I think one of the most important issues to address concerning anal/perianal fistulas is the the pain. I have learned that the rectum is one of the worst places to have pain, and it is a tricky type of pain to treat. Over the past 2.5 years I have been given every type of pain killer you can imagine. Even now, after a successful surgery, I am still healing and still in a significant amount of pain all of the time.
Chronic pain sucks. It can change you. If you have been diagnosed with an anal fistula, and you are suffering from serious to mild pain, you need to address this with your doctor. Do not be shy about it, do not try to put on a brave face, do not “suck it up.” Pain is not good for healing, and it’s not good for your emotional or mental health either. If you are like me, pain medications can be tricky. Most narcotics make me nauseous and depressed, but I ended up having to take Ultracet (which is just Tramadol with Tylenol). If your pain meds make you sick, ask your doctor if you can try something else, and ask for anti-nausea medication if necessary.
I cannot recommend ice packs highly enough. I keep three gel ice packs in my freezer at all times. Wrap it in a towel or dish cloth and lie down on it, or wedge it in between your legs depending on where your fistula is located. Leave it on there for about 15 minutes, alternate with heating pads, and take breaks. It helps so much to relieve the ache, especially right after surgery.
As for post-surgery pain, STAY ON TOP OF YOUR PAIN MEDS!!!! This is so important. You need to rest, sleep, and heal. You can’t do that if you are in excruciating pain. I hate pain killers, so trust me, I know. You might be tempted to skip a dose and tough it out. Don’t. I promise you, you will regret it in a few hours. The thing with pain is that if you let it get worse it takes longer to manage it. If you stay on top of your meds, take them every 4-6 hours as directed, you can keep your pain pretty mild. You won’t need to take so many after the first few days, but don’t try to be tough, don’t try to be brave. Just take the dang pills. If they make you severely nauseous, ask for a prescription for Zofran or some other anti-nausea meds. Other things that help with nausea are ginger, cinnamon, peppermint oil. Take your pain meds with food! This is a big deal! Eat first, then take a pill, in that order.
The hard part is the chronic pain that lingers throughout the ordeal. You might experience weeks where you feel fine, and can move around great. You will definitely experience days where it’s hard to get up and down the stairs, or get out of bed at all. This can get very frustrating and depressing. I highly recommend that you read up on the Gate Control Theory of Pain. A friend of mine who has MS pointed me in this direction, and it has saved me so much grief. This method basically teaches you to distract yourself in various ways from the pain (listening to music, for example, while you do chores). Meditation helps a great deal, too. I struggle with meditation, but there are lots of great guided meditations on youtube that are super helpful. Breathing helps. Acupuncture is great if you can afford it. You might also ask your doctor to refer you to a pain management clinic.
Try to force yourself to move. Take little walks, even just around your front yard. Keeping your circulation going is really important for healing. Know your limits, and don’t overdo it, but try to move a little bit every day.
Realize that pain is going to effect your social life. One night out can mean three days in bed. That might be worth it, your call. Make sure when you do go out to take steps to make it a comfortable experience. Buy one of these:
There are fancier ones out there, but this helps with sitting. Some doctors will tell you not to sit on this right after surgery because it spreads your butt cheeks and can cause more pain. This wasn’t the case for me, but everyone is different. Bring wipes, gauze, and whatever else you might need while you’re out. I will have an entire post on helpful products, but my point here is that if you do venture out in the world, prepare yourself. It’s like going out with a baby, you need supplies.
I hope this is helpful. I will be asking a few doctors to write guest posts for me about pain management in the near future. If you have any tips for dealing with pain, please comment or e-mail me at firstname.lastname@example.org with your advice.
Leah R. Chatterjee