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Advice on post fistula surgery

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Crohn's Disease
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Posted 3/8/2019 12:57 AM (GMT 0)
Hey everyone,

A quick summary - developed perinatal ancess about two years ago. A few drains, then a few failed surgeries to close fistula. I just had a LIFT op following 2 months with a draining seton. Unlike my other failed surgeries, the external wound site where the fistula was is not draining any pus, nor does it hurt after a bowel movement. It’s only draining light pink and a tiny amount of clear ooze. This is cause for real hope for me. It’s the longest it’s gone in years without pus coming through.

However, the inside of my anus still hurts after a bowel movement. It’s the same dull ache I got with my fistula, though it’s a little milder. There’s also a small amount of faintly yellow drainage on the pads I use through the day.

It’s been 2.5 weeks since the surgery.

My question to anyone, is this a case of the internal wound healing very slowly due to daily bowel movements? The LIFT procedure closes the fistula in two places, but it seems to leave a part of the internal fistula opening to heal itself.

I’ve learned to not get my hopes up with fistula ops, but the external site looks and feels like it’s sliwly healing in a healthy way. The concern I have is the ache and drainage from inside my rectum post bowel movement.

Any advice would be really appreciated! The 4-6 week rule for your anus to be back to normal seems quite misguided with fistula. Someone told me the inside of the anus takes months to heal properly.
Posted 3/8/2019 11:26 AM (GMT 0)
Hello smile

Fellow fistula sufferer here.

I don’t fully understand if you still have pus draining through your rectum. Do you have Crohn’s? Is it with active inflamation?

I don’t know your circumstances but from my experience (FiLac, a collagen plug and two days ago Permacol), I’d try to check/feel the skin above (outside the rectum I mean) where the fistula tract is for a new abscess forming.

This happened after my FiLac but the I drained it and that part of tract eventually healed. It took about 6-8 weeks though.

The pain you described in your rectum is all too familiar. In my case it was present while the surgery site was healing and not really at any other time. I only ever had two stitches tops so the pain went away fairly quickly. It could be that in your case it’s just taking a fair bit longer.

Can you call the surgeon to discuss? My CRS uses Whatsapp and while I still feel like a creepy stalker texting him on it, he’s given me reassurence re post-op complications (or panic) on many occasions.

I have/had a complex RVF but it’s now down to just the main RVF tract which I just had Permacol put in. And now we play the waiting game.

Hope things improve quickly for you.
Posted 3/9/2019 10:18 PM (GMT 0)
Hey Newmommy26,

Thank you so much for replying. These fistula are insidious things. So hard to get rid of. An update, for the past couple of days I've had that too familiar ache for about 2-3 hours post BM. I've also had a small amount of pus that slowly drains directly form my anus. The external site for my fistula that had the LIFT operation is still only draining small amounts of light pink fluid, so that's one positive. I pray that the LIFT operation has turned my complex fistula into a simple one, and that a fistulotomy is on the cards next. I won't know until my next check up which is a month away. I'm on the public health system so can't communicate with my specialist directly.
Posted 3/10/2019 8:55 PM (GMT 0)
Is it possible the tract was pretty much cut in half and while the pus is entering, it doesn’t really have a way out, unless it backs up, basically creating another abscess? Not sure if I’m making sense to anyone but myself.

I’m confused why there us pus in the first place though. Do you have active Crohn’s?

Are you in the UK? I dealt with the NHS for a bit and I know you can find out your surgeon’s name and then pester his PA. I did that and eventually, the doctor called me. He was just a useless GI but I presume the same principle works for all consultants.
Posted 3/11/2019 1:03 AM (GMT 0)
I’m in Australia. I just figured that once a fistula is closed off that the infection would quickly burn out? Or is that naive? I guess the fact it was okay for 2 weeks and then started up with pain again says to me that something is going on. I don’t have chrons. A sensitive tummy but no other symptoms and one normal bowel movement per day.
Posted 3/11/2019 6:22 AM (GMT 0)
If the inflammation continues and they removed a way of the pus getting out, it will just find another way of escaping. But surealy your doctors have addressed the original inflammation before surgery so this is hopefully the surgery site acting up.

