Post-Surgery Concerns: Hardness and Pain After Anal Fistula Repair

More than three months after anal fistula surgery, the anal area still feels hard?

Hello Doctor: I underwent fistula surgery in mid-May of this year, and it has been three months since then.
The wound has completely healed.
I take a sitz bath once a day and apply a topical medication for hemorrhoids.
However, when I apply the medication, I still feel a hard tissue around my anal area, which causes slight pain at times.
I also feel a moist sensation around the anus, but when I wipe with toilet paper, I only see a yellowish ointment (or a color similar to feces) and do not notice any purulent discharge.
I consulted a doctor who said everything looks fine.
I would like to ask the doctor: 1.
How long after fistula surgery will the hard tissue and pain sensation subside? 2.
After applying the medication, I often feel the urge to have a bowel movement, but I am unable to do so.
Is this a sign of fistula recurrence? 3.
When I apply medication inside the anus, I feel what seems to be a small opening (toward the direction of the scrotum).
Is it normal to have a small opening? Thank you for your assistance, Doctor.

Yang, 20~29 year old female. Ask Date: 2018/08/25

Dr. Ke Fangxu reply Surgery

1.
Scar tissue after surgery generally takes about six months to gradually absorb, and it is normal for the wound to feel firm during this period.

2.
If it has been more than three months since the surgery, there should be no need to continue applying ointment.
If the phenomenon persists after stopping the ointment, it is best to consult a physician for further evaluation.

3.
To accurately determine what you refer to as a hole inside the anus, a physical examination is necessary.
It is recommended that you consult the surgeon for an evaluation.

Reply Date: 2018/08/25

More Info

After undergoing anal fistula repair surgery, it is not uncommon to experience some degree of discomfort, hardness in the tissue around the surgical site, and even mild pain. Here’s a detailed response to your concerns based on medical knowledge and common post-operative experiences.

1. Duration of Hardness and Pain: After anal fistula surgery, it can take several weeks to months for the tissue to heal completely and for any hardness or discomfort to subside. The healing process varies from person to person, but it is generally expected that any post-surgical hardness and pain should gradually improve over time. In many cases, patients may notice a significant reduction in symptoms within 6 to 12 weeks post-surgery. However, if the hardness persists beyond this period or worsens, it is advisable to consult your surgeon for further evaluation.

2. Feeling of Urgency and Inability to Defecate: The sensation of needing to have a bowel movement after applying medication is not uncommon, especially following anal surgery. This can be due to irritation of the surrounding tissues or nerves that may have been affected during the procedure. However, if you are experiencing a consistent inability to pass stool or if this sensation is accompanied by severe pain, it could indicate a complication such as a recurrence of the fistula or a new issue, such as anal stenosis (narrowing of the anal canal). It’s essential to communicate these symptoms to your healthcare provider for proper assessment.

3. Presence of a Small Opening: The feeling of a small hole near the surgical site, especially if it is close to the scrotum, can be concerning. It is essential to differentiate between normal post-operative changes and signs of a potential complication. After fistula surgery, it is not unusual for patients to feel some irregularities in the tissue as it heals. However, if this opening is new, persistent, or associated with discharge, pain, or other concerning symptoms, it may warrant further investigation to rule out a recurrence of the fistula or other complications.

In summary, while some discomfort and changes in the anal area are expected after fistula repair surgery, it is crucial to monitor your symptoms closely. If you notice any worsening of your condition, persistent pain, or new symptoms, it is essential to follow up with your surgeon. They may recommend imaging studies or further examination to ensure that the healing process is progressing as expected and to rule out any complications.
Additionally, maintaining good hygiene, continuing with sitz baths, and following your surgeon's post-operative care instructions are vital for optimal recovery. If you have any concerns about your medications or the healing process, do not hesitate to reach out to your healthcare provider for guidance. Your health and comfort are paramount, and addressing these concerns early can lead to better outcomes.

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