Hi everyone,
I know that this forum is for fissures, but through the internet I saw that there were questions being asked about fistulas. I had an peri-anal abscess that was surgically drained about a month ago. Since then I noticed that the incision never healed and it would periodically drain and sometimes bleed a bit. I was hesitant to return back to the surgeon because he is not a very nice man and was very aggressive with me during consultation and surgery. He also gave me no after-care after the surgery, so I've been fumbling through this experience all on my own this whole time.
However, after trying to go the gym and leaving because of all the pain I decided I needed to go back to see the surgeon. Today I had my appointment and after taking a look at the incision he said I had a fistula. He then proceeded to tell me what my options were. He said that he could insert a tube into the opening of the incision and comes out through my anus and that would help with the pain and collecting drainage but he said it would not cure the fistula. He also said that there were other procedures but it involved cutting into the muscle which can be particularly risky for females. He also told me I could do nothing about it and just continue to have this open incision drain for the rest of my life.
Obviously none of what he said is particularly comforting. If I have any procedure done I want it to be to fix the problem. A big part of my life is going to the gym and exercising and trying to maintain a healthy lifestyle and I haven't been to the gym for 4 weeks because it is too painful. I've been reading stuff on the web about fistulotomy and I am unsure of how common this is and how risky it is. I heard that there is the risk of incontinence which also terrifies me and makes me think that living with a draining incision must be better than spending the rest of my life with incontinence.
Any input or information you can give to me is greatly appreciated. I live in Toronto and I'm not sure if I should seek the help of another surgeon and get a second opinion?
Thank you in advance!

Hey there,
Just wanted to say Welcome to the forum. There have been quite a few folks in here who have had fistulas and would have more knowledge than I about the surgery. Hopefully some of them can chime in soon! You may find some of PaulsPain, Hopetoheal, Vals(to name a few) post helpful . Paul has a seton (tube) and has a lot of knowledge about fistulas and procedures involving them.

Goodness, ur CRS's EQ is very low i would say... to leave it open for the rest of your life is hardly an option! I'm sorry about your situation, i hope it will settle well soon..

Hi ajv! I'm so sorry you are struggling with butt issues - you've come to the right place, though. There are lots of good people here would can offer great support and advice.
I developed a fistula as a complication of surgery for a fissure. It was a low, superficial fistula and I got it fixed back in late June. I'm not a doctor, of course, so please take all this advice with a grain of salt - I can only share what I learned while I was dealing with my own butt.
From what I've read, approximately 50% of abscesses will eventually form fistulas - that's just the nature of the beast. There are also different kinds of fistulas. Simple fistulas are low and superficial, like the one I had. These ones don't track through the sphincter muscle, or only track through a very small portion of the muscle. In these cases, the doc can perform a fistulotomy, which means the fistula is laid open (or 'deroofed').
Complex fistulas are 'higher' - meaning that the inside opening is higher up in the anal canal. These ones track through the sphincter muscle, and so a fistulotomy is often not a good idea because laying it open would involved cutting too much sphincter muscle. Instead, the surgeon will insert a "seton", which is a thread that encircles the fistula from one open end to the other. There are two kinds of setons: a cutting seton and a draining seton. The cutting seton is designed to cut through the sphincter muscle very slowly, like a wire cheese cutter, but slowly enough so that the muscle can heal as it's being cut. This helps to preserve continence. The idea is to cut the fistula slowly until either the seton come out on it's own or the fistula develops into a low, superficial one that can be fixed at that point by a fistulotomy. The draining seton is usually inserted to make sure that the fistula keeps draining (so that abscesses don't keep forming). These ones stay in for a long time and sometimes are even permanent.
So the different surgical options will depend on what kind of fistula you have - but it may also depend on what caused the fistula. Fistulas can be associated with IBD (like Crohns or ulcerative colitis), and this may make it difficult for the fistula to heal. In the case of crohns, medication is often also needed, and crohns makes it difficult to heal. So, if there's no obvious reason for your fistula, I would say that a good surgeon would rule out any underlying condition before performing surgery, especially if you have a high fistula. If you have a low fistula, there should be very little risk to continence, since little or not muscle cutting should be involved.
I would strongly recommend that you get a second, and even a third opinion. I live just outside of Toronto, so I know the problems with getting to see a specialist in Canada! I'd say get on that right away. Our wait-times are ridiculous, so get a referal asap. You don't want to wait too long to see somebody who can help you.
Oh yeah - I should mention that you might want to be a bit careful about going to the Rudd Clinic. Many of us from T.O. went there out of desperation and a few of us (like me) had some unpleasant experiences with uncaring docs there. A few boardies, like Adam and Redcharger, had good experiences though. It depends on the surgeon. If you do have to go to the Rudd Clinic, avoid Dr. McKenna. He doesn't belive in pain management!
I hope some of this helped! Good luck! I hope you find relief very soon. :)

Hi again everyone,
Thank you so much for the encouragement and for taking the time to explain all this to me. I was very confused indeed and now with this knowledge I will better be able to address this problem going forward.
The weird thing about the abscess surgery I had, is that it did take a long time to heal, however every day it seems to get better. It doesn't discharge that much anymore, and any discharge is very little. The pain I feel is more around the incision itself, and it also has subsided. I'm an accountant so I sit at a desk all day and I feel that it irritates me more during the week and I don't really feel it on the weekends when I'm around and about. I haven't returned to the gym since the last time I had pain so I can't comment there.
My surgeon didn't seem to really do a lot of examining of the incision, he kind of just poked and prodded at it and then said "you probably have a fistula". There was no discussion over high and low fistulas which I feel is important in diagnosing this above given all that hopetoheal has told me!
Either way, I'd like to get some clarification from a different surgeon. I have an appointment booked on November 29 with my doctor and I'm still trying to look for names a surgeons with good ratings that I can ask her to refer me to. I work in Kitchener, and I live in Milton so anywhere from Kitchener to the west end of the GTA is good for me, so if anyone has any recommendations that would be great.
Once again, thanks for all the support and education. This forum is a great thing.

Hey i hope yours suffering has ended, im in ottawa and dr bouchey is one of the best here check him out onlinen:)