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Does Fistula Surgery Hurt?

August 15, 2014

Does anal fistula surgery hurt? Yes, fistula surgery hurts. In fact it hurts more than just about anything I have experienced and that includes both vaginal births and c-sections. What follows is a description of what you can expect following anal fistula surgery including pain level, recovery time and treatment if necessary.

I’ve had fistula surgery twice now, each time with the placement and eventual removal of a seton which means I’ve had four surgeries on my ass. Not all fistula surgeries include seton placement and in fact there are many different procedures for fixing an anal fistula (warning, graphic image). Many times the doctor won’t know which procedure they are performing until they get in there and dig around a little.

So just what is an anal fistula?

Anal fistula, or fistula-in-ano, is an abnormal connection between the epithelialised surface of the anal canal and the perianal skin. Anal fistulae originate from the anal glands, which are located between the two layers of the anal sphincters and which drain into the anal canal.  – Wikipedia

What this means is there is a hole or tube from your anus usually through your butt cheek. An abscess forms when the outlet is blocked. This is painful. It’s like a huge boil and relief usually only comes with lancing the abscess or if it bursts through the wall of the anus and drains out the rectum. Draining provides relief but if the underlying issue isn’t resolved you’ll continue to have abscesses.

I first started dealing with this issue when I was about 22 years old. That was over 20 years ago. I had an abscess that at first itched a little but then eventually became so painful I couldn’t sit without considerable pain. I worked in my father’s medical practice at the time and he was sure it was a pilonidal cyst. I scheduled an appointment with a proctologist in the building and had it lanced on a dreary Good Friday afternoon. Relief was immediate and aside from a little drainage I was totally cured.

And then a couple of years later it was back with a vengeance. Because it was a weekend I couldn’t secure an appointment with a doctor to have it lanced for two days so I took matters into my own hands and lanced it myself. While I don’t recommend you lance your own abscesses I’d seen it done enough to have a general idea even if I couldn’t see what I was doing. I did take the care to sterilize my paring knife.

Again relief was immediate and I went on about life.

I could go years without having any trouble and then it would come back, always worse than the time before. Eventually I ended up in the ER with a doctor who didn’t think it was a pilonidal cyst and was convinced it was a fistula instead.

Honestly I didn’t understand the distinction and even today I am not sure if it started out as a pilonidal cyst but then turned into a fistula. I don’t know but I was finally referred to a doctor who insisted on removing it surgically so I didn’t have to keep going through the pain of the abscess.

Surgery was scheduled and it went very well. I had local anesthesia though I was asleep during the procedure I was breathing on my own. Recovery from anal fistula surgery, placement of the seton (warning, this is a graphic image), was also unremarkable. I had a little soreness the first day but I never even bothered to fill my prescription for Vicodin. The worst part about the first surgery was coming out of the anesthesia. I woke up very depressed. It lasted only an hour but it was pretty bad. You can read more about my first fistula surgery here.

Surprisingly it was not difficult or painful to have a bowel movement. I had been sure to get plenty of psyllium each day (Metamucil) so my stools were firm yet soft which made the need for wiping minimal. That was the key, not having to wipe too much. I also took several sitz bathes each day and that helped to keep the area clean but also provided an opportunity for relaxation. Unclenching the butt cheeks is a scary thing to do following surgery.

I had a seton in place which was basically a string that went through the canal. Generally speaking it didn’t hurt to have it in place but if it got tugged while wiping it could cause a little temporary pain.

There was drainage, which was expected, and I used gauze between my butt cheeks to absorb it.

The next surgery, the one to remove the seton, was schedule a few months later and while a little more painful it was pretty much the same recovery. A little sore but never a need to fill my prescription for pain killers.

At my post op exam the doctor said it looked great and that drainage could continue for quite some time. I’d been dealing with the drainage for years and as far as I was concerned as long as it was draining it wasn’t forming an abscess. Drainage wasn’t painful, not draining was extremely painful.

And life went on. Years went by and it never occurred to me that maybe the drainage should have stopped. Until it did and then things got bad.

With no drainage I had a huge abscess which was hugely painful. I went down to the ER again and sat there, yes, sat there, for 4 hours only to be told it would be hours more before I could be seen. I didn’t live far from the hospital so went home to bed after acquiring some pain medication.

I called the doctor the next day and got an appointment in his office with another doctor on staff. She took one look and said it was time to do the surgery again.

“Great.” I said. “While you’re down there can you please lance that motherfucker?”

She laughed and sliced it open with skill.

Sorry this is taking so long. If you’re still with me we’re almost done.

I scheduled the second procedure, again a two part procedure, after having an MRI to make sure everything was in order. I suspect they were looking for indication of cancer but I wasn’t worried about that.

The first surgery, the one with the seton placement, went just as the first one did. I had it at the beginning of the summer and had made plans to go camping, across country, a week after the surgery. Again, I never filled the pain killer prescription. Though I did take 3 ibuprofen every 5 hours like clockwork. Camping meant a plane ride and hours in the airport lugging a child and luggage around. Maybe not the smartest thing but aside from a little discomfort I was ok.

The second surgery was scheduled two months later and I was sure it would go the same. When they were prepping me for surgery the doctor came in and told me what to expect. She said it would probably be a little more painful than the first one. I wasn’t buying it, I was master at pain by this point, but just in case this time I had the pain killer Rx filled.

