Post-Surgery Concerns After Anal Fistula Removal: What to Expect

Postoperative Issues Following Anal Fistula Surgery

Hello, Dr.
Ke.
I would like to ask you a few questions.
In May, I underwent anal fistula excision at the hospital (it seems there was also some treatment for a mole, according to the discharge summary).
During my last follow-up appointment at the end of June, I inquired about a small amount of blood at the internal opening of the wound when I had a bowel movement, and I also felt discomfort in the anal area afterward.
The doctor informed me that this was a normal phenomenon since the wound was still healing.
By mid-July, there was significant improvement.
However, after starting to wipe after using the toilet, I noticed that due to the uneven skin from the wound, wiping became difficult, requiring multiple attempts.
Sometimes, I would accidentally wipe over the wound, causing sharp pain and redness, as well as anal discomfort (using moist wipes).
I then began to notice a small amount of blood at the internal opening again, and the discomfort after bowel movements returned to what it was before.
Occasionally, there is a little blood at the end of the stool.
(Sometimes, certain sitting positions cause pain in the wound and anal area.) Therefore, I would like to ask:
1.
After three months, is it possible that the internal opening of the wound has reopened? Should I schedule a follow-up appointment? (The location of the wound is right where I sit, which puts pressure on the very end of the wound.)
2.
Is it normal for the edges of a properly excised wound to feel hard? (I initially discovered the fistula myself, and it also felt hard.)
3.
Generally, how long does it take for such a wound, including the internal opening and anal area, to heal completely? (The length of the excised wound is approximately 6 cm.)
4.
Is it normal to feel pressure and pain in the anal area when sitting?
Thank you for your assistance!

J, 30~39 year old female. Ask Date: 2017/08/15

Dr. Ke Fangxu reply Surgery

1.
Based on your description, it seems more like dermatitis caused by excessive wiping.
I recommend washing the area with clean water and applying topical ointment for a while.
If the symptoms do not improve, please consult a physician.

2.
Yes, this is a normal phenomenon during wound healing; however, if it persists for three months post-surgery, you should have it checked by a doctor.

3.
If it is a simple anal fistula, it typically heals completely in about 1-2 months.
It is unusual for it to remain unresolved for such a long time.

4.
This is certainly not normal.
However, given that you also have poor wound healing, it is not surprising that you experience pain while sitting.
I recommend that you consult your surgeon for further evaluation.

Reply Date: 2017/08/15

More Info

After undergoing anal fistula removal surgery, it is common to have concerns about the healing process and what to expect in terms of recovery. Here are some insights based on your questions and the general medical understanding of post-surgical recovery in this area.

1. Possibility of Internal Wound Reopening: It is indeed possible for the internal wound to reopen, especially if there is excessive pressure on the area, such as from sitting. If you are experiencing bleeding from the internal opening or significant discomfort, it is advisable to return to your doctor for an evaluation. They can assess whether the wound has reopened or if there are other complications, such as infection or improper healing.

2. Hardness Around the Surgical Site: It is not uncommon for the edges of a surgical wound to feel firm or hard as they heal. This can be due to scar tissue formation, which is a normal part of the healing process. However, if the hardness is accompanied by pain or if it seems to be increasing, it would be prudent to discuss this with your healthcare provider.

3. Healing Time for Surgical Wounds: The healing time for an anal fistula removal can vary significantly from person to person. Generally, superficial wounds may take a few weeks to heal, while deeper wounds can take several months. Given that your surgical wound is approximately 6 cm long, complete healing could take anywhere from 6 weeks to several months, depending on factors such as your overall health, adherence to post-operative care, and any complications that may arise.

4. Discomfort When Sitting: Experiencing pressure or pain when sitting is not uncommon after anal surgery. This discomfort can be due to the surgical site being sensitive as it heals. However, if the pain is severe or worsening, it is essential to consult your doctor. They may recommend strategies to alleviate pressure, such as using a cushion while sitting or adjusting your sitting posture.

Additional Recommendations:
- Post-operative Care: Ensure you are following all post-operative care instructions provided by your surgeon. This may include keeping the area clean, using prescribed ointments, and avoiding activities that could strain the area.

- Dietary Considerations: Maintaining a high-fiber diet and staying hydrated can help ensure softer stools, which can reduce strain during bowel movements and minimize discomfort.

- Pain Management: If you are experiencing significant pain, discuss pain management options with your doctor. Over-the-counter pain relievers may help, but it’s essential to follow your doctor's recommendations.

- Follow-up Appointments: Regular follow-up appointments are crucial for monitoring your healing progress. If you notice any changes, such as increased pain, swelling, or unusual discharge, do not hesitate to contact your healthcare provider.

In summary, while some discomfort and minor bleeding can be part of the healing process after anal fistula surgery, persistent symptoms warrant a follow-up with your healthcare provider. They can provide tailored advice and interventions to ensure a smooth recovery.

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