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My experience with an Anal Fistula

Approximately 3 months ago I started having stinging pains when I took a shit.

Being the kind of self conscious person – who doesn’t go to doctors – that I am, I figured the advice I would find on google was as good as anything a doctor could give me. I had diagnosed myself as having a fissure – a small tear in the lining of the anus. And I have to give myself a little credit here, because as it turns out, I was probably right.

According to what I had read on google, the standard treatment for a fissure would be a little bit of cream to encourage healing and what not. I’m a man, I figured if I could just deal with the pain while it healed it would be fine. So deal with it I did.

Time passed. The problem persisted.

More time passed. The problem got worse.

Now not only was it stinging while I took a shit, now my anus (balloon knot, if you wish to be so vulgar) would severely swell up afterwards. The swelling would last 12 hours and more, and the whole time there would be some kind of strange discharge coming from my anus, like pus mixed with faeces. Oh yeah, I would also bleed from my anus… bright red blood all over the toilet paper when I wiped. Sometimes the water would turn pink from the blood.

In retrospect, the swelling was probably worse than the stinging. Much worse.

By now I was already strategically planning my bowel movements. If I was going to be at work, I’d make sure to have the bowel movement the night before, because generally the swelling would reduce over night to a point where I could do my job relatively pain free. Reduce – not clear… No.. clearing would take 24 hours +

I had found regular pain killers (ie.. stuff you take for headaches) would help with the pain, so I would take a couple neurofin before a bowel movement in a sad attempt to counteract the pain I was expecting to come. Sure, it may have helped a little, but I was still in agony.

When I wasn’t in pain, I was happy. When I was in pain, I was in pain. I didn’t tell anyone. Not a single fucking person. People must have noticed me switch from happy to borderline suicidal. People must have wondered why all of a sudden I would be biting their head off, getting aggressive over the most minor offenses.

I had trouble sleeping because of the pain. I missed appointments. I wouldn’t show up for work. I turned down opportunities to go out to dinner with visiting relatives (who had to take a plane trip to come see us). All I could tell people was that I didn’t feel like it… and I felt really sorry for myself when people got angry at me. But I couldn’t tell anyone, I was so embarrassed.

Did I mention how much it hurt to fart after taking one of these painful shits? Oh god….

By this stage, the swelling was even more severe. I had 2-3 permanent giant lumps between my testicles and my anus… After taking a shit, these lumps would go rock fucking hard. Dear lord it hurt. Sitting down in this state was impossible. The swelling would still go down after 12 hours or so, but the lumps didn’t disappear.

Feeling increasingly depressed, I told the only person I felt comfortable telling. I told someone I had mostly only ever known over the net, but had met in person several times many years ago.

Amazingly, this person had experienced something very similar. He had experienced a pilonidal cyst right next to his asshole. Based on what he told me I eventually realised I didn’t have the same thing.

Anyway, he told me I should definitely go and see a doctor, because he had waited almost a year before seeing a doctor, and when he finally did, the doctor said that waiting was the worst thing he could have done.

I still naively refused to see a doctor.

The problem kept getting worse.

A week or two had passed, and I told another friend. He pressured me to go and see a doctor, and insisted that whatever it was, a doctor would be able to have me healed up in a couple weeks with some antibiotics and whatever other magic potions he had.

I couldn’t go to the doctor. I couldn’t face the idea of having someone examine my asshole. It was too embarrassing.

During the week I had planned to go out to lunch with mom, and the night before I had taken a torturously large dump which had left me with very very severe swelling. I shouldn’t have even been at work… it was that painful. But anyway, during my lunch break I went out with her to get sushi.

Over lunch she detected that I was extremely depressed and almost seemed to know that the problem was somehow related to my groin area. Maybe I was walking funny, or maybe she just knew that this was the one place a person isn’t going to talk about. I ended up telling her what it was, and she, being the wonderful mother she was, went and made an appointment for me with her doctor… even though I was adamant I couldn’t do it, and told her not to.

I manned up and went to the doctor. I told him I thought I had haemorrhoids (hemorrhoids?) or a fissure. He asked me lots of questions about it and stuff which could be related (ie.. diet) and I told him all about how horrible it all was. He eventually examined my bum, and the only thing that was really uncomfortable about it was the awkward position I had to lay in on the little bed in the corner. It wasn’t painful, and it wasn’t particularly shameful. He was very professional and easy to talk to about the whole thing. And he had a small finger too… which is good. He diagnosed the problem as “piles” and gave me some cream and some suppositories. He told me the problem should be significantly better in a week, and almost cured in two.

When applying the cream, I had now noticed that when pressure was applied to the lumps between my balls and ass, air and liquid would actually come out of my ass. After a very uncomfortable self examination done infront of a mirror with a directional lamp, I had determined that there was a small hole just inside the exit of my anus, and applying pressure made blood and pus come out.

I did exactly as I was told for two weeks with literally no improvement.

I did some more googling and rediagnosed myself as having an anal abscess – an infected pocket inside my ass. And again, I have to give myself a little credit, because I was right again.

I read that abscesses are usually treated by making an incision, under local anaesthetic, in the external swelling, allowing it to drain out so that it can heal. I also read that if left untreated the abscess will turn into a fistula, which is when the pressure builds inside the abscess and it bursts on the surface, leaving a permanent tunnel connecting the inside of your ass to the outside. I also read that by making an incision and draining an abscess, it can turn into a fistula anyway.

