Anal problems (potential sinus)

My surgeon would not lay my fistula open, stating that our surgery causes distinct decrease in sphincter tone, and cutting there he felt was not in my best interest. Mine is a pretty simple intrasphincteric fistula "at 7 o'clock," which is on my right side. I have a seton through mine at this time. I trust my surgeon's views, though I'm frustrated by them. He's a well-rated doctor with a great track record.

Doesn't mean you'll have continence issues after surgery, but I'd ask about that. The general public with fistula surgeries can have continence issues, and with our surgery, we already have a strike against us. If you're someone who has leakage, I'd be very careful treading onward to fistulectomy. Not sure if you're female, but females after vaginal deliveries also have weaker sphincters at times, so that's another factor to think about.

On 9/15 they may take the seton out, since the tract is now mature, and see how I do. I may also start Humira, as I've now elevated C-reactive protein levels, and other autoimmune type things going on with the pouch.

I STRONGLY ADVISE AGAINST the lay open procedure. I had that done and it left me wildly incontinent. Even with a subsequent sphincter repair, I just have low tone and with our lose stools (and even when I get my stools as thick as possible) I have incontinence issues. I cope with meds to thicken stools, a cotton ball tucked up inside, and use a bidet regularly to keep things clean and healthy tissue. I also got a spinal chord stimulator a couple years ago. It helps with the incontinence somewhat, but I still couldn't function without the cotton ball tucked up there, the incontinence is a major issue post-lay open surgery.

If I knew then what I know now, I NEVER would let them operate with that procedure on me. I asked and was reassured time and time again that the surgery wouldn't affect my pouch, which technically it didn't, but it TOTALLY affected the ability of the pouch to maintain continence. Go for a drain or other less invasive procedures first. DO not have the lay open procedure done unless you don't value your continence.

JJA, I remember you telling your story before, which is why, even though I hate my fistula, I trust my surgeon's choice not to cut on me. I'm completely continent, I'm only 43 years old, and having even a degree of incontinence would be worse than what I'm going through.