My fistula story - success

So far, so good.

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My fistula story - success

Postby ctrl+fis » 17 May 2021, 02:53

I'm a 51 yo male, fit and in good health. I'm here to share my personal fistula story, a successful one, with the forum in order to give something back, since the contributions here were a big help in the process, both in terms of encouragement and information. Please bear with my English, as it's my fourth language.

My fistula story started back around August 2020, when I noticed I small, pea-sized lump in my anus. It didn't hurt, so I either got used to it, or it disappeared, I don't remember, and in fact eventually I forgot about it.

No news until December 2020, when I started eperiencing some disconfort in my anal area, a burning sensation. I waited a few days, and since it wouldn't go away, I did some research online, found a good proctologist, and made an appointment with him for the last days of December. I hoped it would be some kind of hemorrhoid, even though I've never had any issues with BM (on the contrary, I tend to have between 2 and 4 daily).

During the appointment, the doctor inspected my anus with some kind of device, and told me that I had a fistula, explaining to me what it was. He found the entry and exit points, and drained quite a bit of pus. He told me it was a simple fistula – not complex, and likely not too deep either, no muscle involved – and that most likely I should have surgery. He told me to return a couple of weeks later in order to see how things developed.

I returned around mid-January and the doctor confirmed everything he said on the first appointment, and again drained pus. I did not have real pain, just discomfort and some stinging/burning. By now, I had done my research – thanks to this forum and other places! – and got to the conclusion that there was no real way around surgery, and that time would not be on my side. He confirmed all this – time could only complicate the situation, the fistula could only get worse as there was no real chance it would heal by itself. So I decided to go for surgery asap, before the covid situation could have operating rooms closed again (as it had happened months ago), and also in order to take advantage of a few months of permanent work from home (I usually work from home anyway, but no work trips etc.) and little leisure activity ahead. My wife came with me to this appointment (we're not married but 20+ years together and very happy), and on this occasion the doctor explained to us where the fistula was located exactly (a small tract in the lower section of the anus, hardly involving any muscle), what his plan was for the surgery (not cutting the fistula open, but rater removing it completely), and the kind of dressing my wife should put in the wound after the surgery (very simple: just a small piece of bandage sort of rolled in the shape of a small cone, and placed right where the fistula was and where the wound would be).

Surgery was scheduled for February the 3rd. I did the preop tests (including covid PCR) in the previous days, and also had a phone conversation with the anesthesiologist (a very nice lady). I had my fair share of worrying during the three weeks leading to surgery. I was mainly worried about pain and BMs after surgery – the idea of the latter was something that I had a hard time dealing with, for obvious hygienical reasons. I did share this with the doctor, but he explained to me that it was going to be fine, that since no muscle should be involved, BMs would be painless. I should just shower and dry the area carefully after each BM (with a hair-drier set in cold mode), and it would be ok. He said that the paradox is that open wounds do not get infected if kept clean, it's bad closing that can cause problems. Still, the idea of stool passing right were a wound would be was something that I found hard to live with.

My personal paradox was that as surgery approached, I was more calm instead of more nervous. I didn't expect that, but this is how it went. I guess it was mostly a sense of inevitability, a feeling of "ok, since I'm gonna do it, lets get it over and done with asap". I guess I'm quite a rational guy deep down, after all.

On surgery day, me and my wife walked to the clinic in the morning (a 45' walk), knowing that I wouldn't be doing much walking on the next days (I'm usually a very active person, I walk and cycle a lot, exercise, take long mountain hikes). I was really very calm – as said, I had been more worried earlier, but as surgery approached I unexpectedly became very cool and even optimistic (I'm usually rather pessimistic). I checked in and waited in my room to be taken to the operating room. I was told that most likely I'd be able to go home that same evening, but if that was not the case, I could spend the night in my room (needless to say, I hoped that would not be necessary).

