I had a sphincteroplasty to repair a fistula (tract from anus into my perineal area- Not RVF) in Sept. 2007. The fistula formed as a result of a 4th degree tear during childbirth. The repair did not work and the doctor went back with fibrin glue for my next surgery, failed and the third surgery... well, I'm not entirely sure what happened but it had appeared to be fixed. After the birth of my second child in 2009 (via C-section), 8 months later I developed an abscess that was created by another (or the same fistula) as before. I had it drained. In September 2010, I had a draining seton to aid in my upcoming surgery, probably flap repair however I am still considering the GORE BIO A plug that others have had successful repairs.
The success rate for the flap repair appears to be higher although the plug seems a little less traumatic. Any advice from anyone out there on which procedure to go with? I have two young energetic boys and am nervous about the recovery. I can't imagine not being able to lift them into their car seats or run outside with them. Wondering when I can do this with them post-op. Any advice on the procedures would be greatly appreciated!
I am going to catalog the days after my flap repair in hopes it will help someone else out there.
My procedure was outpatient and I got home from the hospital around 6:00PM. My first day is my surgery day. I am taking darvocet and toradol every 6 hours as well as colace. I plan to take miralax starting tomorrow if I haven’t had a bowel movement yet.
Day 1: Woke up from procedure in the recovery area with just some pain. They gave me the occasional shots of demeral (sp?) and morphine before I headed back to a room where I was to be discharged after attempting to pee. I had a lot of bleeding when I tried to pee which scared me but the nurse said it was normal for some people. I did pee very little but even though I felt like I had to go really bad, it seemed my bladder was still asleep.
The car ride home was uncomfortable even though I brought a pillow and reclined the seat back as far as possible. When I got home and in a comfortable bed with my legs propped up under a pillow. I felt much better. I still had an urge to pee but couldn’t. My mom had purchased a raised toilet seat and sitz bath for me to use. The raised toilet seat is really helpful so that I don’t strain to sit on the toilet getting up and down. I still couldn’t pee so I lay back down. I drank some water, chicken soup broth and had a popsicle. Then I tried to pee again with all the tricks- running water, warm water in a squirt bottle shooting it at my private parts and finally I peed before taking meds and off to bed.
Day 2: The night was a little rough, not really pain wise but just uncomfortable. My back hurt probably from the positioning during surgery or being propped up all day in the hospital bed. I carefully rolled onto my stomach and slept that way for a little while to relieve my back. This morning I took a comfy legs up and under a pillow position on the couch. I ate egg whites with chopped up peppers for breakfast (Doc said high fiber asap). Lunch I am having soup broth with noodles, triscuits and a well chewed part of apple. I have gas that I can feeling moving and trying to “get out” but because of the dressing that is still in my anus, it can’t get out. Feels a little uncomfortable but I am glad my bowels appear to be working. The doctor said to wait until the dressing fell out during a sitz bath or after my first bowel.
I started getting really really nauseous from the pain pills and could barely function. After puking a couple times, I decided to stop all pain meds and just start taking motrin and tylenol. I am now out of the pain pill puke haze and functioning much better. I can feel pain but only when I move and it's not really that bad. I still have the dressing inside the backside and it's difficult to get flatulence by the dressing but I am doing it. I have loads of gas probably from the pain pills.
So far no BM, which I am nervous about. Been doing sitz baths 3x per day and actually took a quick shower this evening. Plan to eat a light dinner and take some miralax. Will update about tomorrow.
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I should probably mention that I had a silk seton placement prior to this surgery. The seton was in for 7 weeks before I went in for the flap repair. I have seen two colorectal surgeons in Houston Texas. One that did my seton placement and then referred me to a specialist in flap repair. Please ask me any questions you have about my previous surgeries or this one. I am a mother of two young boys and luckily have the help of my mom and mother-in-law and husband during all of this.
Thanks for the update. I have just had a sphincteroplasty (no fistula) a week ago. I'm sure your post will help someone else out there, as these fistulas are unfortunately way too common....
Good luck on your recovery! I am recovering well myself, and am hoping for the best for both of us!
Babygirl- I hope your recovery goes well. My recovery from the sphincteroplasty was complicated because I didn't take any pain meds and was trying to continue nursing my baby. I think it was to my disadvantage to do that because I wasn't focusing on resting and getting better. Also, my surgeon was not the best out there. I am sure you will recover well. If your back or bum starts hurting it helps me to elevate my legs under a pillow to relieve the pressure. I am glad to know someone else out there has been through this. It's not my favorite dinner party conversation.
