Post-Surgery Issues After Fistula Surgery: Pain, Itching, and Concerns

Post-operative issues following fistula surgery?

Dear Dr.
Ke,
1.
I underwent surgery to excise two anal fistulas in December 2019.
About two months post-surgery, I no longer had any discharge, but I have been experiencing slight pain and itching at the anal area, especially after bowel movements.
Occasionally, I feel a prickling sensation, and when I wipe the anal area, I notice a very small amount of what appears to be fecal residue, although I ensure that I clean thoroughly after each bowel movement.
Could these symptoms be a consequence of the fistula surgery? Do you have any recommendations for improvement?
2.
Recently, I noticed a small bump about 2-3 mm in size on the skin approximately 3-4 cm from the right side of the anal opening.
It is not red, swollen, or painful, and it has not opened.
Could this possibly indicate a recurrence of the fistula? Thank you.

Liang, 50~59 year old female. Ask Date: 2021/03/15

Dr. Ke Fangxu reply Surgery

1.
If the fistula surgery was performed more than a year ago, then this phenomenon could either be a recurrence or damage to the sphincter muscle.
To determine the exact cause, a further examination by a physician is necessary.

2.
It is possible, but it could also simply be folliculitis; a physician's examination is required to confirm.

Reply Date: 2021/03/15

More Info

After undergoing fistula surgery, it is not uncommon to experience lingering symptoms such as pain, itching, and discomfort around the anal area. These symptoms can be frustrating and concerning, especially when they persist long after the surgery. Let's address your concerns in detail.

1. Post-Surgery Discomfort: The pain and itching you are experiencing around the anal area, particularly after bowel movements, can be attributed to several factors. After a fistula surgery, the surrounding tissues may take time to heal completely. Even if there is no visible discharge, the area can remain sensitive and prone to irritation. This discomfort can be exacerbated by bowel movements, as the act of passing stool can cause trauma to the healing tissues.
Additionally, the sensation of having residual fecal matter, despite thorough cleaning, may indicate that the anal sphincter muscles are still adjusting post-surgery. It is essential to maintain good hygiene, but also to consider dietary adjustments to ensure softer stools, which can reduce strain during bowel movements. Increasing fiber intake, staying hydrated, and possibly using stool softeners can help alleviate some of the discomfort associated with bowel movements.

2. Skin Changes: The small bump you have noticed near the anal area could be a variety of things. It might be a benign skin tag, a cyst, or even a small abscess. The fact that it is not red, swollen, or painful is a good sign, but it is still essential to monitor it closely. While it is possible for a fistula to recur, especially if there is a history of previous fistulas, the absence of pain and other symptoms makes it less likely.

If the bump persists or changes in appearance, it would be wise to consult with your surgeon or a specialist in colorectal surgery. They can perform a thorough examination and determine whether further intervention is necessary.
3. Management Strategies: To manage the discomfort and itching, consider the following strategies:
- Warm Sitz Baths: Taking warm sitz baths can help soothe the area and promote healing. This can also help with any itching or irritation.

- Topical Treatments: Over-the-counter creams or ointments designed for anal discomfort may provide relief. Look for products that contain hydrocortisone or witch hazel.

- Avoid Irritants: Be cautious with soaps and wipes that may contain fragrances or alcohol, as these can irritate the sensitive skin around the anus.

- Dietary Adjustments: As mentioned earlier, a diet high in fiber can help prevent constipation and reduce strain during bowel movements. Incorporating fruits, vegetables, and whole grains can be beneficial.

4. Follow-Up Care: Regular follow-up appointments with your healthcare provider are crucial. They can monitor your healing progress and address any new symptoms that may arise. If you notice any changes in the bump, such as increased size, redness, or pain, seek medical advice promptly.

In conclusion, while some discomfort after fistula surgery is expected, it is essential to manage these symptoms proactively. Maintaining good hygiene, adjusting your diet, and monitoring any new developments will help ensure a smoother recovery. If symptoms persist or worsen, do not hesitate to reach out to your healthcare provider for further evaluation and guidance.

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