Fistula...

BTAcola

New Member
I recently saw my doc, after I have several spells of blood with my stool. Bright Red. Upon examination, I was informed that I have a "Anal Fistula.". And that it would need to be corrected by surgery. He could not tell me what caused it. So that is my first question? What caused it?.

Secondly, I am in no pain or discomfort during the day. Sometimes when a bowel is being passed it may be difficult and a slight pain but goes away after the bowel movement. And the blood that was assocaited with it a few months ago, has since gone away, however I KNOW the fistula is still there. I was informed that the procedure would have an approx. 2 week recovery of no sitting for longer than 1hr at time, and he said "frankly, you are not going to be able to sit that long" Plus, with the medecine I would be on, (lots of pain meds), I could not fly anyways. At this point in my career, I can not afford to take off 2-4 weeks.

If i do nothing at all, will this eventually correct itself? Or will I have to have the procedure done? What happens if I chose to do nothing at all? There is very limited information online that I can find. Can this turn into a very serious complication?

A final thought... Would this be cause for a notification on my next visit to my AME? Obviously, I would disclose if I had the procedure, but would I have cause for concern with this as well.?

Thank you for your time, I very appreciate it very much!

BTA
 

My Flight Surgeon

Sr. Aviation Medical Examiner
First: An anal fistula is almost always the result of a previous abscess. Just inside the anus are small glands. When these glands get clogged, they may become infected and an abscess can develop. A fistula is a small tunnel that forms under the skin and connects a previously infected anal gland to the skin on the buttocks outside the anus. This is the "escape route" for the abscess infection.

Second: It will just get worse and you will have a longer recovery if you wait.

Third: It will not go away on its own.

Fourth: Report it if you have surgery. It is not DQ.:)
 

BTAcola

New Member
First: An anal fistula is almost always the result of a previous abscess. Just inside the anus are small glands. When these glands get clogged, they may become infected and an abscess can develop. A fistula is a small tunnel that forms under the skin and connects a previously infected anal gland to the skin on the buttocks outside the anus. This is the "escape route" for the abscess infection.

Second: It will just get worse and you will have a longer recovery if you wait.

Third: It will not go away on its own.

Fourth: Report it if you have surgery. It is not DQ.:)
Good to know! Thanks. I will see if I can get the issue resolved in the new year.. DO you think that the Fibrin glue injection is a reasonable request to make to the doctor, or if they say it has to be layed open that is the "final answer". I have only seen one specialist, and I would like other opinions as I was not fond of his practice. I would be a very unhappy pilot if incontinence occured as well as a result of the lay open procedure, as I did find that online said it could be a side effect. Im also informed it is almost a NO recovery time, back to work as normal type of thing. Thanks again for helping with this embarassing problem.

BTA
 

pullup

Homewrecker
I had one of these 3 years ago, and it ended up not being a huge deal. Only difference was mine made it's way to the buttocks and I thought it was a stubborn pimple.

By "layed open" I am assuming that the fistula is removed and the excise wound is left open? If so, then this is how mine was done. Freaked me out a bit to have this gaping wound, but the Doc wanted it to heal from the inside out to prevent infection. I just took a shower 3x a day and let water flow over and flush the wound (I think I used Dial soap but not positive). Put neosporin and gauze back on each time. The recovery time was really nothing because there was no pain for me...I was back to work in 2 days. It was done as an outpatient surgery and I was home within 6 hrs. The time to close the wound fully was about 6-8 weeks, but after the initial healing begins you hardly even notice it anymore. Good luck!
 

BTAcola

New Member
I had one of these 3 years ago, and it ended up not being a huge deal. Only difference was mine made it's way to the buttocks and I thought it was a stubborn pimple.

By "layed open" I am assuming that the fistula is removed and the excise wound is left open? If so, then this is how mine was done. Freaked me out a bit to have this gaping wound, but the Doc wanted it to heal from the inside out to prevent infection. I just took a shower 3x a day and let water flow over and flush the wound (I think I used Dial soap but not positive). Put neosporin and gauze back on each time. The recovery time was really nothing because there was no pain for me...I was back to work in 2 days. It was done as an outpatient surgery and I was home within 6 hrs. The time to close the wound fully was about 6-8 weeks, but after the initial healing begins you hardly even notice it anymore. Good luck!

OK.. good to know but what about using the toilet? Did you notice if it hurt.. i mean.. surly you had to sit down and use the toilet in those 6-8 weeks. Did it hurt?... Embarassing to say.. mine is right next to the uhh.. exit, and a large stool kinda makes it hurt already. and my biggest fear is incontenance. I dont want to not have control of it. In fact.. the whole procedure itself really freaks me out.
 

pullup

Homewrecker
No, it didn't hurt...maybe a slight pain every so often. Embarassing details ahead: I don't know how far in mine was, but trying to gauge the depth of the wound I would say and inch or inch and a half. My exit wound was about 2 and a half inches away, so the excise wound was pretty big (in my eyes at least).

Going to the bathroom was pretty normal, but I would try to take stool softeners if needed. From my understanding, the abcess is stitched up in the rectum, and the tunnel that is formed is cauterized out. Just try to keep it clean! If I had, um, loose stool I would jump in the shower immediately and try to let water run through the open wound. Put some soap in a washcloth and gently try to cleanse the wound (not gonna lie, this hurt like a bitch some times).

In regards to having "control", I never had any lack of control. The wound slices through the sphincter so I guess there is a disconnect there, but it seems that it works as a sum of parts and not as a whole (sorta pun intended!) so you should be OK.