Day 3: This is the first day of taking no narcotic pain meds which is making me feel so much better. The pain is actually really not bad at all. Nothing that tylenol and motrin can't help. I move slowly and walk with someone next to me at all times because I am still very dizzy probably from the anesthesia. I am trying to get up only to go to the bathroom (pee, no BM yet), take small trips around the house just to get my blood flowing differently, to and from the bedroom to take naps when I get too dizzy/tired.
In my morning sitz bath (in the bath tub, not in the toilet topper kind which I also have), I beared down and pulled out the rest of the dressing from the surgery. This is gross but it looked (and felt) like a cigar in my anus. It came out with very little pain so I feel comfortable it was time to do so. Now that the pain meds wore off, I literally felt like I had a finger in my backside and it was making me uncomfortable. So taking this out has made me much more comfortable. My doctor has me applying an antibiotic gel inside my anus three times a day (now that the dressing is out) and I am doing that after my sitz baths. I now have gauze (3x3, medium size from Target) folded in between my cheeks to catch any discharge from the surgery site. I have had some brown discharge and some light blood but not much. I expect more after my first bowel movement.
I am worried I have had a BM yet. With all of my surgeries it has always taken a while for my body to go. After one of my surgeries I was told to take Milk of Magnesia because I couldn't go. I did and nothing happened. So they told me take more. I did and then I was going so often I had muscle spasms in my backside.... the worst pain I have ever had in my life. And I couldn't stop going to the bathroom and couldn't stop the subsquent spasms. It was a very hard time for me so to prevent that from happening again, I am going to wait and see if the miralax I drank last night with gatorade (1 dose) will produce anything. I am also taking colace as a stool softener twice a day.
I am eating but my appetite isn't very strong. I have been eating brown rice, black beans, tomatoes, watermelon, apple, fish, oatmeal-- all fairly light and high fiber foods. I have been drinking copious amounts of water now that I am no longer nauseous. I also have been drinking decaf tea. After my seton placement surgery my throat was hurting SO bad from the breathing tube. The only thing I found to work was chloreseptic spray and cephanol lozenges. This time I asked the anesthesiologist to be more careful and told her about my previous complication. She gave me a steriod to help with the inflammation and this time I have no pain in my throat. Huge difference.
All that is left for tonight is drink more water, do a sitz bath and off to bed sleeping with my legs propped under a pillow. I am really fortunate to have help. My kids are being cared for by my mother-in-law so I don't do anything but rest. My mom is bringing me water, making my meals and walking me to the bathroom. I think it's important to do this until my first appt and see what the doctor says. I want this to be my last surgery so I trying to rest as much as possible on the front end. I'm not sure why my previous surgeries didn't work, I think it may have had to do with the skill level of my previous surgeon and the complexity of my issue but I also think I tried to do too much too quickly.
Day 4: Last night I ended up taking another dose of miralax in gatorade before going to bed. My night of sleep was restless. I was tossing and turning trying to get comfortable. I'm not having terrible pain in my backside, just discomfort in general. Sometimes a twinge in my backside, sometimes my back hurts, sometimes my head... overall I think I just still recovering from the surgery overall. I talked to a nurse today about my dizziness and she said to incorporate more iron rich foods because I may be anemic (which I have been before). So today I ate black beans, spinach, potato with skin on and shrimp. I also asked the nurse about the fact that I haven't gone poop yet and she said to double up my doses of miralax. Hooray. So i took one dose with Sunny D & water... could barely taste it, I highly suggest it. Much better than the gatorade.
So overall today was pretty uneventful, still taking motrin and tylenol, colace and miralax. Walking around every once and while, drinking lots of water, doing my sitz baths, putting on the metrogel and then just resting. I have a little blood still on the gauze in between my butt cheeks but nothing alarming. I plan to do one more dose of miralax tonight and if that fails to work maybe try milk of magnesia tomorrow. When I feel down around my anus to apply the metrogel, I can feel something that feels like stitches and the area is still very "puffy." I'm still worried about how the BM will feel. So the worst part right now is dizziness and fear of the BM. Otherwise not too bad. Report back tomorrow.
So after my reply yesterday and my Sunny D & miralax dose, I had my first BM! Never thought I would be so happy to report that. It wasn't as painful as I thought it would be, there was quite a bit of mucus/blood but overall pretty normal consistency. I immediately showered and used a handheld shower wand to wash off and did a sitz bath. Afterwards I worried that I "didn't get everything out" but realized there is no way to know that so I have to just hope I did.