Smartest thing I ever did.

When I was at home and the anesthesia had all worn off I was in the most pain I had ever been in. I took three ibuprofen because as a single mom I didn’t want to be drugged up and taking Vicodin, even half, knocked me out. The ibuprofen barely even cut at the pain.

I cried all night long and had a fair amount of anxiety due to it. I started spiking a fever and called the doctor’s service. I didn’t feel as though I had an infection and didn’t think it would register so quickly and suspect it was due to the inflammation which is what the doctor told me when she called back.

The next day I got over my fear of the painkiller and took them willingly.

I could take two but wouldn’t be able to function. One was enough to cut the pain back enough to stay awake, though I still couldn’t work because my brain was foggy.

I was coherent enough to post several times about this on Facebook, if you friend me you can laugh your ass off.

Even though I was taking the pain killers I was still in pain. In hindsight I should have planned on taking a week of work and just kept myself drugged up. I couldn’t do that but if I had I suspect my recovery could have been shortened.

I remained in pain and long before I could take another pill the pain came back. I was constantly chasing the pain. Because I was in so much pain I was incredibly emotional. The smallest thing would start me crying and I wasn’t a cryer. Movies, tv shows. Hell, I binge watched The Blacklist and cried because the main character, Ray Reddington, who is arguably a bad guy, did something nice. The cat knocked some hard boiled eggs off the counter top and I cried like a little girl for 15 minutes.

I was raw both physically and mentally.

Each day I told myself that I was a little better but the truth is it took a week before I didn’t have to take a prescription pain killer and was still taking too much ibuprofen. In fact because I was taking so much over the counter pain medication my stomach was tossing and turning. Eating was not pleasurable because I knew it would inevitably lead to a bowel movement and that was just too much to bear at the moment.

You’d think that not eating would result in weight loss but it hasn’t worked out that way for me.

It’s now been over a week and I can see the light at the end of the tunnel though I suspect it’s still a week or two away.

If you are going to have anal fistula surgery be sure to be prepared. If you have kids make a ton of meals in advance. My poor daughter has had nothing but Michelina’s for the last week. They used to be a treat but she hates them now.

Have someone stay with you if you can. The worst part about this whole ordeal was not having anyone to help me out. I had to go to the grocery story, gas station, take my daughter to school and all the other things you have to do each day. It was hell. If you can avoid it, do. I had no one to talk to except for a client who is a therapist in Chicago who’s website I was working on.

I’m hoping this surgery is my last but I have been told that there is no guarantee and since the first one didn’t take I am not so convinced this one will. I will say this, if it doesn’t solve the problem, I will be living with the fistula as I will never go through this much pain again.

What are your experiences with anal fistula surgery? Feel free to share them in the comments.

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  • Reply Healingwoman February 2, 2016 at 3:46 pm

    I had my first fistula surgery mid January. The pain got better but now it’s worse again. I understand what you mean about chasing pain and all the emotions it comes with. I been off of work for 2 weeks. I’m back this week but only for half days. Everyone I go to the bathroom it’s the worst pain.

    I take vitamin c and others to help with the healing. I eat smoothies for most meals and I lost some weight 15 pounds. Unfortunately, they found precancerous cells from a biopsy taken at surgey. So I have high grade analysis dysplasia. Luckily they caught it now!

    Thanks for writing this post. There aren’t many stories out there and it helps to hear yours.

    • Reply redheadranting February 2, 2016 at 10:15 pm

      I’m glad this helped. I searched for a description of what to expect and found very little so that’s how this post was born. I wrote this about a week after the surgery and I recall it getting worse, very worse, about a week after that. I still can’t believe how painful this was. I’m so glad you are doing better and that they caught the cells early. Good luck, and I hope you feel better soon.

  • Reply Tanya October 26, 2017 at 5:59 pm

    I had my first perianal abscess in January 2017. It was only very small & superficial. Months went by & it was healing nicely, but there was a very small opening that wouldn’t close. I went back for my regular post op appointment with the surgeon, she said it looked good but if it didn’t heal in the next 3 months to go back, it didn’t heal so I went back to be told I had a fistula, 6 weeks to wait for it to be fixed. Within 1 week I developed another tiny abscess & another small hole, my partner took me to the ED where they operated & put a Seton in. Sent me home the next day , the way they tied the Seton it was sticking out & causing rub pain. I had developed another lesion, went back to ED, this time a colorectal surgeon took me on, got me onto his emergency surgery list for the next day, he found a second fistula which had tracked into the original one. All small & into the soft tissue only. He layed it open, 2 days after surgery another lesion formed, went to ED was told it wasn’t a fistula but to put barrier cream on. The lay open healed so well, lesion was still there. At my 4 week post op appointment , yep a suspected fistula. Went on a 3 month wait list for a colonoscopy. I had that done 3 days ago. No cancer YAY….but the small fistula had gone a tiny way into the sphincter muscle so another Seton placed. They tied this one much better, like a circle (as I told them about my first experience), the thread is small with a bit bigger loop, they put the suture part inside my anus as they said it would be more comfortable. Im not in pain but just a little discomfort if I sit the wrong way or for too long. Im on holidays at present & go back to work in 2 weeks….Im putting barrier cream on either side of where the Seton presses against to try & avoid rubbing….I started to get a little white blister thing yesterday but its gone now….apparently I may be a bit prone to them…

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