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Fistula really??

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Ulcerative Colitis
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Posted 11/21/2017 5:20 PM (GMT 0)
I have had UC for 11 years now. Ups and downs. I have learned to live with it and manage my symptoms.

I never had any hospital stays.

Now I have been diagnosed with a fistula. Seems pretty minor, but they(rectal surgeons) are recommending surgery, shocker.

I know this is more associated with Crohn's than UC.

Weird thing is I am switched to a mostly plant based diet and have been felling pretty good otherwise.

Anyone have any experience with this?
Posted 11/21/2017 9:18 PM (GMT 0)
Getting a fistula corrected asap with surgery seems smart to me, rather than hoping some time and meds might let it heal naturally. But I am really freaked out by the thought of an opening from anywhere in my rectum to anywhere other than my anus. I do understand any surgery has risks and expenses - but I would want that hole gone asap.
Posted 11/22/2017 12:27 AM (GMT 0)
What exactly do they want to do? I had a fistulotomy a while back. I did not need a seton, they just laid the tract (sp?) open. Medical options were never discussed but I guess biologics could have been tried first. I was in a lot of pain so I wouldn't have wanted to wait anyway.
Posted 11/23/2017 1:13 AM (GMT 0)
I spoke with the medical coordinator today and she explained that the surgeons don't really know what they are dealing with until they perform an examination while you are under. Then they deal with it as necessary. If needed a fistulotomy is done. If more serious a seton is installed. Looks like 1/12 is the date. I am not in to much discomfort unless I am wiping the area.
Posted 11/23/2017 2:42 AM (GMT 0)
what is read is:

What is the difference between a Fistulectomy and a Fistulotomy?
Fistulectomy is a surgical procedure where a fistulous tract is excised (cut out) completely. This is compared with fistulotomy, where the fistulous tract is merely laid open to heal. Fistulae are a feature of many diseases, but commonly fistulectomy refers to an operation for an anal fistula (fistula-in-ano).
Fistulectomy - Wikipedia
https://en.wikipedia.org/wiki/Fistulectomy

if the opening is not too far from the anus and not too deep, the just slice from the opening to the anus, making an open ditch. not sure if they stitch it shut after it heals. in the case of deeper fistula, they cut out the tube of the fistula and some tissue around it, and close it up with stitches.

in between, they push a seton through the hole to insure drainage and avoidance of infection. it is pulled towards the outside every few days, allowing the hole inside the rectum to heal, and then the tube heals as the seton is removed. eventually the outer lips of the fistula heals when there is no seton at all.

I think it is not clear what they do before hand, because they know where the tube exits, but do not know how straight, how infected, or how high up in the rectum the other end is.
Posted 11/23/2017 12:42 PM (GMT 0)
I had a pretty bad fistula that healed without surgery.

It started with an abscess over Easter weekend 2016. I didn't know what was going on at the time, other than it was almost certainly the most acutely painful experience of my life. It ruptured before I was able to get to my doctor, resulting in a horseshoe shaped fistula with multiple tracts.

The surgeon I saw did not recommend surgery, since I am on Entyvio. He explained that he's had several other similar cases that healed without surgery, and after the reading I had done, I was a little skeptical - but also relieved and willing to give it a try.

It was not a short process. At first I had swelling that would come and go, which was painful. Sitz baths helped a lot, and during a sitz bath, I found I could express much of the fluid myself. There was one point where I had a great deal of swelling that I had to see the surgeon for. He made two very small incisions to drain the fluid. After that, the fistula drained on it's own through those incisions and I didn't have a lot of further swelling or pain.

I was getting frustrated with it because it didn't seem like it was healing, but he kept encouraging me to give it time. Then, over this past summer, I could feel the tracts heal one by one. It's completely healed now, and I just have a little bit of scar tissue where the original opening was.

Correct me if I'm wrong, but isn't surgery also painful and a long healing process? Maybe not as long as my experience with letting it heal on its own, but I didn't have to go through surgery either.

I'm not suggesting you wait on surgery, but I thought I'd throw my experience out there as another point of view for you to think about.
Posted 11/24/2017 2:05 AM (GMT 0)
My fistulotomy was painful for about 4 days after surgery, with the first night being quite bad. Mild discomfort followed for several months. I had to keep gauze tucked in my butt cheeks for a week or so to catch any drainage. One tip I can give you is to take the pain medicine before leaving the hospital, whether you feel you need it or not. Also, load up on stool softeners to counteract the opiods or you may deal with constipation which is not pleasant following surgery. Scorching hot baths will provide good pain relief.

As DB said, they do not stitch anything for a fistulotomy. It is left open to heal from the inside out. They use a metal probe to follow the fistula and find out where it goes prior to deciding how to proceed. It is not a gentle process...they twist it all around to make sure they don't miss anything. If they find the fistula has penetrated the muscle then a seton is inserted. It can be a cutting Seton that is gradually tightened until it comes out. There are setons that are left in place as well. These can be left for months or even permanently. Fistulas in UC tend to be shallow. A deeper fistula may indicate Crohn's but it is up to your GI and surgeon to make that diagnosis.
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