The article, “My Anal Fistula Journey-What To Expect” does not contain medical or health advice. The content is based on the author’s personal experience and is narrated for general informational and educational purposes only. It is not intended to replace professional advice. Therefore, prior to taking any action based on any information from the article, we strongly advise you to consult the appropriate professionals.
If you are reading this article, chances are that you have or have had an anal fistula. We can all agree that it is a medical condition that is painful, recurrent, irritating, and equally embarrassing. We hide it, don’t talk about it, tolerate it, and quietly suffer from it. But for how long? What is the remedy? Can medications cure it? Or is surgery the only way out?
I endured this condition for extended periods of approximately ten years. I attempted medications, exercises, dietary modifications, and lifestyle adjustments without success. With the exception of a white, pus-filled mass in the inner curve of my left buttock or in the external region of my rectum that caused unbearable pain, itching, and discomfort every two weeks, I did not develop significant concern until I felt an additional lump growing beneath the skin directly above the rectum. That region was elevated, and I felt as though a grape had been inserted beneath my skin. Nonetheless, the fact that the foreign growth beneath my skin was not painful was alarming. At that moment, I made the decision to have it surgically removed.
Before diving into what comes next, I would like to briefly define a fistula and distinguish it from hemorrhoids and fissures due to the widespread misconception that they are identical in nature.
Hemorrhoids: Often referred to as piles, hemorrhoids are enlarged, inflamed veins in the rectum and anus that bleed, hurt, and cause itching. Although the precise cause of hemorrhoids is unknown, constipation, diarrhea, and straining during bowel movements are thought to be the main contributors to their development.
Fissure: An anal fissure is a tiny tear in the anal canal. During and after a bowel movement, patients most commonly complain of bleeding and sharp pain in the anus. Once more, constipation is typically the main cause, with the skin being overly stretched to allow the passage of waste.
Fistula: A thin tunnel with an external opening in the skin near the anus and an interior opening in the anal canal is what is known as an anal fistula. The anal glands, which are situated between the internal and external anal sphincters, are the source of anal fistulae, which leak into the anal canal. Blockage of these glands’ outflow can result in the formation of an abscess that may later spread to the skin’s surface. This process results in the formation of a fistula.
A qualified doctor must assess each of the previously mentioned medical conditions. It is estimated that 50% to 70% of individuals will encounter complications associated with hemorrhoids, fistulas, or fissures at some stage in their lives. Both males and females of all ages are impacted, although those aged 45 to 65 are affected the most. Failure to maintain a balanced lifestyle and a healthy diet may result in the recurrence of these issues in the near future, even following surgical intervention.
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Meeting the Doctor
Fistula enlargement and fluid discharge occurred once per month in the past. By December 2023, however, it had occurred a minimum of four times per month. The intensity of the pain, itching, and distress increased with each passing month. And for an individual such as myself, who works remotely, maintaining a seated position for ten to twelve hours on a daily basis was becoming an absolute challenge.
Eventually, I got an appointment with the physician, who advised that I undertake surgery without further ado, as the mass beneath the skin was an abscess that, if ruptured, could cause internal organ infection and other complications. Fortunately, this elevated mass beneath my skin was detected, which prompted me to seek medical attention.
For certain individuals, however, the presence of an abscess collection beneath their skin goes unnoticed for an entire lifetime; by the time it is detected, additional prostrate and genital disorders have already developed. Consequently, those individuals experience prolonged and complicated surgical procedures. The expenses associated with the surgery escalate along with the risks and recovery time.
However, I was fortunate in that the recovery period would be approximately 10 days and the operation would last only 30 minutes. Within one, I would be released from the hospital. The physician observed that in addition to the anal fistula, I also had moderate fissures and hemorrhoids, both of which required surgical intervention in order to avert future incidents. The specifics of my operation are detailed below.
Laser ablation of fistula tract
I and D of perianal abscess
Laser fissurectomy and sphincterotomy
Laser haemorrhoidectomy
Lift procedure for perianal fistula
Now, I honestly didn’t know what these names meant until I researched the internet. But one thing the doctor reassured me was that it is a painless procedure with a high success rate, faster healing, minimal bleeding, and a reduced risk of infection. Hearing all of that gave me the necessary confidence to agree to the surgery. But I made one mistake. I underestimated the recovery time post-surgery, which I will discuss later in the article.