Once I was taken to the operating room, I had a chat with the anesthesiologist, agreed again on just inhaled anesthetic (I don't know the technical term), and a few minutes later I was sleeping like a baby. I recall waking up very peacefully, like from a good sleep with pleasant dreams. I just felt some vague, painless soreness around my butt – like there was something stuck around there. While I waited to be taken to my room, the doctor came around and we had a chat, he said there had been no surprises, he excised the entire fistula tract, that was neither long (around 2-3cm if I remember correctly) nor too deep (no muscle involved).

I was taken to my room, my wife was waiting for me there. I was ok. The main discomfort was in my throat, that was extremely dry. As soon as I was allowed, I gargled an entire bottle of water in order to clean my mouth and throat (I'd spit murky white water) before I even swallowed a sip. I had the feeling that all that "dirt" in my mouth and throat had to go out before anything could go in!

Then I started sipping a bit of water, and had a pee. I had been given some kind of strong painkiller for the post-surgery pain in my butt, so I felt no pain. The doctor came around and gave us some instructions for the next days, as well as some prescriptions for two kinds of painkillers, I should alternate them every 4 hours for a few days. He also prescribed an antibiotic ointment, that should be applied on the wound morning and evening. He told me that as soon as I felt like leaving the clinic, I could do it.

I felt ok, so after some three or four hours I got dressed and went home. We walked to the taxi stand and took a cab. I tried to sit on one side of my butt to avoid putting pressure on the central part. It was ok.

Once at home, I had a light dinner and went to bed, but set the alarm clock in order to wake up for the painkiller. My wife changed the dressing and she saw some kind of gauze package inside my anus – this is one of the moments in which some of my previous reading proved useful, since I knew that most likely that was the kind of self-dissolving bandage I had read about (the doctor and nurses could have mentioned that, too, but didn't). I didn't have much trouble sleeping, nor felt a lot of pain. In the morning, I had my usual breakfast (fruit, oatmeal, rooibos tea) and had my first dreaded BM. It went absolutely fine, I didn't feel anything really special. I jumped right into the shower and cleaned myself carefully but thoroughly. After that, I had a sitz bath, just with water. This would be the routine, but tbh I had the feeling that what really did the trick was the shower part, I didn't feel much difference with the sitz baths. But I did them anyway: twice a day, plus one after each BM (which would easily be 2-3 more in my case).

The following days were ok. I felt no real pain, just some mild discomfort now and then. But I was on painkillers, so that was normal. I had surgery on a Wednesday, and by the weekend I felt I could easily ease on the painkillers, so I whatsapped the doctor and he told me I should stick to them for a couple more days, and then I could stop gradually. I did that, and started feeling a constant sort of burning sensation. Nothing dramatic, I could pretty much lead a normal life, except I would work lying down instead of sitting, and I wouldn't walk too much – but a bit more, and a bit faster, each day.

I had a first appointment with the doctor 10 days after surgery. He told us everything was ok, I should use the ointment a couple more days and then quit. For the rest, just take some painkillers after my wife would take care of the wound, as a white substance would appear and she should remove it with a Q-tip, and this could cause some bleeding and pain (the doctor did it during the visit and yes to both, but nothing major).

I remember that on the following weekend, after a cure, I experienced the only painful episode of my entire experience. It really hurt. I had to go out for an errand and walking a couple of blocks and back was hard. But that was it, I took a painkiller and the pain eased after a while. Pain-wise, my experience is similar to that of previous posters – I did have the feeling that the body needed a certain amount of pain/discomfort in order to respond and heal itself. The painkillers just postponed that moment. So you have to relax and endure some moderate pain in order to really start healing. But it's not a lot, in my case it was mostly a constant burning sensation that caused discomfort, but not much more than that.

It's not nice to get used to a constant stinging in your ass, but in my experience that's what you should expect for a few weeks. Re. discharge, I'd find some when changing the dressing every few hours. My wife helped me with it the first days, but soon I'd do it on my own – just fold or roll a piece of bandage and stick it in there. Gradually, the discharge changed from rose (I guess there was blood in it, but I never saw much) to yellow. It also became thicker, more mucus-like. I remembered my childhood scraped knees and the yellowish mucus-like substance that would appear in the open wounds before the scab would form. I don't think I had seen that substance since then.

