Post-Surgery Pain Management After Anal Fistula Surgery: What to Expect

Pain after anal fistula surgery?

Hello! I underwent an anal fistula surgery under spinal anesthesia on October 30th at Chang Gung Memorial Hospital, which lasted about ten minutes.
Upon discharge on October 31st, my surgeon informed me that there were no issues with bacterial infection, and I was prescribed only a week's worth of pain medication (Ponstel) and gastric tablets.
I was advised to take warm sitz baths four times a day and to have bowel movements once in the morning and once at night.
Although there has been a significant amount of wound discharge and blood-tinged fluid, there has been no active bleeding.
However, I noticed some yellow pus while applying medication yesterday.

Now, on the sixth day post-discharge, my pain has gradually increased (starting two days ago).
Initially, the pain was very mild at rest, but it has become more severe (I used to sit for over ten minutes without discomfort, but now sitting causes a feeling of swelling).
Additionally, I still feel residual urine after urination, which has led me to increase my sitz baths to six times a day due to anal pain.
There are also two specific pain points that occasionally throb.

Could you please advise if my symptoms might be caused by a bacterial infection?

Lai Rui, 60~69 year old female. Ask Date: 2017/11/06

Dr. Ke Fangxu reply Surgery

Anal fistula surgery typically results in a larger wound, which can lead to more postoperative pain; however, bacterial infections are relatively uncommon.
Some patients may experience increased pain about a week after the surgery.
If there is no fever or signs of redness, swelling, heat, or increased pain at the wound site, there is usually no need for concern, and patients can apply hemorrhoid ointment to alleviate symptoms.
However, if the pain persists without improvement, it is advisable to consult a physician for further evaluation.

Reply Date: 2017/11/06

More Info

After undergoing anal fistula surgery, it is not uncommon to experience varying levels of pain and discomfort during the recovery process. Your situation, where pain has increased significantly six days post-surgery, warrants careful consideration. Here’s a comprehensive overview of what you might expect and how to manage your symptoms effectively.

Understanding Post-Surgery Pain
1. Normal Pain Levels: After anal fistula surgery, some pain and discomfort are expected as part of the healing process. Initially, pain may be mild and manageable, but it can fluctuate based on activity levels, bowel movements, and overall healing.

2. Increased Pain: An increase in pain, especially if it becomes more pronounced over time, can be concerning. It may indicate several possibilities, including:
- Infection: The presence of yellow discharge and increased pain could suggest a bacterial infection. Signs of infection may include increased redness, swelling, warmth around the surgical site, or fever.

- Inflammation: Post-surgical inflammation can also lead to increased pain, particularly if the area is sensitive.

- Pressure or Tension: Sitting for extended periods or straining during bowel movements can exacerbate pain, especially in the sensitive anal region.

Recommendations for Pain Management
1. Follow-Up Care: It is crucial to maintain regular follow-up appointments with your surgeon or healthcare provider. If you notice any signs of infection or if your pain worsens, seek medical attention sooner rather than later. Early intervention can prevent complications.

2. Pain Management: Since you were prescribed pain medication (Ponstal), ensure you are taking it as directed. If the pain persists or worsens, discuss with your doctor the possibility of adjusting your pain management plan. This may include:
- Stronger Pain Medications: If over-the-counter options are insufficient, your doctor may prescribe stronger analgesics.

- Topical Treatments: Some patients find relief with topical anesthetics or anti-inflammatory creams.

3. Sitz Baths: Continuing with sitz baths is beneficial. They help soothe the area, promote blood flow, and can aid in healing. Increasing the frequency, as you have done, is a good strategy to alleviate discomfort.

4. Diet and Bowel Movements: Ensure you are consuming a high-fiber diet to facilitate smooth bowel movements. Straining can significantly increase pain. Staying well-hydrated is also essential.

5. Monitoring Symptoms: Keep a close eye on your symptoms. If you experience fever, increased discharge, or significant changes in pain levels, contact your healthcare provider immediately.

When to Seek Immediate Help
- Signs of Infection: If you notice increased redness, swelling, or warmth around the surgical site, or if you develop a fever, these could be signs of infection.

- Severe Pain: If the pain becomes unbearable or is accompanied by other concerning symptoms, do not hesitate to seek medical attention.

Conclusion
In summary, while some pain is expected after anal fistula surgery, an increase in pain, especially with accompanying symptoms like discharge, may indicate an infection or other complications. It is essential to maintain communication with your healthcare provider, adhere to prescribed pain management strategies, and monitor your symptoms closely. Early intervention can significantly improve your recovery experience and prevent potential complications.

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