Need Some Advice:Possible Abscess/Fistula, Non-Crohn's

Hi all, would like some advice or input if possible. I am 31 yo gay male, in good physical shape overall, but have had a small mass in my lower rectum for a couple of years. It began bleeding off and on, with bowel movements, I had a colonoscopy, which came back and said I had a benign rectal mass that should be removed surgically. I wanted a second opinion. That doc said I have a benign nodule, and unless it became symptomatic I shouldn't worry about surgery. I used to have anal sex but stopped completely 3 years ago upon my first bleeding episode. Since then, I've taken excellent care of my rectal area, and haven't had anything up there.

Fast forward a year, to a couple months ago, I started having bleeding with bowel movements again, so went back to colorectal surgeon, he did another colonoscopy on me, and found a small inflammatory polyp. He removed it, and said that he noticed an area below the poly which was inflamed and leaked pus. I just had my 4-week follow up exam with him, and he said the area was still there & still leaked pus, his words were "like a volcano". He suggested I have an exam under anesthesia (EUA) to excise this area or a fistulotomy. I should add that other than the one localized area, I don't have any other GI or bowel issues at all. And my bowel movements are regular and fine, and painless.

He told me the polyp he removed was caused by the abscess area, which he seemed to think he could remove quickly surgically. He said he wouldn't know until I have the eua if I have just an abscess or fistula.

So what should I do? I have this dull ache that radiates from my left buttocks and sometimes makes it uncomfortable to sit, and it really stung when the doc pressed on it in the office. But I never have severe pain or even low grade pain. I never have pain with bowel movements, and am never in actual pain. I'ts more of a dull ache sensation, a feeling of fullness back there on the left side, which is where the nodule is located. Is draining a pus-filled area a simple deal?

I am leaning to just going ahead with the EUA and letting him fix what he can. But I don't want to come out worse than when I went in. I've heard lots of horror stories about abscess removal/fistula procedures, etc.

I definately don't want a seton, if I have a fistula, I'd rather have it packed or the biodegradable glue they use. I am a young guy and just want this over with so I can get on with my life. And I don't want to have this procedure and come out being incontinent or having to wear adult diapers or something. That'd just be humiliating.

What should I do? My pre-op outpatient sheet says I am scheduled for "inflammatory nodule excision verses fistulotomy". So can I just ask to speak to the doctor before my procedure so we're on the same page? That's my right as a patient, right?

Also what is the recovery time for fistulotomy/abscess removal? The doc told me the other day that he thinks it should be relatively simple to remove based on his local sigmo exam, but that it would be much more involved if a fistula.
I am relieved that the biopsy on the poly was benign, so I guess I should be lucky, but this whole other thing is an annoyance.

Thanks for any advice/input!!

Hello and welcome to the forum!
I would definitely recommend going ahead with the surgery. If left alone the site is prone to getting infected, the abscess could get bigger and just cause a bigger problem, larger wound, bigger healing time etc.
Of course it would be a good idea to chat to the surgeon and voice your concerns to him.
I have recently had the fitulotomy surgery you mention (no polyps). If the fistula is fairly close to your anus, and they do not need to cut the sphincter muscles then it should be a fairly straight forward procedure. Fistula's can be tricky things so I see where you have read your horror stories but I hope I can give you some reassurance with my success story.
Of course it was stressful having surgery, and painful afterwards particularly going to the toilet, but if you look after your wound and keep it clean then it should heal up. I don't notice mine at all now, and I expect it has completely healed. It has probably taken a couple of months to heal up but it was probably only two or three weeks that it was still uncomfortable.
Please feel free to ask me any questions.

Welcome to the forum. I like the equality sign!

I really can't speak to this issue but if you have to undergo surgery can they just remove the entire mass? This will get rid of pain and potential complications long term. You would also be able to resume a full sex life again.

Wish I could offer more input on the subject. I'd like to invite you to our gay support group on here. Feel free to introduce yourself and certainly you can bring this up there too if you'd like.

LGBT IBD support group:
http://www.crohnsforum.com/showthread.php?t=47953

I went ahead and did the EUA, my CRS said that basically the "mass" consisted of a small slightly-larger than pimple sized place in my rectum. He described it to my cousin who was there with me for the procedure as "very similar to a pimple like you'd get on the face". He said it was quite unusual. But he said he thinks he got it all, and just waiting on the culture results now, and my 4-week follow-up to see how I healed up. Hoping it's over with!