Post-Surgery Concerns: Discharge and Infection Risks After Anal Fistula Surgery

Postoperative care for anal fistula surgery [Continuation 159006]

Hello, Doctor.
I recently underwent my third excision surgery on August 6, with the surgical site located at the 12 o'clock position above the anus and near the perineum.
The wound measures approximately 2cm x 1.5cm x 0.4cm.
Since the surgery, I have not experienced significant pain, and I was discharged home on the second postoperative day.
I have been performing sitz baths with diluted potassium permanganate (KMnO4) in warm water three to four times daily.
Additionally, my primary physician cultured and tested the tissue from the wound, revealing the presence of four types of bacteria.
The test results indicated that oral antibiotics can only eliminate three of the bacteria.
To eradicate all four, I would need to return to the hospital for daily antibiotic injections.
The doctor believes that temporarily managing the three bacteria with oral antibiotics is sufficient.

A few days post-surgery, the wound only exuded serous fluid, but in recent days, I have noticed that when I dab the area around the anus and the wound with a wet tissue before my sitz bath, there is now a discharge that seems to be increasing.
The discharge is light yellowish-white and has a slight fishy odor.
The wound does not feel particularly swollen or painful, but there are occasional itching sensations.

I would like to ask the doctor:
1.
Is this discharge normal?
2.
I have read that green discharge is typically associated with infection; does this light yellowish-white discharge with a fishy odor also indicate infection?
3.
I previously saw that pus has a foul odor; is this fishy smell what is meant by foul? Since "foul" can be subjective, could you provide a more precise description or analogy regarding this odor?
4.
Is this discharge a result of the fourth bacterium not being eradicated?
5.
Should I be more diligent in cleaning and removing this discharge? I have undergone three surgeries within four months, and I feel very frustrated and discouraged, genuinely worried about not recovering.
I hope you can help me with your responses.
Thank you, Doctor.

Xiao Lin, 30~39 year old female. Ask Date: 2020/08/16

Dr. Ke Fangxu reply Surgery

1.
It is normal to have a small amount of discharge after fistula surgery before the wound has completely healed.

2.
No.

3.
No, different bacterial infections can produce different odors; any description of this is subjective.
If there is no redness, swelling, heat, or pain, there is no cause for concern.

4.
No, it is related to the wound not being fully healed.

5.
It is recommended to keep the wound from fistula surgery clean and dry.
You can use cotton balls or gauze to absorb discharge at the anal area.
Some patients find that using sanitary pads works well too.
Taking warm sitz baths can also be beneficial.

Reply Date: 2020/08/16

More Info

After undergoing anal fistula surgery, it's understandable to have concerns about discharge and potential infection risks. Let's address your questions one by one while also providing some context on the healing process and what to expect post-surgery.

1. Is the discharge normal?
It's common to experience some discharge after anal fistula surgery. The body produces fluids as part of the healing process, and this can include serous fluid, which is typically clear or slightly yellow. However, the presence of any discharge should be monitored closely, especially if there are changes in color, consistency, or odor.

2. Is the yellowish-white discharge an indication of infection?
While yellowish discharge can be a normal part of healing, it can also indicate an infection, especially if accompanied by other symptoms such as increased redness, swelling, or pain. The fact that you mentioned a slight odor could be a concern, as foul-smelling discharge is often associated with infection. It's important to differentiate between normal healing discharge and signs of infection, which may require further medical evaluation.

3. What about the odor?
The term "foul" or "malodorous" is indeed subjective, but in a medical context, it typically refers to a strong, unpleasant smell that is distinct from normal bodily odors. A "fishy" or "putrid" smell is often associated with infected wounds or abscesses. If the discharge has a strong, unpleasant odor, it may warrant further investigation.

4. Could the discharge be due to the fourth bacteria not being eradicated?
Yes, it is possible that the discharge could be related to the presence of the fourth bacteria that was not effectively treated with oral antibiotics. If the bacteria are still present, they could contribute to ongoing inflammation or infection, leading to the discharge you're observing.

5. Should I clean the area more frequently?
Maintaining cleanliness in the surgical area is crucial for preventing infection. You should continue with your sitz baths as recommended, as they can help keep the area clean and promote healing. However, be cautious not to irritate the wound further. If you notice increased discharge, it may be beneficial to gently clean the area more frequently, but avoid aggressive scrubbing.

Given that you've had three surgeries in a short period, it's understandable to feel anxious about your recovery. It's important to communicate openly with your healthcare provider about your concerns. If the discharge continues to increase, changes in color or odor occur, or if you experience any new symptoms such as fever or increased pain, you should seek medical attention promptly.
In summary, while some discharge can be normal after surgery, any changes in the characteristics of the discharge should be evaluated by your healthcare provider. They may recommend further treatment, including possibly adjusting your antibiotic regimen or additional interventions to ensure proper healing. Remember, recovery can take time, and it's essential to be patient with your body as it heals.

Similar Q&A

Post-Surgery Discharge Concerns: What to Expect After Anal Surgery

Hello, Director. I underwent an anal fistula incision and drainage surgery at the end of August last year, and then had another surgery at the end of February this year. This time, the surgery was a bit more complex, involving hemorrhoidectomy, anal fistula excision, anal sphinct...

Dr. Ke Fangxu reply Surgery
The healing period for complex anal surgeries can be quite lengthy. However, if there is still discharge after three months, it may not be normal. If the surgeon has examined the area and found no issues, it is likely not a recurrence. Additionally, if a flap surgery was performe...

Understanding Post-Surgery Discharge After Anal Fistula Surgery

Hello Dr. Fang: I had anal fistula surgery over two months ago, but I am still experiencing green discharge that has a foul odor. Could this be a recurrence of the fistula?

Dr. Ke Fangxu reply Surgery
Two months after anal fistula surgery, the wound should be mostly healed. If there are still abnormal secretions, it is likely due to infection or poor healing. It is recommended that you consult your surgeon to determine if medication or a repeat surgery is necessary.

Post-Operative Concerns After Anal Fistula Surgery: What to Expect

Hello, doctor. I underwent anal fistula surgery on November 24, 2022, and since my discharge, I have noticed black specks of discharge at the surgical site. Could this be caused by the absorption of the sutures? I have been using hydrocolloid wound dressings.

Dr. Zhang Shuhao reply Surgery
It is normal for wounds to have discharge; black discharge may be caused by the dressing. You can take warm water sitz baths to maintain cleanliness, and this should improve as the wound heals.

Post-Surgery Concerns: Managing Discharge After Anal Fistula Surgery

Hello Dr. Ke, I would like to ask you about my situation. It has been exactly two months since my anal fistula surgery, and the external wound has healed. However, I occasionally notice a small amount of pus at the anal opening, and I don't feel any pain. I'm hesitant ...

Dr. Ke Fangxu reply Surgery
Based on your description, it seems that an anal fistula may have formed. However, if there is no pain or discomfort, trying antibiotic treatment is also an option. Although antibiotics can be easily obtained at pharmacies in Taiwan, from the perspective of infection control, I s...