Hi Mizar,
I also had the fistulotomy recently and am also in the process of recovery. For the BM's I have also been eating dried prunes and taking prune juice ...you could also try those. If the pain is very strong, it might be better to take the pain meds (even constipating ones but perhaps you can regulate the frequency). I was explicitly told in the post-op recovery to "not tough it out" and take the pain medicine (when pain is intense) and take the stool softener, laxatives etc to counter the constipating effect of the pain meds. Hope this helps.

I agree LordTrinity - I was told the same thing! The pain meds are prescribed for that very reason - I actually took my pain meds prior to packing changes and prior to BMs. Prune juice also helped me out during those early days. Any luck?

Okay, 2:48am, 18 Nov and still no BM. I have a flight to catch at 6:30am and the clock is ticking. Man am I nervous.

Hope the flight was okay! I think it'll be much better once you're back in the comforts of your own home. Keep us posted!

Okay had my first BM this morning after sitting on the toilet for over an hour. The pain was excruciating. My concern now is keeping it clean. I couldn't wipe or dap, but did jump in the shower with the hand held and then did a sitz bath. Still some waste in the sitz bath. Took a bath about four hours later in epsom salt and still some waste in the tub. Should I be concerned?

keep as sft as you can ,loads of water ,keep on as you are doing ,maybe try to spred your buttocks a bit, .stay in the shower using the hand held for as long as you can,are you seeing a nurse ,so she can keep an eye on it ,how big is the wound ,and how deep ect.

It does get better! Are your wound openings deep? I found this is what works for me - wipe with wet toilet paper or baby wipes, rinse thoroughly with handheld shower (best to squat so that the water can spray in there), sit in sitz bath. I have the sitz bath that fits over the toilet. The "waste" you are seeing may just be wound exudate. I find I had quite a bit of that for a few days post-surgery. I also had lots of random bleeding. It died down after about 10 days.
I would recommend keep replenishing the water in the sitz bath with clean water until you see that it's clean. I usually do that.

To be honest, I dont know how deep the wounds are. I just know there was no muscle involvement. The surgeon said I wouldnt need to see a nurse, but to just change the gauze. I did make an appointment to see a doc at the local VA on Friday to check it out.

No muscle involvement is a very good thing! :)
Hopefully the doc can give you some answers.
I actually just came back from a followup appt - It's been 5 weeks since my surgery. I'm thankful to know that everything's looking fine. The nurse seems to think the seton has cut through and is a little lower now. I'm really hoping it will all heal up and fall out on it's own - really don't want to go through surgery again!

Mizar,
Sorry to hear your first BM was so painful....don't wipe or dab at this stage! Use the hand held to rinse all the debris off. Do this gently and be patient...there might be more to come out then you think. Then, finish off with a Sitz bath or better still, I take a regular bath to relax and clean the area and then finish off after with a final shower sprinkle!..
Good on you for avoiding the codeine. I did too - no way I was putting myself at risk with constipation!
As far as the waste goes, it could be due to the type of stool you are having. If it's less solid and more "flakey" and less binding, then it takes a lot longer to clean up than a stool which is more solid and binding (but still very soft!)
I find sometimes, if my stool is of this flakey consistency that I can also find some minor debris later, that either was not cleaned properly in the first place or perhaps "worked its way out" a bit if I pass gas. I'm not sure but it doesn't often happen and I'm sure for you is nothing to be concerned at at this stage. Always check with a GP if any doubts.
Don't forget also you also had surgery on 5 fistulae! So the recovery might take a while longer and be different to someone who had a simple Fistulomy for one fistula....
As far as laxatives go, I would not take them unless absolutely necessary and you are having issues going to the toilet. If you are passing stools easily, keep up with a regular stool softener to keep things soft. Olive Oil is a great addition to helping lubricate the area (I take a tablespoon of Extra Virgin before bed!) Perhaps - you also need to add a little more fibre if the stools are "falling apart". You need almost a mushy pea/ soft whipped icecream consistency at this stage in your healing but one that "holds" together. Hope that makes sense???
Don't be too concerned but just chat to your GP/ CRS if you are unsure about anything. :)