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Thread: rectal fistula

  1. #1

    rectal fistula

    5 wks. ago I thought I had a pressure sore. Stayed off it, it grew to size of golf ball & burst. Dr. said abcess. Did antibiotics, it came back. After 5 visits, surgeon says it's a fistula and will need surgery. At this point-yes, please. I've been layin on my side all this time. Problem is w/ the surgeon. He has a good rep, but knows squat about SCI. Thinks I have no feeling (even tho I'm a C5-6 that walks into his office). Sticks his finger up my butt and says "Can you feel that?" Q-tip in wound, same question. I'm afraid he'll underestimate my anesthetic needs and I'll be fighting on the table. I know he underestimates my pain levels. Has anyone else had this surgery? Or problems w/ a surgeon like this? I'm scared...Betheny

  2. #2
    Yes, I had a rectal fistula which progressed to a fistula. The rectal surgeon fixed it as an ambulatory surgery case, no overnight stay. Empty out thoroughly beforehand so you can go 2-3 days with no bowel care and eat low residue foods so when you start up it's not traumatic to the wound.

    You'll need to keep it clean which, for rectal procedures, means sitz baths, 15 mins AM/PM. Sammons corp has a great unit that fits over the toilet and hooks up to the sink and shoots water up at the site while sitting in the commode chair. I wish I had gotten this years ago. I'd strongly recommend getting it beforehand.

    Also evaluate your bowel program to see if you're causing any more stress on the area than needed, from cushion, sitting time, food, stimulation, bearing down pressure, etc.

    It's a simple procedure, common in the general population. Make sure he knows about SCI dysreflexia and anesthesizes you properly. I had a spinal. Also make sure he knows the emergency meds for dysreflexia and has them on hand for the procedure and in the recovery room.

    I had mine about 6 years ago with no recurrence. Make sure you have an experienced rectal surgeon.

  3. #3
    "Yes, I had a rectal fissure which progressed to a fistula."

    Should have proof read it.

  4. #4
    Just reread you're post. I'd get another opinion. Fistulas are a canal that forms in the tissue, it's not a swelling. Hemhorroids, especially if thrombosed are swellings. A fistula often shows as nothing more than an opening on the surface.

  5. #5
    You need to speak up about your concerns. In reality, YOU are paying the physician's salary. YOU are employing him to perform a service. You definately have a RIGHT to have your questions answered and to have everything explained to your satisfaction. If this doesn't happen, you can refuse to sign the consent for surgery. You are also entitled to a gentle exam. A physician should not examine you any differently than a person with full sensation. These are your rights. You need to advocate for yourself. (EMK)

  6. #6

    fistula diagnosis

    I believe they finally got the right diagnosis. I finally got him to listen to me, I described as a feeling of having a toothpick running from the inside to the outside. (I thought of it as The Golden Toothpick of Pain).I can feel a tab inside my rectum during my BP. And SCI Nurse, I know you're right. I have to not be a weenie this time. I'll call my SCI doc Mon., see what concerns I need to bring up w/ the surgeon. Then I'll call the surgeon and defend myself. He's talking about doing a "light anesthetic" which means I won't remember it. If that's all it takes, great, I just have such a fear of thrashing and getting my sphincter muscle cut.I'll also look into the sitz bath deal, I'm worn out getting in & out of the tub all day for weeks. Thanks, y'all. Betheny

  7. #7

    Sitz baths

    The device from Sammons Preston is called a Sit-In-Bath. $50.00.I ordered it yesterday. Thanks for this extremely helpful suggestion and all your info. You've really relieved my mind. Betheny

  8. #8

    AD

    A surgical procedure for a rectal fistula in someone at risk for autonomic dysreflexia can cause significant AD during the procedure. Use of "conscious sedation" will NOT block AD. You must be sure the surgeon knows about AD, that you are monitored for your blood pressure continously during the procedure, and that anesthesia be on standby to provide medications and/or spinal or epidural anesthesia if it should develop (with conscious sedation there is rarely an anesthesiologist in the room).

    I would recommend printing out the clinical practice guidelines on AD and giving them to your surgeon to read at least 2 days prior to the surgery.

    http://www.pva.org/NEWPVASITE/public...pubs/adt02.htm

    (KLD)

  9. #9
    I gave the surgeon a copy of the PVA guidelines. As I said in my post I had a spinal anesthesia. Even though we cannot feel, the anesthesia prevents the pain nerve signals from triggering AD. In AB folks, barring any complications, the MD's let you go after you can feel your toes. However in us we can't feel them anyway. So he just waited an extra long time before releasing me.

    Be sure to give it as much pressure free healing time as possible, i.e. out of the chair. Hey while he's in there he may want to deal with any nasty hemhorroids you may have. Or it may be too much for one day. Check with him.

    Ask him where it is using a clock position (ex. 12:00, with 12 being your front). Then stay away from that area when doing bowel care.

  10. #10

    To my advisors

    I insisted on an evaluation by a rectal surgeon rather than the general guy. He just gave me a bad vibe. So I see the new doc Wed. I'll take in the info on AD. Thanks again-B

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