Post-Surgery Care for Fistula: Key Questions and Answers

Post-fistula surgery

I have a few questions after my fistula surgery last week:
1.
I notice that there is blood and tissue fluid on the gauze every time before I take a sitz bath, but the timing for changing it is quite irregular.
How often do you recommend changing the gauze? Should I reapply medication or just replace the gauze directly?
2.
After each sitz bath and changing the medication, the wound is very painful.
Is this normal? (The ointment I'm using is Neomycin.)
3.
Today, while using the restroom outside, I couldn't take a sitz bath or rinse, so I used wet wipes.
As a result, the wound has been bleeding continuously, and I noticed blood in my stool.
Will this affect the healing of the wound?
4.
The doctor prescribed a stool softener to be taken four times a day.
Since the surgery, I have been experiencing diarrhea.
After a follow-up visit, the doctor reduced the dosage to twice a day, but I am still having diarrhea.
Is it safe for me to take over-the-counter medications like antacids or anti-diarrheal medications?

Ming, 20~29 year old female. Ask Date: 2016/12/28

Dr. Ke Fangxu reply Surgery

1.
It is normal to have slight bleeding and tissue fluid at the surgical site after fistula surgery.
It is generally recommended to soak the wound at least three to four times a day, gently pat it dry afterward, and then cover it with gauze or a dry cotton ball.

2.
When using a basin, the amount of povidone-iodine added should not be excessive, as it may cause irritation to the wound.
If applying ointment causes pain at the wound site, it is advisable to temporarily stop using the ointment.

3.
There should not be any issues.

4.
If diarrhea is caused by taking a stool softener, it is recommended to temporarily discontinue its use.
If diarrhea persists after stopping the stool softener, you may consult a physician for a prescription.
Self-medicating could potentially lead to constipation, which may result in bleeding and pain at the wound site.

Reply Date: 2016/12/28

More Info

Post-surgery care for a fistula can be quite challenging, and it’s essential to follow proper guidelines to ensure optimal healing. Here are some key considerations and answers to your questions based on medical knowledge and best practices.

1. Frequency of Dressing Changes: After a fistula surgery, it is common to see blood and serous fluid on the dressing. The frequency of changing the dressing can depend on the amount of drainage. Generally, it is advisable to change the dressing whenever it becomes saturated or at least once a day. If the dressing is soiled or wet, it should be changed immediately to prevent infection. When changing the dressing, if the wound appears to be healing well and there is no sign of infection (such as increased redness, swelling, or foul odor), you may not need to apply medication each time. However, if your doctor has prescribed a topical antibiotic, it is usually recommended to apply it after cleaning the wound before placing a new dressing.

2. Pain After Dressing Changes: Experiencing pain after changing the dressing and applying medication is not uncommon, especially if the wound is still healing. The use of Neomycin ointment can sometimes cause irritation, particularly if the skin is sensitive. If the pain is severe or worsening, it is crucial to consult your healthcare provider. They may recommend pain management strategies or alternative medications that might be less irritating.

3. Impact of Hygiene Practices: Using wet wipes instead of soaking in a sitz bath can be less effective for cleaning the area, especially after surgery. If you notice bleeding after using wipes, it could indicate that the area is still sensitive or that you may have inadvertently irritated the wound. While occasional bleeding may not significantly impact healing, persistent bleeding or blood in your stool should be reported to your doctor immediately, as it could indicate a complication that needs to be addressed.

4. Managing Diarrhea and Medication: Diarrhea after surgery can be concerning, especially if you are taking a stool softener. It’s essential to communicate with your healthcare provider about your symptoms. They may adjust your medication or suggest dietary changes to help manage your bowel movements. Self-medicating with over-the-counter medications like antacids or anti-diarrheal medications should be approached with caution and ideally discussed with your doctor first, as they can interact with your prescribed medications or affect your recovery.

Additional Considerations:
- Wound Care: Always wash your hands before and after changing the dressing. Use sterile or clean techniques to minimize the risk of infection.

- Signs of Infection: Monitor for signs of infection, including increased redness, swelling, warmth around the wound, or discharge that is yellow or green. If you notice any of these symptoms, contact your healthcare provider.

- Diet and Hydration: Maintaining a balanced diet and staying hydrated can support healing. If you are experiencing diarrhea, ensure you are replacing lost fluids and electrolytes.

- Follow-Up Appointments: Keep all follow-up appointments with your healthcare provider to monitor healing and address any concerns.

In conclusion, post-surgery care for a fistula requires careful attention to wound management, pain control, and monitoring for complications. Always consult your healthcare provider for personalized advice and adjustments to your care plan. Your recovery is paramount, and addressing these concerns promptly can lead to better outcomes.

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