Very lucky
I wanted to share my story, only to give people encouragement that there are varying stories on the healing timeline and straightforward cases; but, you won't know until you get it looked at and get it taken care of.
35 year old male, relatively healthy with no underlying conditions.
TL;DR only took me 2 weeks to recover after a mostly superficial fistulotomy, and having a surgeon you're comfortable and confident in is important if you are fortunate to have the choice.
My timeline:
August 2025: Felt a bump grow, which I thought was just a pimple at first, around my taint area and superficial. I went to get it checked at Kaiser, and my doctor had noted that I had an anal fissure back in 2019 so he recommended that I go see a colorectal specialist. I am not shy about bringing things up with my doctor when I notice things, so I think this may have helped to catch this earlier than much later, rather than to ignore any off things.
Sept 2025: Did an incision in the hopes that it was just an external abscess that would just clear when poked and heal. Didn't have the best interaction with the specialist at Kaiser, bedside manner was very odd and seemed all over the place with thoughts and not able to explain to me my options. The incision was also cut in the wrong place at first, and two cuts had to be made. This resulted in a longer healing period for this time, which was frustrating.
November 2025: Confirmed that it was a fistula, as it was not healing over and still bleeding. Anal fistulotomy recommended and I read a lot on this thread being a bit scared of the long healing process. I requested a different colorectal surgeon after my negative interactions, and was brushed off with the comment that "they will just tell you the same thing". I insisted though, since I didn't feel comfortable with this surgeon, and then got rescheduled to a different surgeon, but I wouldn't be able to see him until 4 months later to talk about my options again and get a second opinion.
January 2026: I got a new job, so luckily my open enrollment period started again and I did some research that there was a doctor in my city who specializes in anal fistulotomy procedures. I switched insurances to be able to go to UCSF and see Dr. Varma after researching specialists online.
February 2026: Visit to Dr. Varma and her team, they explained everything very well to me and why the fistulotomy is the best option, and also what all the different possibilities would be once I go through with the surgery, and how they will determine what path to go down when I'm on the operating table. It was nice that she had a team that was able to share their experiences helping many others before me through it. They said if my fistula goes through the muscle, they will insert a seton, and I will have to go back another time for a follow-up procedure. If not, they will move forward with a fistulotomy and I will begin the healing process.
April 2026: Procedure day was VERY straightforward. I tried to have a bowel movement that morning in order to buy some healing time post-surgury, but I was too anxious to go. Looking back on it, I should've had more fiber and hydrate a LOT leading up to the surgery. I was nervous, since I hadn't had surgery since I got my tonsils out as a kid. My body handled the anesthesia well, and I was out for 30-45 minutes and apparently, the procedure only took 20 minutes or so. Don't remember a thing other than being face down and ass up in the operating room with pillows before waking up in the recovery area. The team told me that my fistula was all superficial (meaning within 30% of the outside of the anal area), so it was very straightforward and they were able to do the fistulotomy.
Day of surgery healing: Lots of time in bed and rest, felt pretty good with operation pain meds still sort of working + the advanced tylonol. Took Tylenol PM to sleep. No bowel movement.
Day after surgery: Still too nervous to have a bowel movement. Had lots of water non-stop to make sure stools would not be hard.
2-3 days after surgery: finally had a my first bowel movement with some Miralax, and it was not nearly as painful as I thought it would be (I timed it so I was still taking extra strength Tylenol an hour or 2 before doing sits baths and attempting to go). Partly because my fistulotomy was mostly superfical, but there was still blood.
~3-6 days after: I kept taking Tylonol PM for a few more days and then decided to stop since it was starting to affect my overall mood and not getting the best sleep. I still used gauze at night consistently and also did sits baths with epsom salt for 10 minutes+ a few times a day. Just played Switch to keep myself entertained and be good about sitting for the recommended time and then showering after. Minimal blood in bowel movements.
6 days later: I was back working from home and took my first walk around the neighborhood. I think I pushed myself a bit more than I needed to but it made me understand where my limits were. No more blood in bowel movements.
1.5 weeks post surgery: I'm able to go out to dinner, walk around okay and go to work in the office, still with gauze, but no longer taking tylonol for pain.
2 weeks post-surgery (pretty much back to normal day to day): still healing, but its not affecting my day-to-day. Long walks around the city is no problem. Went to a few concerts even, and live is pretty much back to normal for me. Still sleeping with a bit gauze at night, with less and less discharge each day.
3-weeks surgery: today as I'm writing this, I had my follow-up video appointment. Basically, only a tiny bit of discharge at night, and I just regularly clean the area when I use the restroom when I'm out and about. Team told me the chances of infection after a fistolotomy is .5% (5 years of doing this as a PA, she said she's only seen one infection and the person had other unerlying conditions that may have contributed).
Hope this gives people hope to just go check out your options and get the procedure done sooner than later if you're able to. I don't know if that contributed to my case, but I'm glad I got it done because I was ready to just live with the fistula for a couple of years and see if it would get worse just out of being nervous or scared.
Tips: hydrate a lot leading up to the surgery (but NOT the day of, since you want to de-risk any throwing up of liquids due to the anesthesia), get into the routine of psyllium husk fiber (I put them in smoothies), find a way to entertain yourself so you look forward to long sit baths.