Day 5: In the morning I was feeling a little less dizzy and overall happier. My night was fairly restful. I set an alarm on my phone to wake up and take my motrin on my every 6 hour schedule. After eating breakfast, I had two more BM's... not sure if my body was cleaning itself out or what but after that I was pretty sore. I soaked after each time and took some tylenol. Each time on my gauze was a little blood, a little liquid stool. The day was fairly uneventful. I walked around a bit more, stood a bit more, ate a bit more. Still drinking water, eating high fiber, doing my sitz baths and resting as much as possible.
DAY 6: Woke up to a significant amount of dark red blood, soaked almost through my 3x3 gauze pad. I had another bowel movement, some more blood but it seemed to be less. Talked to my doctor's office and they didn't seem to think it was normal, if the blood continues I have to go in today and see the doctor. I am saying all kinds of prayers now. Wondering if I have been too active? It's just hard to sit and lay around when the pain isn't really that significant. I've got my feet up now and am resting, hoping that the blood was just from the bowel movements and not from the surgery breaking down.
DAY 6: Cont... blood was consistent throughout day but slowed down a bit. Decided to wait for my doctor's appointment which is tomorrow (1 week post-op!) On top of the new blood issue, my other seems to be frequent bowel movements, I have 3 per day and after the third my bum starts to feel kind of raw. I have been using a shower wand to clean off and then immediately doing a sitz bath but still I am uncomfortable. I guess most people have problems with constipation but I have never been that way. So I may consider taking the colace only once per day.
DAY 7: Dr. APPT DAY. Everything leading up to the doctor's visit was my normal- rest, sitz bath, eat high fiber, drink water, take motrin, etc. At the doctor's office he just examined me on the outside, no probing, minimal poking. He said the blood is coming from a blood clot on the outside of my rectum from the "donor site"-- for my surgery he said he took skin/tissue from somewhere else to help create the flap because I had so much scar tissue/unhealthy tissue from my previous surgeries. So that explains the blood. I told him about my other issue of having 2-3 bowel movements per day. He said he would prefer I was only going one. I should have asked what I could do but didn't. I may call the doctor's office and ask a nurse. Overall, he said everything looks good and I need to rest as much as possible for the next week. Still no major exercise for 4-6 weeks.
So my plan moving forward is to try some things to decrease my frequency of bowel movements. Eat less, eat a more balanced diet--- think I may have been overdoing it on the fiber rich foods. So I may add back in things like bananas and cheese, etc. Hopefully to make things move a little slower.
I got a copy of the operative report when at the doctor and it says that my procedure was treatment of a complex fistula (low transsphincteric with a short tract) with dermal advancement flaps.
Hi Jane, thanks for the updates. I can imagine you were very worried about the bleeding. Hopefully the wound will heal quickly, so you won't bleed anymore. It sounds like a complicated fistula surgery that you had.
The Following User Says Thank You to Babygirl43 For This Useful Post:
Thanks Babygirl for your concern. The bleeding has stopped and now I just have wound care of the site where he took some of my tissue to help with the flap repair.
DAY 12: I am on day 12 of recovery. Not much has happened since my last post. I am still resting as much as possible but doing more for myself every day as far as getting drinks, doing my sitz bath in the tub vs. the toilet topper. I'm still trying to find a happy medium between not going to the bathroom and going too many times. I am eating a fiber rich diet with more fruit than before, drinking tons of water, taking colace and drinking decaf tea in the morning. Hot fluids can sometimes signal your bowels to empty and it definitely works for me that way. I find if I go in the morning, I usually don't have to go anymore throughout the day.
Last night I was kind of freaked out again, this time because I was sitting in my normal legs under a pillow, slouch position and I felt some gas that was having trouble getting out, so to speak. It almost felt like it may have gone out another place or tried to... which means the fistula tract is still there but I'm not sure if it was all in my head or not. It seems like it would be a distinct feeling but since my fistula tract is close to my backside and I have been dealing with it for so long, I am pretty much sort of lacking the ability to distinguish. I have decided not to worry unless it happens again. And even still, there's not anything I can do about it so there is no point in worrying. I pray it's all in my head.
DAY 14: 2 weeks, POST-OP.
