Post-Surgery Concerns: Symptoms of Anal Fistula Recurrence

Postoperative issues following anal fistula surgery?

Hello Doctor: I underwent anal fistula surgery on August 6, 2019.
I took a photo of the wound with my phone, and it looks like it is healing well.
The doctor mentioned that my fistula wound is very close to the anal opening, which causes the healing tissue to be pulled during bowel movements, resulting in slower healing.
Is this true? My wound appears to have only a small area near the anal opening that is still red and hasn't fully healed.
I am still soaking in a sitz bath about three times a day, adding approximately a bottle cap of Betadine, but as of today, I still notice some purulent-like discharge from the wound, although the amount is minimal.
I'm unsure if this situation indicates a recurrence, and I'm quite worried.
I asked the doctor about the symptoms of recurrence, and he only mentioned that the wound would hurt, without mentioning discharge.
Therefore, I would like to ask the doctor what the symptoms of a fistula recurrence are.
Thank you.

James, 20~29 year old female. Ask Date: 2019/11/11

Dr. Ke Fangxu reply Surgery

All fistulas are located very close to the anus, so they naturally heal more slowly.
However, it is not normal for a fistula to remain unhealed three months after surgery.
Symptoms of fistula recurrence include the reappearance of a skin opening and purulent discharge, and sometimes there may also be swelling, pain, or bleeding.
If you are concerned about recurrence, it is advisable to seek a second opinion from another physician.

Reply Date: 2019/11/11

More Info

After undergoing anal fistula surgery, it's understandable to have concerns about the healing process and the potential for recurrence. Your experience of having a wound that is close to the anal opening can indeed affect the healing process. The proximity of the surgical site to the anal canal means that normal bowel movements can put tension on the healing tissue, which may slow down recovery. This is a common issue in such surgeries, and it’s important to follow your surgeon's advice regarding care and activity during the healing period.

Regarding the discharge you are experiencing, it’s not uncommon for some patients to notice a small amount of discharge from the surgical site as it heals. This can be due to several factors, including normal healing processes, irritation from bowel movements, or even the presence of residual inflammation. However, the presence of purulent (pus-like) discharge can be concerning and may indicate an infection or a recurrence of the fistula.

In terms of symptoms that may indicate a recurrence of an anal fistula, here are some key points to consider:
1. Pain: Increased pain around the surgical site, especially if it becomes sharp or throbbing, can be a sign of recurrence. While your doctor mentioned that pain is a symptom, it’s important to note that the nature and intensity of the pain can vary.

2. Discharge: As you mentioned, the presence of discharge is significant. If the discharge becomes more frequent, changes in color (especially if it becomes more yellow or green), or increases in volume, this could indicate a problem.
3. Swelling or Redness: If you notice increased swelling or redness around the surgical site, this could also be a sign of infection or recurrence.

4. Fever: A systemic symptom such as fever can indicate an infection, which may be associated with a recurrence.

5. Changes in Bowel Habits: Any changes in bowel habits, such as increased difficulty or pain during bowel movements, may also warrant further investigation.

6. New Fistula Tract: If you notice any new openings or tracts forming near the original surgical site, this could indicate a recurrence.

It’s crucial to maintain open communication with your healthcare provider. If you are concerned about the discharge or any other symptoms, it is advisable to reach out to your surgeon or a colorectal specialist. They may recommend further evaluation, which could include a physical examination or imaging studies to assess the healing process and rule out any complications.

In the meantime, continue with your wound care regimen as advised, including sitz baths and the use of antiseptic solutions like Betadine, as these can help keep the area clean and promote healing. However, if you notice any worsening of symptoms or new concerns, do not hesitate to seek medical attention sooner rather than later.

Overall, while it is normal to have some anxiety about the healing process and the potential for recurrence, being proactive about your health and staying in touch with your healthcare team can help ensure the best possible outcome.

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