Hello Drs,
Would you please give me some input on a medical-lifting related issue? I’ll be glad if you read the whole lengthy post I’ve written, but of course I understand if you don’t have the time for that - so a quick summary of my question: I had a perianal fistula, it’s healed now, I noticed lifting/hip flexion seemed to aggravate it while I had and I don’t just how safe high intra-abdominal pressure is - so I’m still afraid to lift heavy now, because I fear it might re-tear the skin inside and cause the fistula to come back. Do you think this is something to worry about, or am I perhaps a bit too unreasonably worried?
I’m a 26 years old male. About four years ago I had a peri-anal fistula, which developed after a perianal abscess. I don’t know how the abscess developed in the first place, but it might have been a consequence of somewhat heavy drinking and constipation. The fistula crossed the sphincter muscles too much, and I have no inflammable bowel disease, so the chosen procedure, which worked, was to first place a draining seton and then (about a month later after the seton placement) do the advancement flap surgery to cover the internal opening of the fistula.
It’s been three years since the successful surgery, and while I’ve done some lighter full depth squats/front squats with 90kg and deadlifts with 120kg without any issues, I’m still quite afraid to start trying to use heavier weights/trying to progress by adding weight, as I fear it might cause another fistula somehow. The doctor has told me I shouldn’t worry about doing these things.
I’m somewhat hesitant as I would really like to avoid having to deal with this problem again. As far as I’ve read, fistulas seem to recur quite often, and the surgery success rates are about 85% if I remember correctly (using advancement flap and presuming no IBD). Additionaly, while I had the fistula, I noticed that movements with a lot of hip flexion like squats/deadlifts, especially if coupled with a wide stance, really aggravated the area and caused pain. While the biggest danger (as far as things I know of, and which I can effect) for me is constiption, given the observation that high hip flexion caused me pain when there was an active fistula, I’m still afraid to do such movements now. I’m also afraid of doing movements that might drastically increase intra-abdominal pressure, such as heavy squats and deadlifts.
Do you think that there is any reasonably likely mechanism by which heavy squats and deadlifts could cause the fistula to recur? I obviously don’t understand these things well, but I do have the fear that a heavy lift could cause a re-tear in the internal opening of the fistula, especially given that the skin might always be weaker/tighter there since it was treated by the advancement flap.
Still, I suspect I might be overly worried. The disease was very unpleasant since it was quite painful at times and humiliating. The treatment was also lengthy, since my setons kept breaking (I think as a consequence of being physically active and lifting weights), and so in total it took quite a few surgeries and months before I finally had the advancement flap surgery. The whole process was mentally challenging, since I was afraid it might never heal and I just wanted the surgeries to be behind me already. Thus, my mentally negative experience might be making me overly worried.
I would really appreciate any sort of input, regarding how risky heavy lifting might be for me, and whether I should perhaps avoid certain lifts. Sorry for the lengthy post.