Post-Surgery Concerns: Bleeding and Pain After Fistula Surgery

Post-fistula surgery

Hello, doctor.
I had a fistula and external hemorrhoid surgery on October 20, 2020.
It has been two months since then, and I have recently experienced slight bleeding and sharp pain.
After one bowel movement, the bleeding increased (soaking half a tissue).
What could be the possible reasons for this?

An An, 20~29 year old female. Ask Date: 2020/12/21

Dr. Ke Fangxu reply Surgery

Theoretically, the wound should be completely healed one month after surgery.
If there is still significant bleeding, it may indicate poor wound healing or residual bleeding from internal hemorrhoids.
It is advisable for you to have the surgeon check it again.

Reply Date: 2020/12/21

More Info

After undergoing fistula surgery and an external hemorrhoid procedure, experiencing some bleeding and pain two months post-operation can be concerning. It's essential to understand the potential causes and what steps you can take to address these symptoms.

First, it's important to recognize that some degree of bleeding and discomfort can be expected after such surgeries. The surgical site may still be healing, and the tissues can be sensitive. However, the amount of bleeding you described—enough to soak half a tissue—warrants further investigation. Here are some possible reasons for your symptoms:
1. Incomplete Healing: Surgical sites, especially those involving the anal area, can take time to heal completely. If the tissue has not fully healed, it may be prone to bleeding, especially during bowel movements.

2. Straining During Bowel Movements: If you are experiencing constipation or straining during bowel movements, this can lead to increased pressure on the surgical site, resulting in bleeding. It's crucial to maintain soft stools to minimize strain.

3. Infection: An infection at the surgical site can cause increased pain, swelling, and bleeding. Signs of infection may include redness, warmth, and discharge from the wound. If you suspect an infection, it's important to seek medical attention promptly.

4. Fistula Recurrence: In some cases, the original fistula may not have been completely resolved during surgery, leading to recurrence. This can cause pain and bleeding as well.

5. Hemorrhoid Issues: Since you also had an external hemorrhoid procedure, it's possible that residual hemorrhoidal tissue could be causing discomfort and bleeding.

6. Scar Tissue Formation: As the surgical site heals, scar tissue can form, which may lead to discomfort or pain. If the scar tissue is tight or pulls on surrounding tissues, it could cause sharp pain.

Given these possibilities, here are some recommendations for managing your symptoms:
- Dietary Adjustments: Ensure you are consuming a high-fiber diet to promote soft bowel movements. Consider incorporating fruits, vegetables, whole grains, and plenty of fluids into your diet.

- Stool Softeners: If you're experiencing constipation, over-the-counter stool softeners can help ease bowel movements and reduce straining.

- Warm Sitz Baths: Taking warm sitz baths can help soothe the area, reduce discomfort, and promote healing. Aim for 15-20 minutes a few times a day.

- Avoid Straining: When using the bathroom, try to relax and avoid straining. If you feel the urge to go, respond to it promptly to prevent constipation.

- Monitor Symptoms: Keep track of your symptoms, including the frequency and amount of bleeding, as well as any changes in pain levels. This information will be helpful for your healthcare provider.

- Follow-Up with Your Surgeon: Given the amount of bleeding you described, it is crucial to follow up with your surgeon or healthcare provider. They can perform a thorough examination to determine the cause of your symptoms and recommend appropriate treatment. They may also check for any complications or the need for further intervention.

In conclusion, while some bleeding and pain can be normal after fistula and hemorrhoid surgery, significant bleeding should not be ignored. It's essential to communicate openly with your healthcare provider about your symptoms to ensure proper care and recovery.

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