Post-Surgery Concerns: Managing Anal Fistula Recovery and Symptoms

Postoperative care for anal fistula surgery [Continuation 159006, 159626]

Hello, doctor.
Since I underwent my third anal fistula surgery (I have a simple low anal fistula) at the beginning of August, it has been almost two and a half months.
During my follow-up appointment in September, my doctor indicated that my wound had healed, but I noticed that there was still a small amount of discharge from the anus, although there was no pain anymore.
About two weeks later, after having a bowel movement (which was soft stool), I wiped myself (and there was no pain at that time) and found fresh blood on the tissue.
I didn't think much of it, assuming it was a burst internal hemorrhoid.
A few days later, I began to feel pain at the site of the previous wound inside the anus, and the pain was particularly intense when the anus relaxed, contracted, or when I sat down.
Then, when I wiped my anus with tissue, I noticed there was discharge, which was yellowish-white.
This situation lasted for over a week, and the pain and discharge began to decrease until they eventually resolved.
The following two weeks were uneventful, except that sometimes when I sat down, I felt a prickling sensation in the anus, but changing my sitting position would make that sensation disappear.
About a week ago, after having another bowel movement (again, soft stool), I wiped myself and noticed fresh blood on the tissue again.
Following the same pattern as before, I started to experience pain and discharge from the anus, but this time the pain lasted longer, and the discharge sometimes resembled eye discharge.
The situation has not improved since then.
I would like to ask the doctor: 1.
Is this situation due to a false healing of the wound inside the anus? Why isn't it healing? Or is it related to the fistula issue? 2.
Is there inflammation in the anus again? 3.
Given that I have had three surgeries within six months, does this situation require another surgical intervention? 4.
What methods can help the wound inside the anus heal faster and better? Is there anything I should definitely avoid? Thank you.

Xiao Lin, 30~39 year old female. Ask Date: 2020/10/22

Dr. Ke Fangxu reply Surgery

Because online consultations cannot provide a thorough examination, it is not possible to determine the issue or confirm if there is inflammation; this requires an in-person evaluation by a physician.
I have previously addressed your concerns multiple times.
If you are still experiencing issues six months post-surgery, you should have a detailed discussion with your surgeon to decide on the next steps in your treatment plan.

Reply Date: 2020/10/22

More Info

Post-surgery recovery from an anal fistula can be a complex and sometimes frustrating process. It is not uncommon for patients to experience ongoing symptoms even after what appears to be successful surgical intervention. Based on your description, it seems that you are experiencing a combination of symptoms that may indicate a few potential issues.

1. Hypothetical Healing Issues: The presence of fresh blood on toilet paper after bowel movements, along with pain and discharge, could suggest that the surgical site is not healing as expected. This could be due to a phenomenon known as "pseudo-healing," where the outer layer of tissue appears to have healed, but deeper layers may still be inflamed or not fully closed. This can lead to intermittent bleeding and discomfort, especially during bowel movements.
2. Inflammation: The symptoms you describe, including pain and yellowish-white discharge, may indicate inflammation or infection at the surgical site. While some discharge can be normal, especially in the early stages of recovery, persistent or worsening symptoms should be evaluated by your healthcare provider. The presence of pus-like discharge could suggest an infection, which may require treatment.

3. Need for Further Surgery: Given that you have undergone three surgeries in a relatively short period, it is understandable to be concerned about the need for additional procedures. Whether further surgery is necessary depends on the assessment of your current symptoms and the condition of the surgical site. If there is evidence of a recurrent fistula or significant complications, your surgeon may recommend additional intervention. However, many patients can manage their symptoms with conservative treatment, including medication and lifestyle modifications.

4. Promoting Healing: To facilitate healing, consider the following recommendations:
- Dietary Adjustments: Maintain a high-fiber diet to ensure soft stools and minimize straining during bowel movements. Adequate hydration is also crucial.

- Hygiene: Keep the anal area clean and dry. Gentle cleansing with warm water after bowel movements can help, and using unscented wipes may reduce irritation.

- Pain Management: Over-the-counter pain relievers may help alleviate discomfort. However, consult your doctor before taking any medication.

- Avoid Straining: Try to avoid straining during bowel movements, as this can exacerbate symptoms. If you experience constipation, consider using stool softeners or fiber supplements.

- Follow-Up Care: Regular follow-up appointments with your surgeon are essential to monitor healing and address any complications early.

In summary, while some discomfort and discharge can be normal after anal fistula surgery, persistent symptoms warrant further evaluation. It is crucial to communicate openly with your healthcare provider about your concerns and any changes in your symptoms. They can provide a tailored approach to your recovery, which may include further diagnostic tests or treatments to ensure optimal healing. Remember, recovery can take time, and patience is key as your body heals.

Similar Q&A

Post-Surgery Concerns After Anal Fistula Procedure: Your Questions Answered

Hello Doctor, I apologize for bothering you multiple times. I underwent a fistula micro-surgery in January, and it has been about four months since then. I would like to ask the following questions: 1. I still experience some pain at the surgical site after prolonged sitting. I...

Dr. Zhang Shuhao reply Surgery
1. The size of the surgical wound for a fistula may take several months to heal completely. A qualified colorectal surgeon's assessment of the fistula's condition is generally reliable. If a more skilled surgeon believes the surgery has failed, it is advisable to consul...

Post-Surgery Concerns: Managing Symptoms After Anal Fistula Surgery

Hello, Doctor. This issue has been bothering me for several days, and I must seek your advice. I hope you can clarify my concerns. I underwent anal fistula surgery in mid-April of this year and was discharged three days later. I experienced pain for over a month, and the wound he...

Dr. Ke Fangxu reply Surgery
Based on your description, it seems like a recurrence of a fistula. I recommend that you go back to your surgeon for an examination. If you are not planning to undergo surgery again for the time being, you can start with warm water sitz baths for a while and observe if there are ...

Post-Surgery Recovery: Understanding Anal Fistula Healing Process

Hello Dr. Ke, I had a bit of a lapse in memory around the end of June when I developed an "anal abscess" due to frequent wiping from diarrhea. Initially, I was unaware of the condition and visited a small clinic where I was prescribed painkillers and anti-inflammatory m...

Dr. Ke Fangxu reply Surgery
If an anal abscess is left untreated for too long, there is a higher chance that it will develop into a fistula. This type of fistula is generally more complex to manage and has a higher likelihood of recurrence. Currently, you have undergone drainage of the abscess and a fistulo...

Post-Surgery Anal Issues: Understanding and Managing Persistent Problems

Dear Doctor, I had constipation issues when I was younger and underwent surgery for hemorrhoids/fissures two years ago. Six months later, I experienced pus discharge from my anus and was diagnosed with my first anal fistula. When I asked the doctor about the cause, he was uncer...

Dr. Ke Fangxu reply Surgery
These two issues seem to be related, possibly due to having undergone multiple anal surgeries in a short period, which may have resulted in decreased anal sphincter pressure. To confirm this phenomenon, an anal manometry test would be necessary. However, it appears that there are...