My doctor never gave me any indication that this wouldn't be a routine surgery. Are complications possible? Sure, just like ANY procedure you do, but I am sure they are very very very minimal and you have a greater chance of infection, etc from post-surgery. As far as the procedure freaking you out, if I had actually thought about it I guess I woulda been freaked out. I called my doctor because it was still bleeding, he said "it's time" and scheduled me for surgery 2 weeks later. I went in aroun 7AM, they got me settled and then I waited. Doc stopped by to reassure me and told me not to worry at all, then they wheeled me down to the OR. This freaked me out hardcore because I was thinking that I could never wake up again, lol. I tried to fight the anesthesia, but once they injected it my eyes dropped half down and then BOOM! Out for the count! I was looking at the clock so I knew it was 10:05AM when I went lights out, I was waking up in the recovery room at 10:40AM, so it took 35 minutes...including traval and wake up time. When I produced control over my muscles (walking and peeing) then they discharged me.

Sorry for the long post, but I want to calm your fears. I tried to be as detailed as possible to show that it really is not a big deal. Yours sounds a lot smaller then mine and should be done in like 10 mins. Any other questions?
 

BTAcola

New Member
No, it didn't hurt...maybe a slight pain every so often. Embarassing details ahead: I don't know how far in mine was, but trying to gauge the depth of the wound I would say and inch or inch and a half. My exit wound was about 2 and a half inches away, so the excise wound was pretty big (in my eyes at least).

Going to the bathroom was pretty normal, but I would try to take stool softeners if needed. From my understanding, the abcess is stitched up in the rectum, and the tunnel that is formed is cauterized out. Just try to keep it clean! If I had, um, loose stool I would jump in the shower immediately and try to let water run through the open wound. Put some soap in a washcloth and gently try to cleanse the wound (not gonna lie, this hurt like a bitch some times).

In regards to having "control", I never had any lack of control. The wound slices through the sphincter so I guess there is a disconnect there, but it seems that it works as a sum of parts and not as a whole (sorta pun intended!) so you should be OK.

My doctor never gave me any indication that this wouldn't be a routine surgery. Are complications possible? Sure, just like ANY procedure you do, but I am sure they are very very very minimal and you have a greater chance of infection, etc from post-surgery. As far as the procedure freaking you out, if I had actually thought about it I guess I woulda been freaked out. I called my doctor because it was still bleeding, he said "it's time" and scheduled me for surgery 2 weeks later. I went in aroun 7AM, they got me settled and then I waited. Doc stopped by to reassure me and told me not to worry at all, then they wheeled me down to the OR. This freaked me out hardcore because I was thinking that I could never wake up again, lol. I tried to fight the anesthesia, but once they injected it my eyes dropped half down and then BOOM! Out for the count! I was looking at the clock so I knew it was 10:05AM when I went lights out, I was waking up in the recovery room at 10:40AM, so it took 35 minutes...including traval and wake up time. When I produced control over my muscles (walking and peeing) then they discharged me.

Sorry for the long post, but I want to calm your fears. I tried to be as detailed as possible to show that it really is not a big deal. Yours sounds a lot smaller then mine and should be done in like 10 mins. Any other questions?
actually yes.. and thank you.. very informative... However... Do you recall about how much down time you had? My current employer woud FLIP OUT, and probably have to hire a contract pilot to do the flights if I was out for more than say two weeks. But you said that you had to go back for a second procedure. which means MORE time off work. Thats my biggest concern. I HATE letting people down, so I will NOT take off work if I dont have to haha. I know, im sick.. im a workaholic, but hey, i love my job, nature of the pilot right?? Mainly... im not so concerned about the right now. Im concerned about later on down the road that this would come back to haunt me.. I may not lose control of the bowel now.... but would I later on down the road in life? Ya know what im saying? Im still a fairly younger guy... late 20s, but Im thinking of like.. late 40s, 50s, 60s, I dont wanna wear a diaper climbin into the cockpit ya know.. I guess... My main concern is .. HOW THE Hell, i ended up with this.. what cause the infection to spread into the fistula etc etc.. wrong diet... not enough exercise, too much exercise.. etc etc ya know?...So... I think I will look into this procedure a little more, but if it means like a month total not being able to fly due to medications and rest, etc etc... I still see it being a LOOOONG time before I do this...Thanks,Concerned BTA haha
 

pullup

Homewrecker
Not sure where you got it from, but I only had ONE procedure and was back to work in 2 days. It's a little ginger to sit on so you just have to find a position that works. As for getting it done...you really have no choice. The "tunnel" has already formed and it won't close up on it's own. As for what caused it? Read what the good doc wrote up a few posts. Regarding problems later in life, I am not a doctor but I really can't think of a reason why you would have some, the wound heals and everything goes back together. Just do it!
 

BTAcola

New Member
Not sure where you got it from, but I only had ONE procedure and was back to work in 2 days. It's a little ginger to sit on so you just have to find a position that works. As for getting it done...you really have no choice. The "tunnel" has already formed and it won't close up on it's own. As for what caused it? Read what the good doc wrote up a few posts. Regarding problems later in life, I am not a doctor but I really can't think of a reason why you would have some, the wound heals and everything goes back together. Just do it!

HAHA.. Ok. ya i read what he wrote.. just wondering what cause "that" lol. I see what your saying however. Ya I will make some plans for the beginning of the year once things settle down for awhile ... But once I do get some plans made, i'll update this again.

Thanks everyone and especailly DOC for your help. And please if anyone else has had this issue, please let me know of your experience.
Thanks Again
BTA
 
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