At the Hospital
Day 1
My first day was all about the tests and ensuring that my insurance would cover all the costs. Since I will be under the effects of general anesthesia, the doctors and nurses did almost all the tests related to my heart to check whether I will be able to absorb anesthesia or not. They were an ECG, an echocardiogram, and an X-ray of the chest. They also collected my blood and did all the routine tests like RBS, HBA1C, LFT, thyroid profile, urea, creatinine, all the hematology and serology parameters, and a routine examination of my urine sample. Later in the day, I got ready for an MRI fistulogram, and by day’s end, I was fasting and drinking only Coloprep for my colonoscopy the following day.
Day 2
I had my colonoscopy at 10 a.m. in the morning after spending the whole night having watery bowel movements. I was sedated, so I do not remember anything. After waking up, I was told that the surgery would commence at 2 p.m. Around 1.45 p.m., I was taken to the operating room. After some initial, final-minute checks, I was administered two anesthetic injections into my spine. Frankly, I was a bit worried about how an injection would feel on my spine, but it felt like nothing more than a mosquito bite. A few minutes later, my lower body went numb, and the surgery began. I felt absolutely nothing. Everything went perfect. After the surgery, the surgeon showed me the drained abscess and the infected muscle and tissue that were removed. I was taken back to my room. I felt relieved that the surgery was finally over after 10 years of suffering. But little did I know what awaited next.
It was around 6 p.m. when I started feeling my legs back, accompanied by an intense, excruciating pain in my rectum. It was only the beginning. That pain was unbearable, and it felt like someone stuck a ping pong ball inside. I couldn’t sleep or rest. The pain was getting stronger. Every second felt like a minute, and every minute felt like an hour. I was barely managing myself. I ate a little at around 9 p.m. and started feeling nauseous immediately. The nurses were constantly administering medication through my IV, but the pain was constant and not going away.
Time passed, and it was around 3 a.m. when I wanted to urinate. Again, little did I know what awaited me next. I went to the toilet but couldn’t urinate. My bladder got bigger, and my pain got worse every second I remained standing on the toilet to urinate but couldn’t. I needed help immediately. I informed the nurses, and a doctor came in with a urinary catheter as if they were already prepared. Of course they were. I was the fool who didn’t foresee this.
Honestly, I don’t even know if that pipe is called a urinary catheter or not. Because a urinary catheter is normally attached to a bag at the end, right? And the pipe is generally about 3 feet long. But that pipe that the doctor had in his hand was only about 1 foot and was thinner compared to the thickness of a urinary catheter. The doctor started inserting that pipe into my penis and started poking it inside, and it felt like my soul was leaving my body. That was the worst experience I ever had. And believe me when I say this: I have busted my head open several times during my teenage years and had plenty of sutures and surgery experiences before, but this urine-draining experience was definitely my worst.
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Day 3
Around 9 a.m., I had to urinate again. I was hoping and praying to urinate naturally. I stood on the toilet for about a minute, and voilà, there it is. It was only a few drops, but it was natural. I was smiling again. But there was a huge burning sensation inside. As per the nurses, it was the medications in my blood stream that were causing this burning sensation inside my penis. I felt like my genitals were on fire.
During this entire period of time since the surgery, I was constantly feeling this rectal pain, which was unbearable and intolerable. I even had to adjust my breathing to deal with it. I was walking with my buttocks up. Then a male nurse entered my room and said, “It’s time.” But time for what?
He asked me to face the wall, spread my legs, and put my hands on the wall. It was like he was going to frisk me for carrying firearms or something. He told me to take a deep breath, and then he pulled something suddenly out of my rectum. I screamed out in agonizing pain.
Now, do you recall my previous remark that it felt as though a ping-pong ball had been inserted into the rectum? Well, it was a gauze bandage that was stuck inside to hold the dressing in place and control the bleeding. A little while later, after the gauze bandage was taken out, the pain dropped a bit.
It was in the evening when some final discussions took place about my health, and I was getting ready to be discharged. The insurance covered all the costs, my transportation was arranged, and I thanked the hospital staff for their service. I was going home.
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Back Home
Now, folks, this is not the end of this article yet. My time at the hospital was only Round 1.
After returning home, I was getting ready for my first bowel movement. It is something that I could inadvertently avoid during my stay at the hospital because I was not eating much. But that was going to change now that I had returned home. Eventually, I had to go after a day of eating boiled vegetables and fruits served by my lady.
