I am a 28-year-old gay man living in Toronto, Ontario. I found this website to be very helpful to look through when I was going through this whole process and so I thought it was important for me to write about my experiences. Also, I found there was very little discussion on these websites from the perspective of a gay man, which I think is important to have because one of my biggest fears was (and is) that I will not be able to have sex again after this fistulotomy.
I've had a history of small fissures and haemorrhoids since about February 2012 when I first developed a fissure using a sex toy. They come and go now and then, so I've been very careful over the last few years having sex. In August 2016 when I had sex with my partner, something felt like it ripped and I was bleeding. I went to bed and woke up in the middle of the night with full-body shivers (I had no control over my limbs which were almost comically moving around) and a heavy fever. I went into the Hospital and they diagnosed me with bacteremia (which we later figured out was caused by an infected abscess).
Shortly after the hospital visit, I felt a pea-sized lump just on the outside of my anus. I went to my family doctor who thought it was a hemorrhoid. I wasn't convinced as I had had hemorrhoids before and this felt a lot harder than a hemorrhoid. It was also regularly discharging and bleeding (only spotting). I asked my doctor for a referral to a specialist and he sent me to the Rudd Clinic in Toronto.
For anyone from Toronto, I would consider going elsewhere. First, I've had two experiences there and in both I felt that they were not comfortable with gay men, or at the very least not comfortable discussing concerns of a gay man. I also felt like they were dismissive of my questions/concerns. My doctor started trying to push a fistula probe through my fistula without warning or consent, which was extremely painful. I went to my family doctor and pushed for a referral to Dr. Burnstein at St. Michael's Hospital instead.
Dr. Burstein was fantastic. He took his time with me, answered all of my questions and was comfortable discussing my concerns about being able to have sex again. Essentially what he said is there are no guarantees, as the scar tissue can feel differently for different people. That being said, he correctly pointed out that I was probably unable to have sex with the fistula as is, so it can't get any worse. So I decided to go ahead with it.
I had my surgery on December 2, 2016 - just about a month ago. I did it under general anaesthetic and it lasted about 20 minutes. I woke up in the recovery room and was pretty out of it. I maybe had up to a 3/10 in terms of pain at this point - they were managing it well. It turns out my fistulotomy was fairly superficial, with the entrance and exit fairly close to the anus.
I was discharged home about 4 hours after surgery. My doctor told me that some people go back to work within a couple of days, but that some will take up to 2 weeks off. I didn't want to take a chance that I would set it back so I decided to take the full two weeks off (while just answering some e-mails here and there).
The day after the surgery I had to take out the packing gauze, etc and have a bath to clean it. I was told to have a bath 4 times a day and every time that I had a bowel movement. I used a mix of a sitz bath in the toilet and full baths - too much effort to do a full bath every time. The gauze came out fairly easily without much bleeding. The cut looked gross (it seriously looked like someone took a melon baller to my anus!), but it was not very painful.
I was on hydromorphone for pain, which I stopped taking after 48 hours because I was having some constipation. I was very nervous for my first poop, and probably ended up pushing too hard the first time I pooped at about 65 hours post-surgery because I mentally just needed to get past that first poop. Try not to rush it like I did, as it was a bit more painful than it had to be, but even then, it was only a 4/10. I would wipe with baby wipes after each bowel movement.
I was told that I didn't need any nursing care and didn't need to repack the gauze. It was recommended that I use menstrual pads in my underwear, mostly to protect my clothes from the bit of discharge and bleeding that was coming out. I used the Always light flow pads, which were mostly not a problem, though the sticky wings would sometimes catch on my thigh hair which was painful! More painful that the surgery site to be honest!
I didn't sit down for the first two weeks as I didn't want to put pressure on the area. I did a mix of lying down and standing (I set up a pseudo standing desk at my kitchen counter and played on my computer there). I also limited my walking in the first two weeks as I found that even walking 200 metres around the corner to get a coffee made the surgical site feel uncomfortable. Though I really limited my motion, I'm not sure it was necessary. It made me feel better that I was taking care of it and doing the best I could for my recovery, but I probably could have pushed myself more. I also could have probably pushed myself more if I had continued with the pain medication. Through this whole process, I never hit more than a 4/10 on the pain scale, and that was rare. I would say most of the time was a 1-2/10 or just discomfort and not pain.
My first time going out for a longer walk (30 minutes long) about 2 weeks post-surgery felt OK. When I got home, though, I had more bleeding than any other time for about 5-10 minutes. That never happened again after.
At the two week mark, I started walking around more and sitting for up to 2 hours. I was still trying to limit my sitting as much as possible. At the 3 week mark I saw the surgeon again. He said it was healing great and that I didn't have to see him again. He also encouraged me not to cancel my trip to Vancouver the next day (a 5-hour flight). He said it may be uncomfortable, but it would not set back my recovery at all or aggravate the surgical site. He just said to avoid hot tubs, etc and try to stand on the flight as much as possible. So I went out and spent 5 days over the holidays in Vancouver. The flight was uncomfortable, but I sat on one of those doughnuts and was probably up for 10 minutes every 30 minutes.
I'm now at the 4 week mark. I barely have any bleeding/discharge - just a small amount here or there. I'm having very regular bowel movements which generally aren't painful - sometimes a bit irritating but that's all. I still have a bath after every bowel movement, but my doctor said it wasn't strictly necessary anymore. He said the whole thing should heal up within another 6 weeks and that it is very rare for it to recur.
All in all, this was a very easy recovery despite my anxiety leading up to it. The pain was generally very low and it didn't take long for me to become mobile again. I'm now back at work full time and that is going well (though it's awkward carrying around baby wipes to the bathroom!).
I should also note that I think I had what was probably one of the simplest fistulotomies out there, so this may not be everyone's experience. But I know as I was researching I read some horror stories and freaked out that would be my experience. I wanted to let people know that the stories are not all bad. If anyone has any questions, feel free to get in touch.
I will update this thread at the two months mark and then keep people posted if I am able to successfully have sex again. My bet is I won't try for a year just to be absolutely safe.