Post-Surgery Concerns: Pain and Bleeding After Anal Fistula Repair

Postoperative care related to anal fistula surgery?

Hello Dr.
Ke: My father underwent surgery for an anal fistula on July 31.
He had three follow-up appointments until September 8.
During this period, he experienced pain and bleeding from the wound.
At the last appointment on September 8, the doctor examined the wound and mentioned that it should be healed in about two weeks.
After that, he did not return for further visits.
A few days later, the pain and bleeding improved significantly.
However, in the past two to three days, my father has reported that he is starting to feel some pain again, similar to what he experienced with the fistula, and there has been some bleeding.
I would like to ask Dr.
Ke if this phenomenon is normal.
Could this be a recurrence of the anal fistula? Thank you!

AlonsoChen, 30~39 year old female. Ask Date: 2020/09/30

Dr. Ke Fangxu reply Surgery

Whether it is a recurrence of a fistula can only be determined by a physician's examination.
It is also possible that it is caused by the contraction of the surgical scar.
If there is no redness, swelling, or pus, the likelihood of recurrence is lower; however, a follow-up examination is still necessary to confirm.

Reply Date: 2020/09/30

More Info

After undergoing surgery for an anal fistula, it is not uncommon for patients to experience pain and bleeding during the recovery process. The healing of surgical wounds, especially in sensitive areas such as the anal region, can be complex and may involve various factors that contribute to discomfort and bleeding.

Firstly, it is important to understand that the surgical site may take time to heal completely. The initial post-operative period often involves inflammation and tissue repair, which can lead to pain and occasional bleeding. The fact that your father experienced a gradual improvement in symptoms after the initial surgery is a positive sign, indicating that the healing process was underway. However, the recurrence of pain and bleeding after a period of improvement raises some concerns.

One possibility is that the pain and bleeding could be related to the normal healing process. As the tissues regenerate, there may be moments of discomfort, especially if the area is subjected to strain or irritation. Activities such as sitting for prolonged periods, straining during bowel movements, or even minor trauma can exacerbate symptoms. Therefore, it is crucial to follow post-operative care instructions, which may include dietary modifications to prevent constipation, proper wound care, and possibly the use of sitz baths to promote healing and comfort.

However, the recurrence of symptoms could also indicate a potential complication, such as the formation of a new fistula or the incomplete healing of the original site. Fistulas can sometimes recur if the initial surgery did not fully address the underlying issue. If your father is experiencing symptoms similar to those he had before the surgery, it is essential to consult with his surgeon or a specialist in colorectal surgery. They may recommend further evaluation, which could include imaging studies or an examination to assess the surgical site for any signs of recurrence or complications.

In terms of management, if the pain is mild, conservative measures such as warm sitz baths, over-the-counter pain relief medications, and a high-fiber diet can be beneficial. However, if the pain is severe or accompanied by significant bleeding, it is crucial to seek medical attention promptly. The surgeon may need to reassess the situation and determine if further intervention is necessary.

In conclusion, while some pain and bleeding can be expected after anal fistula repair, the recurrence of these symptoms warrants further investigation. It is essential to maintain open communication with healthcare providers and to seek medical advice if symptoms persist or worsen. Early intervention can help prevent complications and ensure a smoother recovery process.

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