Post-Surgery Concerns: Managing Fistula Discharge and Healing

Postoperative discharge, fistula?

Hello, Doctor.
I underwent anal fistula surgery on May 7, with the external opening located in the groin area.
The doctor indicated that the fistula was somewhat longer than usual.
Since the surgery, the discharge from the groin wound has significantly decreased, but last week, there was some discharge from the fistula opening.
Upon follow-up, the surgeon noted that the fistula healing was not ideal, with some necrotic tissue and discharge.
The doctor expressed some of the discharge and cauterized the fistula opening.
The doctor also examined the anal area and confirmed that there was no internal opening, advising me to apply pressure from the anus to the groin fistula location to help expel the discharge, as my fistula runs from the bottom up, making it difficult for the discharge to flow out on its own.
I would like to ask the doctor the following questions:
1.
When I apply pressure to the fistula, I feel some pain at the anal area.
Is this normal?
2.
When I apply pressure to the fistula opening, sometimes there is discharge and sometimes there isn't, with the latter being more common.
Does this indicate that I am recovering normally? If I observe the gauze, there is discharge each time, and the amount varies depending on how long I have the gauze on, for example, it feels like there is more discharge after 4 hours compared to 2 hours.
Additionally, there is also discharge from the surgical incision.
3.
I have noticed that when using a squat toilet, there is sometimes bleeding from the fistula opening (groin area).
Is this normal? Currently, there is no bleeding when using a seated toilet.
4.
The discharge is not only from the fistula opening; there is also discharge from the surgical wound, but the amount has decreased significantly compared to right after the surgery, and the wound seems to be about 70% healed.
Is this a sign of normal recovery?
5.
After researching, I found that typically, fistulas may not have discharge for 1 to 2 months.
However, I would like to know if there will always be discharge until the fistula tract is completely healed? Do I need to wait until the fistula is fully healed for there to be no discharge?
6.
The discharge has changed from yellow to yellow-green since the surgery.
Is this normal? The surgeon asked if I had experienced yellow-green discharge before.
Prior to the surgery, my discharge also changed from yellow to yellow-green, but the doctor did not express any opinion after hearing this.
Note: The external opening of the fistula is located approximately in the lower left area of the scrotum.
I have many questions and hope you can clarify them.
Thank you.

Niming, 20~29 year old female. Ask Date: 2020/06/17

Dr. Ke Fangxu reply Surgery

The previous text mentioned that the external opening is located in the groin area, but later it changed to the lower left side of the scrotum.
So where exactly is it? Regardless, it is a rather long and complex fistula.

1.
It is not uncommon to experience pain upon pressure if the internal opening of a normal complex fistula is not found.

2.
A decrease in discharge is certainly a good sign; however, one should be cautious that the discharge may not be decreasing but rather accumulating due to incomplete drainage, which could lead to a significant outflow after reaching a certain volume, and that would be concerning.

3.
Increased tension on the wound and slight bleeding during a squatting position is also normal.

4.
This may require observation for 1-2 months to confirm.

5.
Yes.

6.
The change in discharge to green suggests an infection; however, wounds in this area often accompany varying degrees of infection.
If it is not severe, enhancing sitz baths should suffice.
If there is swelling, pain, or foul odor, a physician should be consulted for examination and treatment.

Reply Date: 2020/06/17

More Info

After undergoing anal fistula surgery, it is common to have concerns about the healing process and the management of discharge from the surgical site. Here, I will address your questions and provide additional insights based on medical knowledge regarding fistula healing and postoperative care.

1. Pain During Pressure on the Fistula: It is not uncommon to experience some discomfort or pain when applying pressure to the fistula site, especially if the area is still healing. The presence of pain can indicate that the tissue is sensitive or inflamed. However, if the pain is severe or worsening, it is essential to consult your surgeon for further evaluation.

2. Variability of Discharge: The inconsistency in the discharge from the fistula opening can be a normal part of the healing process. It is expected that as the fistula heals, the amount of discharge may decrease. However, if you notice that the discharge is consistently present and particularly if it has an unpleasant odor or changes in color, it is advisable to inform your healthcare provider. The fact that you observe more discharge when the dressing is left on longer could indicate that the area is still producing fluid as part of the healing process.