Personally (and based on your predicament re contacting the surgeon), if you can handle the pain, I’d monitor the amount of pus that is produced. If it increases, get yourself back to the orthopaedics where you were operated on or if the pain gets too much and you can’t be seen, A&E it is.

Also, and you probably know this, if you get a fever, you’d need to be seen immediatelly too.
Posted 3/12/2019 11:54 AM (GMT 0)
Hi DBrookenz. Sorry to hear about your continuing trouble with that fistula.
I think however that your choice, the LIFT, is THE best alternative approach to fistulotomy. Plus it really does improve things on most occassions as you point out. I am praying it will help you my friend.
Keep us posted!
Posted 3/16/2019 1:47 AM (GMT 0)
Thanks Dimitri,

I have an appointment with specialist in two weeks. The original external opening of the fistula seems to be healing up. It’s not painful and only discharges a very small amount of pink stuff through the day. That’s one big positive! On the other hand, I still get the familiar ache inside my anus about an hour after a morning bowel movement. It’ll last about 3-4 hours, and when I check my guaze in the afternoon there is a small amount of dark yellow pus like stuff on it, which seems to have come straight from my anus.

It’s all perplexing to me. If there’s an abscess building then wouldn’t it run to an external hole somewhere? How can the abscess build if the LIFT op I got stitched up the internal opening?

I’m praying that the LIFT has at least turned my original complex fistula into a more simple one, and if so then I can be a candidate for fistulotomy.

Does anyone know of a fistulotomy has to be preceded by seton like other repair operations, or is that not needed?
Posted 3/18/2019 1:55 PM (GMT 0)
Hello DBrookenz,
let me try to answer from my experience and bump your post. I hope somebody else contributes as well because I've never had the L.I.F.T.
1) the external opening can indeed close and you can still get drainage. The drainage could be the result of the wound healing, not necessarily an indication of a fistula. I got drainage for about 40 days post following my last surgery. Pus-like drainage is more white, healing drainage is yellow. As long as you get the latter it's good. Although they look really similar, I was actually not in a position to differentiate drainage in my last surgery vs past surgeries until I was healed.
2) A draining seton is not necessary in orded to have a fistulotomy.
The pain you feel post BM concerns me a bit, but I use to also hurt in the area post surgery (not particularly after a BM though). I stil do on occassion, it's more sensitive overall.

How are you holding up buddy?

Post Edited (Dimitri71) : 3/18/2019 8:07:34 AM (GMT-6)

Posted 3/28/2019 2:34 PM (GMT 0)
Hi Dimitri,
Thank you for sharing your experience that you had with anal fistula. Here is my story, 3 months ago, I had a anal abces went to the ER and they operated me straightaway, the CRS has put a seton for the drainage. 26 days after I had Filac surgery. Everything went well appart for a little blood when swiping my butt when going to the toilet. 2 months after the Filac surgery, I started to have pus or serum... I don’t know. CRS can’t see me before next week. He said to me I need to take Flagly is case it’s a relapse... Do you think it’s a relapse ? How did you know the first Filac surgery didn’t go well ? Did you have some pus ? If yes how much?

Thanks for your reply
Posted 3/28/2019 5:52 PM (GMT 0)
Hi Djeah, sorry you're going through this. Usually when there is pus, unfortunately yes, it means that the fistula is probably still there.
I had two FiLac surgeries that failed before going for a cutting seton surgery; I knew they failed if if I still had pus on month post surgery.
In any case, the two surgeries failed but from what my CRS said they did improve the fistula, thus laying the ground for a cutting seton surgery.
So you may need a more "drastic" approach now. Talk about it with your CRS because they are the only ones who really know. All the best!
Posted 3/28/2019 7:35 PM (GMT 0)
Thanks for the quick reply. I didn’t have pus when I had seton, and I didn’t have pus until 2 months Filac post surgery... I don’t understand, how come ? Is it possible the fistula hasn’t reopened as the skin hasn’t cicatrized entirely and pus. And it’s really a small amount of pus doesn’t even stain my underwere, I only see it when I swipe up my butt with toilet paper.
Posted 3/28/2019 9:00 PM (GMT 0)
Hi, if it's so little, then it could just be drainage from your bowel due to the surgeries ( that you did not notice before). Do you have any swelling or an abscess forming? If you press the area does it leak any pus, does it hurt? These things are really tricky to figure out i can totally understand your concern.
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