Around this time some new things had started happening. Now, when I farted, gas would actually go into the abscess… that’s right. My farts would inflate the abscess. Fuck it hurt… it really hurt. However, I did find that applying pressure to a certain area would allow gas to pass freely without entering the abscess. I also discovered that applying pressure to the swelling several hours after a bowel movement and draining as much pus as I could (and believe me, there was a lot) would significantly lessen the pain.. but I couldn’t continue to live like that.

I went back to the doctor, he had another look and agreed it was probably an abscess or a fissure, and referred me to a specialist.

I went to the specialist the next day. He asked me a bunch of questions. I told him how awful it was. He then examined me… he didn’t have a small finger. The telescope type thing he put up there wasn’t small either, but im pretty sure his finger was bigger. He was much less gentle than my doctor, but he definitely knew what he was doing.

He was certain that I had an abscess that was on the verge of turning into a fistula. He believed that I had originally had a fissure, which left untreated, turned into a chronic fissure which then got infected and turned into an abscess. He booked me in for surgery in two weeks time, and prescribed me with two antibiotics, stool softener and some painkillers for the mean time. The surgery I was to have was called a Fistulectomy.

A fistulectomy involves surgically removing the complete fistula tract and then leaving it to heal by itself from the inside out, without stitches. This requires daily packing to soak up all the bad stuff and keep the wound open so that it will heal from the inside out, thus avoiding another abscess. In the end I asked him about the surgery and he revealed that the procedure I had was actually more of a fistulotomy, which is pretty much the same thing, except the tract isn’t cut out, it is simply de-roofed and then the infected tissue is scraped away.

The antibiotics didn’t help much, but the painkillers were great. I could finally sleep without being in complete agony after a bowel movement.

I saw the specialist again and he decided to book me in for an MRI the day before the surgery.

The weekend before the surgery the antibiotics actually started working! Now there was no significant swelling or pain after shitting. I was a little worried that I was going to be having an unnecessary surgery and that the problem was going to clear up by itself, but a conversation with the specialist over the phone quickly put that theory to rest. That weekend, the abscess also officially turned into a fistula. I now had a tiny pin sized hole outside my asshole which pus and blood would drain out of.

Day before the surgery – I go and have the MRI. The MRI itself was fine, not scary or anything. Hard to keep my legs completely still, but since they are only scanning my anal area, that’s not such a big deal. I talked to the specialist later in the day and he tells me there is definitely a fistula which may have one or two tracts.

Day of the surgery – I go to a private hospital and a nurse gives me this weird little enema thing which I administer myself. It was this tiny little tube with a long nozzle and it makes you want to completely empty out your bowels – which I did… and it wasn’t particularly pleasant, but the antibiotics and painkillers were helping.

Specialist comes in shortly after, tells me the surgery is going to be delayed for another 2 hours. I get asked a bunch of questions by a nurse. Lay in bed watching discovery channel on tv.

2 hours pass, two nurses come in and wheel me off into theatre. When I arrive I am greeted by the anaesthetist who asks me a bunch of questions. By the way did I mention, all of these people are very nice and do their best to make me feel comfortable.

I’m then moved on to the operating table and the anaesthetist gears me up. The 10 seconds after he starts pumping the anaesthetic into my IV were pure bliss. I don’t remember going out, I just remember the sensation of my whole body buzzing.

I wake up, greeted by an attractive nurse who is extremely friendly… I’m pretty fucked up, not in pain though. I’m eventually wheeled back to my room and left to rest.

Family comes and goes, my leg is numb as hell and I’m having trouble sleeping because of it. Doctor comes in and tells me that the surgery was a success and that the fistula was mostly superficial so there will be very little chance of incontinence… this is a relief. He says the fistula was unique because there were two tracts instead of just one.

Next day I go home and sleep in my own bed – my how we take our own beds for granted.

Not much else to say about my recovery. I was scared to take a shit, but as it turns out, it wasn’t really painful at all. The pain from the fistula was 100000 times worse than the mild discomfort I was having now. I take a bath mixed with table salt after every bowel movement as advised by the specialist, and when I get out of the bath I’m in no pain at all (I think the baths are absolutely essential if you don’t want to experience any pain afterwards).

I was taking mild painkillers, but I’m not actually sure that I needed them. I was never in any significant pain. Seeing the wound in a mirror (A handheld mirror) was quite shocking for the first time… I mean it’s a really big wound….

Here is a picture, probably taken about a week after the surgery. Please keep in mind, it doesn’t hurt, it just looks bad.

Every day for the next two weeks a nurse would come to my house and pack the wound. The packing was a little painful sometimes, but for the most part, completely pain free. I would try to have my bowel movements and baths in the morning before the nurse came, and this strategy worked quite well. When it didn’t work, I just put a bandage over it and left it until the nurse came back (ok I lie, I actually packed it myself on several occasions… but it didn’t always turn out so well).

Two weeks after the surgery and I go back to work. Before work I go to see a nurse and have it packed like before.

It’s been a week since then, and so far everything is great.

Still pain free, no longer depressed… Just fucking happy that this phase of my life is almost over.

If you came to this blog because you’re suffering like I was, don’t be a fucking douche bag. Go to the god damn doctor. I’m fucking telling you.. you NEED to go to a doctor, this is not something you want to leave.

The whole thing has costed me around $2K when you include the visits to the chemist, MRI etc.. My medical insurance was pretty shit, but it helped a lot. I plan to upgrade my medical insurance to full coverage soon in case I ever need it again.

Use a specialist. Don’t go through the public health system. You want someone who’s done this type of procedure many times before

Anyway, i’ll keep you posted.

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