The next appointment with the doctor had been set for one month later, some 5-6 weeks after surgery. During that time, I whatsapped him twice. The first time, to inform him of the changes in the discharge, and of the fact that the wound was not really hurting anymore, and that I was not wearing any dressing while walking, because by now I was walking quite a bit and I felt that the bandage irritated my anus when I moved (not necessarily the scar, just around that area). I had the feeling that most of the burning pain came from the irritation caused by the dressing. And in fact, getting rid of it while moving helped a lot. The doctor said everything was fine. The second time I whatsapped him was just a week before the appointment, because my wife said that the wound was healing pretty fast now, and we were not sure that was ok. He had told us that the scar had to heal from the inside out, and I had also read about it, so I wanted to make sure it wasn't closing the wrong way. The doctor was cool and said that the wound had to heal and that he'd check it out next week, that we didn't need to worry. We just had to keep the wound clean and that was it.

On that appointment, the doctor confirmed that everything was ok and I was healing well and quickly. I have to say that I kind of expected that would be the case, because I have a very fast metabolism, and despite my age, wounds still heal quickly (albeit not as quickly as when I was younger), and hair and nails grow pretty fast. I guess the 2-4 daily BMs have to do with that, too.

The next appointment was set for two months later, a bit later than three months after surgery, because his schedule was pretty full. That was last week, mid May 2021. Around mid April, some 10-11 weeks after surgery I had the feeling that I was pretty much over it. I started using gradually my bycicles again, and that was a clear sign that I felt that the area was ok. Somewhat tender, of course, but ok. No more discharge, no more stinging or burning sensation – not constant anyway. I went alone to the appointment last week – actually, I cycled there – and it was really a 10 minute one. The doctor just had a look, touched the scar a bit, and confirmed that the wound had healed completely and that I could go back to my normal life. I told him that I still feel the need to clean myself thoroughly after each BM, and he said that it was always a good standard practice for everyone, but that if I couldn't do it, it was safe now. I asked him whether the fistula could come back, and he answered that if it did, it would not be related to the previous one. He said he was fully and officially discharging me.

So all in all, I'd say that the more distressing part of the entire episode was the stress and the worrying of having an issue – and later a wound – in that specific part of the body. It's psychologically destabilizing, so you have to do your best to keep your head cool. The pain was never unbereable – nor with the fistula, nor with the wound – and most of the time it was more discomfort than pain. For me, the entire episode lasted some five months since I started having discomfort until I healed the wound, and about two and a half months to get well after surgery. I find it important to note that the healing process always was of the "two steps ahead, one step behind" kind, so you have to be ready for regular setbacks. In my experience, they're normal. Even now, I feel completely healed but since the area is tender, I may have a few days with some minimal discomfort, and then go back to no discomfort at all.

My conclusions based on my personal experience are: 1) I was lucky to have a low and superficial fistula. I'm aware that complex fistuae imply much longer and tougher processes, that may have very little to do with mine. If that is your case, I feel sorry for you and you have all my sympathy. I guess you should be ready to multiply my patience and endurance x100 times. 2) It was good to make an appointment with the doctor asap, and to do some research in order to choose a really good one, with lots of experience. It was also good not to wait for surgery, as I can't see anything good coming from waiting (as I said, that's when I was under more psychological stress). 3. After surgery, you should focus on keeping the area as clean as possible. The lower the fistula, the easier to do that. I guess that making sure stools are soft is important too, but for me that was easy, as I can't recall ever being constipated in my entire life. 4. Be ready for an irregular healing process, focus on the bigger picture of progress, and keep a healthy lifestyle (good food, active life, enough rest).

Take it easy and be confident and patient. Good luck to y'all!
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Re: My fistula story - success

Postby patience_and_healing » 05 Jun 2021, 00:54

Thank you for the detailed account of your journey to being healed! May you never have to deal with this again.
8/16-12/16: Fissure due to antibiotics
5/17: Botox to sphincter, fissure healed
9/19: Trigger point injections and pudendal nerve block
11/19: Botox to pelvic floor
8/20: Botox to pelvic floor in new location.
On and off in pelvic physical therapy
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