I realized that I could not strain my bowels and had to allow the clearance to take place naturally. It was a moment of severe pain and intense burning. The experience was so painful that my body started to shake, and I couldn’t tolerate it any further. There was a bit of bleeding present in the stool, and I figured out that the next 2 weeks will be horrible. After the defecation, I had to take the “Sitz Bath.” It is where you fill up a tub of hot water mixed with betadine and sink your buttocks in it. So then I was experiencing burning and pain, which escalated even further the moment my rectum came into contact with hot water.
This process of taking a sitz bath was to be repeated several times a day. The more, the merrier. But just like the saying goes, to reach heaven, you must pass through hell. Clearing my bowels became a nightmare, and I had to prepare mentally every time I went to the toilet. I even began smoking to get through the pain. Now, I am not promoting smoking here, but I needed some kind of stimulus to help me get through that intensely painful experience.
Now, after the bath, it was time to dress the wound. It was something that only my wife could do, as I could not see my own rectum. Yes, using a mirror was possible, but for the first week, my pelvic movement was automatically restricted due to the pain.
I turned over on the bed, lifted my buttocks up for my wife to apply the cream, and complete the dressing. And then my wife gave me the good news. And that is, I still have a bit of poop on my rectum. The bath was for reducing pain and swelling, but my buttocks were so puffed that I could not reach my rectum with tissue or cotton swabs. I tried my best to clean it as much as I could, but that was not enough.
Then, my wife came up with an ingenious idea to clean my rectum and apply the cream.
Introducing- Q-tips.
Yes, ladies and gentlemen, Q-tips are what we use to clean up the ears. I never thought of using that anywhere else. The approach to using this technique was cautiously carried out. My wife was patient and took her time. The cleaning and dressing of the wound took 15 minutes. The accompanying pain came free of charge.
And now this whole shebang of clearing the bowels, taking a sitz bath, cleaning the rectum, applying cream, dressing the wound, etc. was repeated several times a day, and it lasted for 2 weeks. It was a painful and time-consuming experience. After 2 weeks, the pain began to drop, and I was able to manage this process by myself. After the third week, I resumed work again.
Medications
I won’t name any medication here because it differs from patient to patient depending on medical history and conditions. But some of the most common were medicines to prevent infections, nausea, acidity, vomiting, heartburn, a bloated stomach, etc. There were antibiotics, painkillers, stool softeners, medicines to improve blood flow and blood clotting, medicines to reduce swelling and inflammation, and other gels and ointments to reduce burning, itching, and discomfort.
Post-Operative Care
My follow-up appointment was scheduled after 2 weeks, but I had to postpone the appointment by another week because I was still having a little bit of bowel incontinence. My ability to hold on or keep my rectum closed to prevent incontinence was still not at 100%.
I was advised to consume a fiber-rich diet and drink plenty of water. I was told to not miss any medication and apply the cream and jelly consistently, even if the pain is getting better. I was prohibited from eating any oily food or any other fast food. My wife threatened to kill me if, by any chance, she found out that I was ordering food from outside when she was not home. And I don’t blame her, especially when she had to clean poop off my rectum for 2 weeks. But honestly, I didn’t know if I could stay away from chicken wings, a lamb steak, a pot roast, or barbecue ribs. Yummy!!!!!
So far, it has been one month since my surgery, and my life is back to normal. I am blogging again, running, exercising, working, shopping for groceries, and clearing my bowels daily without any pain. Recovery was taking time because my rectum was not getting any rest as I was constantly clearing my bowels. Eating junk food also stopped. It had to. I cannot allow myself to go through that painful experience again. Fistulas, hemorrhoids, and fissures are notorious for coming back in the future. A balanced lifestyle with proper sleep and a healthy diet can prevent that.
So, “That’s all, folks!” I hope this article helps in providing you with an insight into what this anal fistula is all about. It is a medical condition on a very private and delicate part of the human body. So obviously, I couldn’t use any pictures. Who would want to have a look at my crack, right? But please make sure to consult your physician on what could be the right approach to dealing with this condition, if you have one. There is nothing to be embarrassed about. There is nothing to hide. Consulting with your physician about this condition sooner rather than later would be the wise approach. Then you can make an informed decision on how you want to proceed next.
Thanks for reading. Good Luck.
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