me (I live in a tropical country where this is abundant and has been used to heal wounds in our culture) to mix with the warm water and I also put epsom salt in the water to speed the healing.

There was not much pain when lying down or doing a little walking. The pain was maybe a 3 at most. I only used Paracetamol as needed and had only to consume maybe 5 total for the entirety of my recovery.

The swelling was very big, there were 3, one for each hemorrhoid that was removed. I worried that they might not grow smaller but only time would tell. There was also a giant cut that I could feel from the fistulotomy. I did not look at my anal area as I did not want to remember it in this way and would rather see it when it was much better. Basically, I just made sure to keep it clean. Because of the swelling, I could not feel every part of the anal region so it helped that I used a bidet after BMs, and a hand held shower wand in the shower.

I used sanitary napkins to catch discharge during these days and there was a lot. I probably changed 3 napkins per day. I would have bleeding, pink/brown discharge and a constant feeling that the anal region was wet with some kind of slime.

As for eating, I made sure to get enough fiber but not too much. I realized previously while trying to treat my hemorrhoids with fiber that too much fiber bulks up my stool too much and it can be hard to pass so I just had enough fiber per day. 1 serving of fruit and 1 serving of vegetables a day were enough. Stool softeners definitely helped to ease BMs as obviously the area is really sensitive. I felt really nauseous the first 5 days and I attribute it to the antibiotics. Flagyl is a pretty strong antibiotic so make sure to take it with food.

Over the first 7 days the swelling went down but only a little. The wound from the fistulotomy felt like it did not get any better on the outside. I also have this weird symptom that I saw mentioned in a couple of other forums. When I'm trying to sleep and at the point where I'm about to fall asleep, I jolt awake and involuntarily squeeze my anal muscles resulting in of course pain, and me waking up. This would happen 3-4 times during the night until I was so exhausted I just fell asleep. This also happens when Im asleep or napping and Im startled, let's say when my wife accidentally makes a loud noise or someone knocks on the door. This eventually got better in week 2 and completely gone by week 3.

Week 2 (Day 8 − 15)

I had my first checkup with my CRS on Day 8. I was really nervous about going out for the first time as my stomach was in bunches and didn't want to have a BM at the hospital. Praise God I made it through. The CRS said everything looked good and clean. He suggested putting a cotton ball with some honey between my cheeks to reduce swelling. I tried this a few times but it just hurt me so I had to stop. I was scheduled for a next checkup in a month because he said everything looked okay and the swelling will go down with time.

Everyday, I felt better and better. Swelling started to go down slowly during this week. I kept up with my stool softeners and no need for paracetamol or any pain killers. Continue to eat meals with a good amount of fiber. The pain after BM's started going down after day 10 and became better and better. Eventually I could just use the shower wand with hot water and the pain would subside. I would of course still have a sitz bath after.

Also by day 10, I could feel the fistulotomy wound starting to close slowly. There was still a giant wound but the edges were starting to grow tissue and fill out. Discharge from the surgery seemed to be slowing down as I only have to use 1 sanitary napkin a day that has little discharge.

By day 15, I was wondering why I was still having 2-3 BM's a day for 2 weeks. Prior to surgery I used to go once every morning and that was it. I went online and found out Senokat/Senna is a laxative so I asked my CRS if I could stop it as I was going to start working soon and wanted to avoid having a BM at work if possible. He agreed. In my country, stool softeners without laxatives are not available so I didn't have a choice of going on Colace or something. My anus had healed enough that even without the stool softeners, I was able to have a BM with only a little discomfort after.

You want to avoid straining in your BM as much as possible. I used to strain a lot, not because I was really constipated, but because I was always in a hurry to have my BM over with and so by this point, I was retraining myself to not strain during a BM and just wait for it to happen. This was a bit problematic because of the pain while waiting but I think slowly I'm getting there.

By around day 12, swelling started to decrease more quickly.

Week 3 (Day 16 − 23)

Everyday brought more improvement to the swelling. Swelling seems to decrease day by day so just be patient. By day 18 I could feel the wound from the fistulotomy was almost closing with tissue. BM's are a lot better with very minimal pain and discomfort after. Discharge is very minimal that I don't wear a sanitary napkin anymore. I do sometimes get clear discharge with a slight fishy smell but not a lot.

I've returned to work on day 19. I walk/commute to work in the heat (takes me 30 mins) so I'm a bit sweaty when I get to the office and my anal region is itching (probably because of the sweat and discharge). What I do when I get to the office is to pat the anal region with a wet wipe to clean it, and put a dry tissue in between the butt cheeks to dry it. Once, clean the anal region is no longer itchy.

I was initially worried also about a sensation that I felt wind passing through the fistulotomy scar or gas bubbles moving in the anal region but over time that sensation went away also.

Week 5

I went back to my CRS and he says he thought the wound would have completely healed by now. He says there is a small wound left and that it will close in 2 weeks time. It looks good and I should keep i clean. The swelling has become smaller over the weeks.

Week 6

Still more of the same. I have slight discharge with prolonged sitting and exercise causes itching.

Week 7

Still more of the same. I went back to the CRS and says the the wound should have fully healed by now but that there’s a small portion left to heal. Discharge still persists and will persist until fully healed.

He explained that every time I have a BM, the tissue and wound breaks a little so has to heal again. He says to wait a few more weeks for complete healing.

Week 9

Discharge is very minimal and a small part of tip of wound left.

Week 10

Small amount of discharge still persists but I can sit better. At this point I’m not minding my butt so much and I use a donut when sitting on chairs.

Week 11

Small amount of discharge still persists but pain going away. I read about a Scientific paper that say it takes 80-100 days (delayed healing) to heal a midline posterior fistulotomy at the 12 and 6 o clock. This is what I had done so it’s probably right that it takes a bit longer to heal.

Week 14

The wound has fully closed now. CRS says I had a bit of delayed healing but nothing to worry about. The tissue is still soft. Discharge persists but CRS says it is not from the cut area, instead is the anal canal leaking. He says because some muscle was cut, the muscle that holds liquid in was compromised and so there is leakage.

CRS says leakage will decrease over time (months to a year) as muscles in that area improve and take over.

1 Year Update

I had the fistulotomy about a year ago and over the year the anal leakage has improved. It happens occasionally but not enough to be a bother. My anal region has healed very well and I have no sign of any incontinence aside from the aforementioned minimal anal leakage that happens from time to time. Leakage usually happens when it is hot and humid and with prolonged sitting.

Over the year though, I did find out that I had a chronic fungal infection in my anal region that caused the itchiness. My theory is that it was caused by the fistula drainage at the very start when the area was practically moist 24/7 for about 2 months. This cleared up with medication.

Regarding the swelling, they got smaller and smaller over time but never completely vanished. That’s fine with me as it’s only a cosmetic thing at this point and who looks at our butts? :)

Overall, I thank God that my case was minor and was completely fixed with the fistulotomy. My CRS told me before that it wasn’t something I did that caused the fistula, it’s just sometimes these things happen and so I had faith that God had a plan for all this. The worst part of it all was just in my head with all my anxiety and worry. I hope my detailed experience can help others out there who are anxious and worrying about their own surgeries. Feel free to send me a private message for any questions. God bless you all!

Thank you so much for taking the time to relate your experience. I'm sure that this will be of great use to those with similar conditions who come after you.

Congrats on what sounds like a great surgery and I wish you continued good health in the future.