Challenges in Healing After Anal Fistula Surgery: Common Concerns and Solutions

Incomplete healing after anal fistula surgery?

Hello Dr.
Ke:
I underwent anal fistula surgery at the end of January this year.
After the surgery, I returned for follow-up appointments to check the wound, and my attending physician confirmed that the healing process was progressing well.
However, at the end of March, I noticed a small hole appearing in the center of the healed wound, which oozed blood but had no discharge.
Upon my return visit, the doctor suggested that this might be due to the fragility of the postoperative wound and prescribed a topical ointment and antibiotics for treatment.
A week later, during my follow-up, the wound was nearly healed, but two days later, the same area ruptured again.
To be cautious, I consulted another physician, who indicated that this might be due to excessive cleaning and advised me to continue monitoring the situation.
However, two weeks later, the wound still has not fully healed.
I would like to ask Dr.
Ke:
1.
Is it normal for postoperative wounds to repeatedly experience localized ruptures? Could this lead to an infection and a recurrence of the fistula?
2.
After bowel movements, I only rinse with water and use a sitz bath, but no matter how long or thoroughly I rinse, I still notice residual stool in the sitz bath, and the amount is not insignificant.
I have been following the doctor's advice to only rinse the wound area without intentionally touching it, but when drying, I still see a significant amount of residual stool on the wet wipes.
I am unsure where the stool is coming from, and I wonder if external hemorrhoids could affect cleanliness, as they have become very noticeable after the surgery.
Thank you, doctor, for your patience in reading this.

Xīn Dì, 30~39 year old female. Ask Date: 2021/04/23

Dr. Ke Fangxu reply Surgery

1.
If the wound continues to reopen after such a long time post-surgery, it is advisable to have the surgeon check for the possibility of a fistula recurrence.
2.
External hemorrhoids can indeed affect cleanliness; however, it is not possible to determine whether the issue is due to external hemorrhoids or a surgical wound causing fecal leakage through online consultation.
Complex fistulas may also result from a larger surgical area and could lead to fecal leakage due to the incision of the sphincter muscle.

Reply Date: 2021/04/23

More Info

After undergoing anal fistula surgery, many patients experience challenges during the healing process, which can lead to concerns about complications and proper care. Your situation, where a previously healed wound has reopened, is not uncommon, and there are several factors to consider regarding healing, hygiene, and potential complications.

1. Recurrent Wound Breakdown: It is not unusual for surgical wounds, especially in the anal region, to experience some degree of breakdown during the healing process. The skin in this area is sensitive and can be affected by various factors, including pressure, moisture, and friction. If the wound is reopening, it may indicate that the tissue is still fragile or that there is excessive tension on the healing area. While this can be concerning, it does not necessarily mean that an infection is present or that the fistula will recur. However, it is crucial to monitor the wound closely for signs of infection, such as increased redness, swelling, warmth, or discharge.

2. Hygiene Practices: Maintaining proper hygiene after anal surgery is vital for preventing infection and promoting healing. It is common for patients to notice residual stool after cleaning, especially if they have external hemorrhoids or skin tags that can trap fecal matter. Using water to clean the area is generally recommended, as it is gentler than wiping with toilet paper. However, if you are still noticing significant residue, it may be beneficial to consider a few strategies:
- Gentle Cleaning: Instead of vigorous scrubbing, use a handheld showerhead or a peri-bottle to gently rinse the area. This can help minimize irritation while ensuring cleanliness.

- Sitz Baths: Regular sitz baths can help keep the area clean and promote healing. Soaking in warm water for about 15-20 minutes can soothe the area and help with hygiene.

- Moist Wipes: If you prefer using wipes, opt for unscented, alcohol-free options that are designed for sensitive skin. This can help reduce irritation while still providing effective cleaning.

3. Impact of External Hemorrhoids or Skin Tags: If you have external hemorrhoids or skin tags that have become more prominent post-surgery, they can indeed affect your ability to clean the area thoroughly. These structures can trap fecal matter, making it difficult to achieve complete cleanliness. Discussing this with your healthcare provider may lead to recommendations for treatment options, such as topical treatments or, in some cases, surgical removal if they are significantly impacting hygiene.

4. Monitoring and Follow-Up: It is essential to keep your healthcare provider informed about any changes in your wound or concerns regarding hygiene. Regular follow-up appointments are crucial for assessing the healing process and addressing any complications early. If the wound continues to reopen or if you experience significant discomfort, further evaluation may be necessary to rule out underlying issues.

In summary, while it is not uncommon to experience challenges in healing after anal fistula surgery, it is essential to maintain proper hygiene and monitor the wound closely. If you notice persistent issues, do not hesitate to reach out to your healthcare provider for further guidance and support. They can provide tailored recommendations based on your specific situation and help ensure a smoother recovery process.

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