Posted 12/11/2011 10:41 PM (GMT 0)
I have done a lot of searching for information from people who have had a fistulotomy with seton placement and have had very little success finding any info until I found this site where one member chronicled his journey through fistulotomy surgery. I found the writings informative and helpful and wanted to share my experience as well for anyone who may be facing this procedure. Just to add some back story, 4 years ago I was diagnosed with stage iv colon cancer, nonsurgical, terminal. They told me I had between 18 to 24 moths to live. Well, here I am 4 years later with no evidence of cancer. I quit my chemo in February of this year but actually started having clean scans 6 months after I started chemo. All of that is kind of neither here nor there. about 4 months into my chemo I started to notice a very deep pain in my left buttock area which was very warm to the touch. I did some research and figured it must be an anal abscess and sure enough when I went in for my bimonthly exam with my oncologist, it was. My surgeon at the time had a resident (my cancer hospital is part of a teaching hospital) come in and drain the abscess and place a large rubber drain up into the tract which had been made to drain the abscess. I was told to come back in 6 or so days to have the drain removed but as it would turn out I ended up in the emergency room with a horrible bladder infection and had them remove the drain about 3 days after it was placed so I wouldn't have to make the 1 1/2 hour drive to the surgeons office. A little while after I had the drain removed I noticed that I was getting seeping out of a small hole next to my anus where they had made the initial incision so I went to see my surgeon about it and she said it was a fistula, which are pretty common with abscesses, and that the only way to treat it would be to put a seton in it. Well, aside from the abscess I had been through the ringer with other health issues and didn't want to have to go through another uncomfortable procedure. Now fast forward to spring of this year, I had spent the last 3 years trying to manage my bowels and get them regulated because chemotherapy makes everything go out of whack and had managed to get them as normal as they could be considering. As long as my stool waas fairly firm the fistula did not act up at all, hence no draining. Well going off of chemo threw everything out of whack again and my stools went from being firm to being anywhere from loose to liquid. The looser the stools the angrier my fistula got! Well after 9 months of trying to get my bowels into a normal state I had had enough, if I wasn't going to be able to normalize my bowels I needed to get rid of the disgusting fistula. I met with the colorectal surgeon at the cancer hospital for a consultation and scheduled my surgery for the following monday. On Monday December 5th I underwent a fistulotomy with a seton placement under MAC anesthesia with a local block.
Monday- a bit sore after the procedure, quite a bit of blood from the incision site. Sent home with Oxycodone which I started that evening, had a bowel movement that evening which was soft but no problems.
Tuesday- Moderate pain in the morning so I took some Oxy, had two bowel movements in the morning which were soft but no problem.
Wednesday morning 4 am- woke up needing to pass some stool, they were very hard like stones, went back to bed. Later Wednesday morning, passed more hard stool, pain not too bad so I passed on the Oxy. Didn't have any more bowel movements the rest of Wednesday and I know If I don't go I'll get severely constipated so I took some milk of magnesia before bed.
Thursday morning- had to pass stool immediately upon getting up. Proceeded to have about 5 bowel movements in a 2 to 3 hour period. Burned like hell! Took the recommended sitz bath after each one but was in severe pain. Started Miralax, Citrucel and stool softeners. Started the Oxy again. I was tentative to take it again because I know that is what's causing the constipation but the pain was unbearable.
Friday-Painful in the morning so I took an Oxy at noon only as I had to go somewhere later in the evening and it makes me spacy. Also realized that the Oxy was making it hard to urinate. Had a few BM throughout the day without indecent with firmer stool. Decided to try some Lortab from a previous surgery to see if they would be as effective as the Oxy for the pain but with less side effects. They seemed to do the trick.
Saturday- best day yet, minimal pain managed with Lortab. Passed very small amount of hard stools. Realized that I was getting constipated again so took some more milk of magnesia before bed.
Sunday(this morning)- awoke to an urgent need to have a bowel movement. Again, burned like hell. I had taken a Lortab upon waking but it did absolutely nothing. Proceeded to have 4 or so more bowel movements each time the pain getting worse. I was able to wait about 5 hours after the Lortab before I had to take an Oxy. Now I'm relaxing on the couch relatively pain free but there is still a nagging ache.
Even though I an only 6 days post surgery I have made some important realizations. The pain management and constipation is cyclical. If I need to take the pain medication it makes me constipated which makes me have to strain which creates pain which I have to take the Oxy for which causes constipation which.......etc, etc. I also realize that the milk of magnesia is making my stools so loose that much more fecal matter is entering the fistula tract than when my stools are firm which is creating a lot more pus which increases the pain exponentially(like when I had the initial abscess).
I also wanted to mention that my surgeon placed a draining seton and not a cutting seton because he states that cutting setons have a higher rate of incontinence. He is a very well respected colorectal surgeon who was one of the originators of the fistula plug (which he says does not work by the way).
So right now I'm trying to find the right balance of medications to relieve my pain and regulate my bowels. I an scheduled for a recheck in 6 weeks. I'm not sure if the plan is to take the seton out at that time or not but I will update my journey as it happens and I hope my story will be informative to others who have to have a similar procedure. Thanks for listening!