3. Bleeding with Certain Positions: Experiencing bleeding from the fistula opening when using a squat toilet may indicate increased pressure or strain in that position. It is essential to avoid straining during bowel movements, as this can exacerbate bleeding or discomfort. If you notice that sitting does not cause bleeding, it may be beneficial to use that position for bowel movements until you have fully healed.

4. Healing Progress: The reduction in discharge and the observation that the surgical wound is healing (approximately 70% healed) are positive signs. Healing can take time, and it is essential to monitor the wound for any signs of infection, such as increased redness, swelling, or discharge that is foul-smelling.

5. Discharge Until Complete Healing: It is typical for a fistula to continue to produce discharge until it is fully healed. The presence of discharge indicates that the body is still working to heal the area. Once the fistula tract is completely closed, the discharge should cease. The timeline for this can vary significantly from person to person, depending on the complexity of the fistula and individual healing responses.

6. Color Change of Discharge: The change in discharge color from yellow to yellow-green can be a normal part of the healing process, especially if there is a presence of white blood cells fighting infection. However, if this change is accompanied by other symptoms such as increased pain, fever, or a foul odor, it is crucial to consult your surgeon. Your surgeon’s lack of concern may indicate that this change is not unusual, but it is always best to keep an open line of communication with your healthcare provider regarding any changes you observe.

In conclusion, while some discomfort and discharge are normal after fistula surgery, it is crucial to monitor your symptoms closely. If you experience significant pain, changes in discharge that concern you, or any other unusual symptoms, do not hesitate to reach out to your healthcare provider for further evaluation. They can provide tailored advice based on your specific situation and ensure that your recovery progresses smoothly. Regular follow-up appointments are essential to assess healing and address any concerns you may have.

Similar Q&A

Post-Surgery Concerns: Managing Discharge and Bleeding After Fistula Repair

Hello doctor, I had a fistula surgery a month ago. The outside of the wound looks like it has healed, but there is still a little discharge that resembles pus. Is this normal? Also, last week I experienced some bleeding while using the restroom due to hard stools. Will this affec...

Dr. Ke Fangxu reply Surgery
The recovery period after fistula surgery is generally longer, typically requiring one to two months. During this time, there may be discharge from the wound. If the wound has healed but purulent discharge appears, it may indicate a recurrence of the fistula. It is generally reco...

Post-Surgery Concerns: Managing Wound Healing After Fistula Surgery

I underwent a fistula surgery in early December 2022. For the first 1-2 weeks, the wound had a lot of clear discharge, but a few days before my follow-up appointment, the discharge changed to thick yellow. During my follow-up, I mentioned this to the doctor, but he didn't sa...

Dr. Zhang Shuhao reply Surgery
It is recommended to continue warm sitz baths and apply ointment. If there is any discharge, you may gently express it to keep the area clean. If the swelling is gradually improving, there is no need to worry. Typically, there is no immediate recurrence after the procedure. Durin...

Post-Surgery Concerns After Fistula Procedure: What to Expect

Hello doctor, I had a fistula surgery on June 15th. Is it normal for it to keep draining fluid? The doctor said I could just wipe it with a wet tissue; is that okay? Does the wound need to be treated with ointment? The doctor told me that I don't need to apply any medication...

Dr. Ke Fangxu reply Surgery
It is normal to have discharge after fistula surgery, which may sometimes last for up to a month. Using feminine pads can be more convenient during this time. Once the surgical wound heals, the discharge will subside. Generally, it is not recommended to apply ointments to the wou...

Post-Surgery Concerns: Managing Drainage After Fistula Surgery

Hello, Director Hsu: I underwent a fistula surgery in Taipei on December 29. After the anal packing was removed on the 30th, I have been experiencing a discharge of blood-tinged fluid, and today, the 31st, I still have this fluid seeping out at home (which has a foul odor). Is th...

Dr. Xu Kaixi reply Surgery
The recovery of the wound after fistula surgery typically takes about one to two weeks. During this period, some bleeding or discharge is normal. It is not recommended to rinse the wound directly with warm water, as this can be more irritating than sitz baths and may not be benef...