5 Things I Wish I'd Known Before My Fistulotomy

My first fistula surgery was a fistulotomy. My general surgeon described it as a relatively straightforward procedure. I was told to expect a few days of discomfort, maybe a week off work.

That is not what happened.

The recovery was brutal in ways nobody had mentioned. Wound care was a full-time job. Sitting was a nightmare. And the information gap was staggering. I couldn't find a single honest resource that told me what to actually expect or how to manage the weeks after. I pieced it together alone at 3 AM from Reddit threads and medical forums.

What follows is the list I wish someone had handed me before I went in.

Important: This content reflects personal experience and community-sourced tips, not medical advice. Every fistula case is different. Always discuss treatment decisions with your colorectal surgeon or gastroenterologist. What worked for one person may not be right for your situation.

1. The wound is left open on purpose — and that's going to look alarming

Most people assume surgery ends with stitches. Fistulotomy doesn't work that way.

The procedure involves cutting open the fistula tract so it can heal from the inside out. You leave the OR with an open wound, a small channel in the tissue that will gradually fill in over weeks. There may be gauze packing. It will look alarming the first time you see it.

This is normal. This is the plan. I wish I'd understood that going in instead of processing it in the recovery room.

How long it takes to close depends on the complexity of your tract. A simple intersphincteric fistula tends to heal faster than a transsphincteric one. Ask your surgeon specifically how deep your tract was and what that means for your timeline. You deserve a real number, not "it depends."

2. Ask whether a general surgeon is the right surgeon

This one I learned the hard way.

My fistulotomy was performed by a general surgeon. When it failed , and it did fail. I finally found a colorectal surgeon, someone who specialized specifically in this. The difference in knowledge, in clarity of explanation, and in treatment options was significant.

Colorectal surgeons handle fistulas regularly. They're more likely to accurately assess the complexity of your tract before surgery, which matters for both surgical approach and realistic recovery expectations. If you haven't already, it's worth asking whether your surgeon specializes in this area before you schedule anything.

Not every fistulotomy fails. But if yours is anything other than a simple, straightforward case, a specialist is worth the extra step.

3. The first bowel movement is the thing everyone dreads, and you need to prepare for it before surgery

Nobody in the pre-op appointment warns you about this with the level of candor it deserves.

The first post-fistulotomy bowel movement is uncomfortable. The dread leading up to it is almost universal. And the time to start managing it is before the procedure, not after.

A few things that actually help:

Ask your surgeon about stool softeners in advance. Getting ahead of it is better than catching up while already in pain. Ask what your surgeon advises for your situation.

Fiber helps more than you'd expect. Keeping stool soft and well-formed (not loose, not hard) makes a real difference. Many patients use psyllium husk in the days leading up to and following surgery.

A sitz bath immediately after every bowel movement. Not optional. Warm water, ten to fifteen minutes. It eases discomfort and keeps the wound clean. This becomes the ritual that gets you through the first week.

The dread is almost always worse than the reality. Not painless but survivable. And it gets easier.

4. Your sitting situation needs to be solved before you come home

You're going to discover very quickly that standard chairs, car seats, and couches apply pressure in exactly the wrong place after a fistulotomy.

What actually helps:

A coccyx cushion — the kind with a U-shaped cutout at the back. Not a ring donut, which can actually increase pressure in some positions. A proper coccyx design offloads weight from the surgical area.

Bring it to the surgical center for the ride home. The drive back is longer and more uncomfortable than you expect. Have someone bring the cushion to you at discharge, or pack it in your bag.

Think about your work setup. Sitting through a full workday in a normal chair during early recovery isn't realistic. A standing desk, regular breaks, or an accommodation conversation, figure this out before you're already trying to manage it from the couch.

Arrange all of this before surgery. You won't feel like problem-solving afterward.

5. Wound care is more hands-on than you're expecting — and it starts immediately

Post-fistulotomy hygiene is a several-times-daily commitment, and it's one of the things nobody adequately prepares you for. The wound needs to stay clean to heal. Toilet paper doesn't accomplish that.

A portable bidet handles the heavy lifting. The travel-size squeeze bottle type works fine and travels with you. Fill it with warm water, use it after every bowel movement, pat dry gently. Thirty seconds. It makes an enormous difference.

Beyond that: gauze pads placed against the wound between sitz baths absorb drainage and protect the area. Your surgeon may send you home with them, or they're available at any pharmacy.

When I was going through my first recovery, I had none of this figured out on day one. I was improvising in real time while in pain. The routine sounds like a lot when you read it but after a few days, it becomes muscle memory. But starting with a system in place is a very different experience than building one from scratch while recovering.