Post-Surgery Discharge After Anal Fissure Treatment: What to Expect

Postoperative discharge after anal fissure surgery?

Dear Dr.
Ko,
I underwent surgery for an acute thrombosis on October 31.
Less than ten days later, I developed a granulation tissue that was larger than the thrombosis itself, and it was very painful during those days.
During my follow-up appointment, the doctor cut it without anesthesia, and I screamed in pain (leaving half of the granulation tissue still outside).
Is this normal?
The days following the procedure were truly hellish.
I was in unbearable pain and returned to the hospital daily for 24-hour pain relief injections, which I received for five days.
Despite the pain management, I was still in pain, so I decided to switch doctors.
The new doctor examined me and diagnosed me with chronic anal fissure combined with a mucosal prolapse, and he mentioned that I actually didn't have much hemorrhoids.
He said that during the first visit, I didn't need surgery; a simple manual reduction would have sufficed (I felt like confronting the first doctor because he told me I didn't have an anal fissure and insisted on surgery, claiming I would be fine in 3-5 days).

After the consultation, I immediately decided to undergo outpatient laser surgery on November 17.
Miraculously, the pain I had been experiencing disappeared the next day! It has now been over six weeks, and I would like to ask if it is normal to still have discharge? Is it taking too long? Does the presence of discharge indicate that the wound has not healed? However, I no longer feel pain in that area.
I have been using gauze for two months, and it is quite bothersome.

Thank you for taking the time to read and respond.
I wanted to share my painful experience with everyone!

Fei Er, 30~39 year old female. Ask Date: 2018/01/02

Dr. Ke Fangxu reply Surgery

There are two different surgical methods for thrombosed hemorrhoids: incision and excision.
It is unclear which one you underwent, but generally, only excision surgery can lead to the complication of granuloma.
Postoperative pain may be due to anal stenosis caused by surgical sutures; otherwise, it should not persist for such a long time.
The second surgery likely involved an incision of the sphincter, which is why the pain has resolved.
As for the outpatient laser treatment, based on your description, it is not possible to determine which type of instrument was used, and therefore, the reason for the delayed wound healing cannot be confirmed.
It is advisable for you to have the physician who performed the laser treatment examine the wound to establish a proper diagnosis and treatment plan.

Reply Date: 2018/01/02

More Info

After undergoing surgery for an anal fissure, it is common to have a range of experiences during the recovery process. Your situation, involving the development of a larger granulation tissue after the initial surgery and subsequent pain, highlights some of the complexities that can arise in post-surgical care. Here’s what you can generally expect after such a procedure, along with some insights into your specific concerns.

Post-Surgery Expectations
1. Pain Management: It’s not unusual to experience significant pain after surgery for an anal fissure, especially if there were complications such as the formation of granulation tissue. The pain can be exacerbated by the removal of this tissue, particularly if done without anesthesia. It’s important to communicate openly with your healthcare provider about your pain levels and to explore effective pain management strategies, which may include stronger analgesics or alternative therapies.

2. Granulation Tissue: The presence of granulation tissue is a common response to injury and surgery. It is part of the healing process, but excessive granulation can lead to discomfort and complications. If the tissue was trimmed but still causing issues, it may require further treatment or monitoring. Your experience of pain during the trimming procedure is regrettable, and it’s understandable to feel frustrated, especially if you felt that your concerns were not adequately addressed by your first physician.

3. Discharge and Secretion: It is normal to have some discharge from the surgical site as it heals. However, if you are experiencing prolonged discharge beyond six weeks, it’s essential to consult with your healthcare provider. While some discharge can indicate healing, excessive or foul-smelling discharge may suggest an infection or other complications. The absence of pain is a positive sign, but the ongoing discharge warrants further evaluation to ensure that the wound is healing properly.

4. Follow-Up Care: Regular follow-up appointments are crucial after surgery for an anal fissure. These visits allow your doctor to assess the healing process, manage any complications, and adjust your treatment plan as necessary. If you are still experiencing discharge, your doctor may want to perform an examination to determine the cause and ensure that there are no underlying issues.

5. Lifestyle Adjustments: During recovery, it’s important to maintain a diet high in fiber and to stay hydrated to promote regular bowel movements, which can help prevent further irritation of the surgical site. Additionally, practicing good hygiene and possibly using sitz baths can aid in comfort and healing.

6. Emotional Support: The pain and discomfort associated with anal fissure surgery can take a toll on your emotional well-being. It’s important to seek support from friends, family, or even counseling if you find that the experience is affecting your mental health.

Conclusion
Your experience with anal fissure surgery and the subsequent complications is not uncommon, and it’s important to advocate for your health. If you continue to have concerns about your recovery, including the ongoing discharge, do not hesitate to seek a second opinion or further evaluation from a specialist. Healing can take time, and each individual’s recovery process is unique. Remember to prioritize your comfort and well-being as you navigate this challenging period.

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