Post-Fistula Surgery: Recovery, Concerns, and Sexual Health Insights

Post-fistula surgery

Hello Doctor: I underwent fistula surgery on December 20, 2018, and was discharged three days later.
I had previously looked in the mirror and saw that the surgical incision was about 2-3 cm next to the sphincter, with an external incision of 2-3 cm that was open when I was discharged.
After discharge, in addition to oral medication, I also applied antibiotic ointment to the external wound.
My last follow-up appointment was on January 23, 2019, at which time the external open wound had healed, but there was still some discharge.
The doctor performed a digital examination and found a wound about one finger's length inside the anus.
The doctor mentioned that the location of the fistula varies for each person, so the depth of the incision may differ, and advised me to apply antibiotic ointment to the internal anal wound.
I would like to ask the doctor: 1.
Is it normal for the internal anal wound to still not be healed after a month? 2.
Is it normal to still have some discharge at times? Could this be a sign of recurrence? 3.
I have tried using a cotton swab to clean the wound inside the anus, but I noticed bleeding; how can I avoid this? 4.
As a gay man, will this affect anal intercourse in the future, and how long should I wait before resuming normal anal intercourse?

Fenglin, 20~29 year old female. Ask Date: 2019/01/29

Dr. Chen Jiaming reply Surgery

1.
The depth of the anal fistula varies among individuals, and the healing time for surgical wounds also differs.

2.
It is common to have discharge from the anus after anal fistula surgery; however, some may experience pus while others may only have normal intestinal secretions.

3.
Please wear gloves and use your fingers to apply some ointment inside; do not use cotton swabs as they may easily injure the mucosa.

4.
Scar tissue will form around the surgical site after fistula surgery, and excessive dilation too early can lead to tearing or pain.
It is advisable to extend the time and gradually increase the degree of dilation.

Reply Date: 2019/01/29

More Info

Post-fistula surgery recovery can be a complex process, and it’s understandable to have concerns about healing, discharge, and sexual health after such a procedure. Based on your situation, let’s address your questions one by one.

1. Is it normal for the anal wound to still be healing after a month?
Yes, it can be normal for the internal anal wound to take time to heal, especially after a fistula surgery. The healing process can vary significantly from person to person, depending on factors such as the depth and location of the incision, the individual's overall health, and how well they follow post-operative care instructions. It’s not uncommon for internal wounds to take several weeks to a few months to fully heal. If you are still experiencing discomfort or if the wound appears to be worsening, it’s important to follow up with your healthcare provider.

2. Is it normal to still have discharge after a month? Could this be a sign of recurrence?
Some discharge can be expected during the healing process, especially if the wound is still in the process of healing. However, if the discharge is persistent, has a foul odor, or is accompanied by increased pain or swelling, it could indicate an infection or a recurrence of the fistula. It’s crucial to monitor the characteristics of the discharge and report any concerning changes to your doctor.

3. How can I avoid bleeding when using a cotton swab to clean the wound?
Bleeding when cleaning the area can occur if the wound is still sensitive or not fully healed. To minimize this, consider the following tips:
- Use a gentle touch when cleaning the area; avoid applying too much pressure.

- Instead of using a cotton swab, you might find it easier to clean the area with a soft cloth or gauze that is moistened with saline or a mild antiseptic solution.

- Ensure that you are not irritating the wound by cleaning too frequently. It’s often recommended to clean the area only as needed and to allow it to heal without excessive manipulation.

4. Will this surgery affect anal intercourse, and when can I resume it?
After a fistula surgery, it’s essential to give your body adequate time to heal before resuming anal intercourse. Generally, most healthcare providers recommend waiting at least 4 to 6 weeks post-surgery, but this can vary based on individual healing and the advice of your surgeon. It’s crucial to have a follow-up appointment with your healthcare provider to assess your healing progress before resuming any sexual activities. They can provide personalized advice based on your specific situation and ensure that you are healed enough to avoid complications.

In summary, while some aspects of your recovery may be normal, it’s essential to maintain open communication with your healthcare provider. They can provide the best guidance tailored to your healing process and help address any concerns you may have about your recovery and future sexual health. Remember that patience is key in the healing process, and prioritizing your health and well-being is paramount.

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