Leaky fistula

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Hi

I wonder if anyone can help me. I had a large peri anal abscess on my left Cheek, it burst and crossed my mid line to my right bum Cheek and I got sepsis. I was in hospital for about 3 weeks and had several surgeries to clear the infections and dead tissue.

It lead to an anal fistula which I have had 2 seton surgeries on and last month a Fistulotomy to lay it open. Prior to this surgery my consultant thought 30% of it was attached to my sphincter but during the operation she discovered it was 60% attached. Due to concerns over incontinence she only removed or laid open part of the fistula and put a seton in to keep it open and draining until the next surgery (which is tomorrow).

I'm used to it draining puss and discharge but more recently I have noticed it seems to be draining stool. I have to change my pad 3 times a day due to the

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  • Posted

    Oops pressed post by accident

    To continue,

    Changing pad 3 times a day due to the amount of faeces leaking on to it.

    I'm concerned that my sphincter muscles are not working as they should, which was always a possible side effect of the surgery. I also struggle to hold wind at times.

    My bowel movements the past two weeks have been irregular and difficult. I don't feel like I totally empty my bowels and when I push its not coming out as a solid matter, and it seems to take forever to wipe and clear the area.

    Has anyone else experienced this sort of thing, where the draining turns to faeces?

    I'm having the rest of the fistula laid open tomorrow and am thinking about asking if it's worth having a temporary stoma bag fitted as this was discussed previously

    Any advice gratefully received smile

    Thanks.

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    • Posted

      Hi Laura

      I was similar to you my fistula was high but it did stay on one side. I was like you no chrons, I was negative on my diabetics test but do show all the signs of diabetics if I have straight sugar, honey, dextrose etc. However my diet at the time was not great as I have IBS. My underlying issue was my immune system was poor due to a lack of nutrients and by eating tons of veg each day for a few months I healed my fistula. But after 5 operations my big muscle was damaged. But you have to remember this is first op, you have a major wound so your ability to vacate your bowels is going to be affected at the moment and you will have problems. Hopefully it is only temporary and will heal. It sounds like your surgeon is very sensible and understands the damage cutting can do so is trying to avoid leaving you with any long term scarring. If you have time read the other messages on this non dental Abscess thread. Many people are saying diet helps to manage this condition. Your diet may be fine so it may not be the reason this happened to you there are many reasons it could happen. But it could be one area to speak to your dietician about to help heal the fistula along side treatment from your physician.  Re the stoma I will leave you to speak to your surgeon about this to make a decision. Happy to answer any further questions. Please let us know get on. I hope you are on the mend soon. 

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  • Posted

    Hi Laura,

    I have a few questions-

    1.) Do you have Crohn's disease or diabetes?

    2.) If not, do you have frequent constipation or frequent diarrhea?

    3.) Is this your first perianal abscess?

    All of these questions are important as what should be done and the prognosis can sometimes be very different.

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    • Posted

      Hi Cporosus1

      Thanks for your reply.

      No I don't have chrons or diabetes. My consultant did a biopsy and it came back clear of chrons. Regarding diabetes I've had many blood tests done and they have said there is no diabetes.

      I would say I get constipated more than diarrhoea. I have had faecal impaction a lot with overflow which is the lose bowels.

      Thanks

      Laura

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  • Posted

    Thanks Laura...well the good news is that, even with it be higher and more complex, since you don't appear to have any underlying health condition it should eventually heal with a low recurrence rate. I had a perianal abscess about 2.5 years ago on the left front side of my perineum. About two months after drainage I needed a fistulotomy (thankfully it was fairly low so they could do it in one operation) and it took 3 months until it was fully healed. I've had no more problems barring the occasional hemorrhoid and one small fissure. 

    The drainage sounds normal but you should ask your doctor just in case. I've found the best thing to do is use a psyllium fiber supplement like Konsyl or Metamucil as these will make you stool less messy/cleaner and also keep you from being constipated. It might make you poop more, but this is a good thing (so long as it isn't diarrhea). You'll also want to purchase a bidet for your home if possible (squatty potty makes a $30 bidet that I've been using for years, it works great), this will keep the area clean post-bowel movement and it won't require you to jump into the shower everytime you have a bowel movement. Since yours is much larger it might take a long time to heal, but since there is no Crohn's or any other condition that would impair your healing, I imagine it should fully heal and have a low recurrence rate (provided you are using a colo-rectal surgeon). 

    The reason I asked about your bowel habits is because I'm always curious to know what could have caused these non-Crohn's/non-disease related perianal abscesses (actually, 90% of perianal abscesses are not Crohn's related...but you wouldn't know it from reading these boards). In my case I think it was years of straining and forcing poop out finally taking its toll. 

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    • Posted

      Hi Cporosus1,

      Thanks for your reply! Sounds like you've had a hard time with it too, glad to hear things are improving now.

      Well yesterday was interesting! Had my surgery and was first on the list so had no time to sit and worry despite only having 2 hours sleep the night before as was so worried.

      Had an enema which was not too bad, I still felt like there was a blockage even after emptying my bowels.

      The fistula laying open went as planned and I have a 4x4cm hole there which was already there from when she removed the other half last month.

      I had the scar removed which was the size of my hand and was purple and stretched and at risk of Tearing. So she's cut that away and I now have two lines of neat stitching (32 stitches) looks really tidy but it's totally lost the curve of my bum Cheek, sort of looks like one of those mirrors you get at fair grounds eek! But ultimately its going to be less tight and won't get the tears I was having.

      Very sore today now I'm home, she loaded the area with general anaesthetic whilst I was under general to help the sensation. It's all coming back to life now and is pretty painful. Am taking tramadol, paracetamol, ibuprofen and 3 days of antibiotics (metronidazole). Took senna last night too as concerned about next bowel movement.

      I'm going to dressing clinic later so a nurse will check the stitches etc, need to ask them about bathing as I think the fistula would benefit from it but not so sure about getting the stitches wet?

      I'm in the UK so can't chose a surgeon however I think I've struck gold with mine! She is absolutely amazing, speaks in terms I van understand and draws pictures to help explain things.

      I spoke about a temporary stoma and we will look at that in a month once the fistula has healed. I'll make a note or those things you suggested though as that could help. She's going to do some kind of test on my colon to see if it's working properly, I can't remember the term she used as was still woozy from the general anaesthetic.

      Thanks again for your reply, really helpful smile

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