Well, I am feeling a little discouraged. I know it's only 2 weeks post-op but the hole where the fistula came through in my perineal area is still open and big (sort of), and with my previous recent surgeries (abscess drain and then seton placement, I remember the fistula hole closing a little each day. I am also having drainage onto my gauze (put in between my cheeks) which is more than when I first got home from this surgery. I am worried the surgery broke down and the fistula is draining fluid... there is really no way to know until I go see my doc. The fistula hole is probably 2 cm from my anus and so it's hard to tell from the gauze which hole the discharge is coming from. I guess it's possible the fistula tract could still be draining but from the looks of what is on the gauze, it's not just surgery discharge. It's definitely stool as well.
My next appointment is in 6 days so my plan is keep resting, keep doing my sitz baths, keep doing everything I'm doing and hope for the best.
One problem with this surgery is that the pain isn't that bad. I know, sounds silly but because the pain isn't too bad as long as you keep up with the motrin (or other anti-inflammatory drug), there really isn't much pain, just minimal discomfort. So in some sense I think I may be still doing too much even though I feel I am doing ABSOLUTELY NOTHING. The first week I had someone helping me up each time I got up from the couch or bed, this week I have been doing that myself. I also have been getting up and walking to get myself water or something to eat, taking my showers, etc. I would say I get up about 20 times a day to do a small trip to the bathroom or kitchen. I have made short trips to my mom's house in the car, one trip to the doctor's office but really nothing else. I tried to sit at the dining room table on a cushion and was really uncomfortable. I do sitz baths in both the toilet topper and in the bath tub. I even have a elevated seat toilet so I don't have to squat as much when I go to the bathroom. I have also laid on the floor with a mirror to "look at things" --- not that there is much to see, two hole and my crazy blood clot area that is getting better. I had some bruises on my backside (cheeks just around the anus) after the surgery also, I'm sure from the instruments they use.
So if this fails, I am not sure why. Maybe I should have eaten less, stuck to a liquid diet at first so that I had less volume of stool. Or maybe I should have been bed ridden... or maybe the fistula I have is in such a bad spot it's impossible to fix. I don't know but I hope and pray that this is going to heal. I'm ready to stop making excuses to people of why I haven't been around, or what I had done. I usually tell people back surgery OR I say it's personal OR if it's a good friend I explain in few details. No one understands though. I do feel lucky though, that this isn't a terminal illness. I still have full use of my arms and legs... there is a lot to be thankful for. That being said, I can't help but wish I had the fistula in my arm... ha ha, would be less embarassing to try to explain. If you are reading this you probably understand what I'm talking about. In any case, if you are following my story, I hope my notes help you decide what is right for you- surgery or not and how to take care of yourself afterwards. Maybe you'll learn from my success or my mistakes. Either way, good luck. I'll keep you posted.
DAY 18: Well, I feel more optimistic now. I am remembering that even after my very original surgery- sphincteroplasty, that I had damage to my internal sphincter muscles and therefore had trouble holding gas. After the surgery it got significantly better, with time, but I always still had SOME issue like when I would drink too much wine or sometimes just a tiny bubble of air will escape without me being able to feel it. I am hoping that's what is happening now. Maybe the lack of control is not the air traveling through a fistula tract but escaping from my backside... it's funny that I am actually hoping for this.
I went up and down a staircase for the first time yesterday. My doctor said I could but to go slowly and "walk gingerly" or cautiously. I had no trouble or pain with the stairs but as I've said before, I don't have much pain at all, just mild discomfort. I am trying to limit my trips up and down stairs to once per day.
My next appointment with my surgeon is in a couple days so I probably won't post until after that. I don't really have much to report. I still have some drainage on my gauze, I still have some weird air sensations every once and while, still doing everything I did from the beginning to care for myself and STILL trying to rest as much as possible.
So I am currently almost a month post-op now. At my 3 week check up my doctor did the internal-not-comfortable-at-all exam and said "THINGS LOOK EXCELLENT"... he gave me a very good report and was very optimistic about my recovery. I told him about my concerns with the air but he did not seem worried about that, said it was probably my weakened sphincter letting gas escape. He gave me a little more leniency with the amount of activity to do but over said to take it easy as possible for another 2 weeks then I should be "back to full strength." And I don't think he means totally full strength but in a good place where I can resume more normal life activities.
I go back in a week so I will report back then and see how things go. Oh, I also found out the type of flap repair I had was pretty unique. My surgeon is one of 12 in the world who do the flap repair this way. It is a newer technique and so far the results have been very successful. So I feel pretty lucky that I have found this surgeon and I am hopeful that this surgery will be successful.