Post-Surgery Care for Fistula: Managing Wound Healing and Discomfort

Post-fistula surgery

1.
After my fistula surgery, since the incision was not sutured, I notice some stool comes out from the wound when I have a bowel movement.
After cleaning the wound with rinsing and sitz baths, should I pack gauze into the wound to absorb secretions and a small amount of blood, or is it sufficient to place gauze only on the outside of the wound?
2.
If I keep gauze packed inside the wound, will it affect the healing process? I have been packing gauze inside the wound to absorb drainage for the past few days.
3.
When I have a bowel movement, I feel swelling and pain in the anal area, similar to the pain at the wound site.
However, after rinsing and taking a sitz bath, the discomfort significantly alleviates.
Is this normal? I have a small external hemorrhoid near my anus, and when a friend applied medication, they mentioned that the small hemorrhoid is gone, but there is no visible wound.
The doctor did not specifically mention treating the external hemorrhoid, so I would like to know if it is normal for the anal area to swell and hurt during bowel movements.
4.
After surgery, the hospital only prescribed medications for softening stools, anti-inflammation, and reducing swelling.
Is it necessary for me to take antibiotics?

A Tang, 20~29 year old female. Ask Date: 2020/07/15

Dr. Ke Fangxu reply Surgery

1.
There's no need to insert it; just leave it outside.

2.
It can indeed have an impact, so do not insert it.

3.
It's normal; external hemorrhoids can often be managed easily.

4.
Antibiotics are not necessary unless there is an infection.

Reply Date: 2020/07/15

More Info

Post-surgery care for a fistula, especially after a procedure like a fistulotomy, is crucial for promoting healing and minimizing discomfort. Here’s a comprehensive guide addressing your questions and providing additional insights based on medical knowledge.

1. Wound Care and Dressing: After a fistula surgery, it is common for the wound to remain open to promote drainage and healing. When it comes to managing the wound, it is essential to keep it clean. You can use saline solution or mild soap and water to gently clean the area. After cleaning, you can apply a sterile dressing. Regarding your question about packing the wound with gauze: it is generally advisable to avoid packing the wound tightly. Instead, you can place a sterile gauze pad over the wound to absorb any drainage. If you feel that the wound is producing a significant amount of discharge, you may need to change the dressing more frequently. However, packing the wound tightly can create pressure and potentially impede healing, so it’s best to follow your surgeon's specific instructions regarding wound care.

2. Impact of Packing on Healing: Keeping gauze tightly packed inside the wound can indeed affect healing. The goal is to allow the wound to drain while also promoting granulation tissue formation. If the gauze is too tightly packed, it may cause irritation or pressure, leading to delayed healing or even infection. It is essential to monitor the wound for signs of infection, such as increased redness, swelling, or discharge that is foul-smelling. If you have concerns about the amount of drainage or the condition of the wound, it’s best to consult your healthcare provider for personalized advice.

3. Discomfort During Bowel Movements: Experiencing pain and swelling around the anus during bowel movements is not uncommon after fistula surgery, especially if there is any irritation or inflammation in the area. The sensation of pain can be exacerbated by the presence of hemorrhoids, which you mentioned. It’s good to hear that sitting in warm water (sitz baths) provides relief, as this can help soothe the area and promote relaxation of the anal sphincter. If the pain persists or worsens, or if you notice any new symptoms, it’s important to reach out to your healthcare provider for further evaluation.

4. Medication Management: The medications prescribed post-surgery, such as stool softeners and anti-inflammatory drugs, are essential for managing pain and preventing constipation, which can exacerbate discomfort during bowel movements. As for antibiotics, they are typically prescribed if there is a concern for infection. If your surgeon did not prescribe antibiotics and there are no signs of infection (such as fever, increased pain, or purulent discharge), then they may not be necessary. However, if you have any concerns about potential infection or if your symptoms worsen, it’s advisable to discuss this with your doctor.

In summary, post-surgery care for a fistula involves careful wound management, monitoring for signs of infection, and managing discomfort effectively. Always follow your surgeon's specific instructions and do not hesitate to reach out to them with any concerns or questions. Healing takes time, and being proactive about your care can lead to better outcomes.

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