Anal fistula - suggestions?

Hi, and welcome! Can you clarify what you mean when you write that Lomotil/Imodium are "not a great solution?" Do they work poorly for you, or is there some other issue with them?

Welcome.  As long as you are from the NYC area, I'm going to suggest Dr. Afanah, I think that's how you spell it.  He is at Weill Cornell and is doing research on anal fistulias.  I know this because my son had an internal one, from his small intestine leading to an abscess in his pelvic cavity. It's a long long story and we had a boat load of surgeons and doctors involved, Dr. Afanah being one of them.  He is a wonderful doctor, and truly an all around nice guy.  PM me for more information if you are interested.  Good luck!

I am dealing with an apparent anal fistula right now which is not leaking and appears to be closed, although I had a 2 week stretch of leakage back in February when it apparently drained and closed. I saw a colorectal surgeon who said due to the proximity to the anus he would be very reluctant to do surgery due to potential weakening of the anal sphincter and incontinence. If you already had two surgeries on the fistula you have likely weakened the muscles in the area and the advice Mayo gave you is probably sound. You certainly don't want the incontinence getting worse than it is, although if it's draining it's a concern and my understanding from what I was told is it should be treated first and foremost medicinally, in my case with increased frequency of Remicade infusion and new antibiotics. Hope you find something that works. Good luck.

BTW I am closing in on 54 and had my surgery in 1992 with Dr. Gorfine and Dr. Gelernt who were in the same group as Dr. Bauer, now called Manhattan Surgical then called something else. That is a good surgical group and Gorgine did 2 J Pouch revisions on me, the last of which in 2000 was successful.