Scar Tissue: Painful Bumps After Fistula Surgery

The scar from a fistula may appear as a bump similar to an acne lesion?

Hello Doctor, I have undergone three fistula surgeries in total.
The first was for abscess drainage, the second developed into a fistula, and after debridement, I needed to have multiple surgeries, so I had the third surgery in March of this year.
I went for a follow-up appointment in mid-April, and the doctor said there were no significant issues.
However, in the past few days, I noticed a bump on the scar that looks like a pimple and is slightly painful.
Additionally, I would like to ask if it is normal for the area around the scar to feel a bit hard.

L, 20~29 year old female. Ask Date: 2021/05/01

Dr. Ke Fangxu reply Surgery

Scar hardening after multiple fistula surgeries is normal; typically, the scar tissue will soften within six months post-surgery.

Reply Date: 2021/05/01

More Info

After undergoing multiple surgeries for a fistula, it is not uncommon to experience changes in the scar tissue, including the formation of painful bumps or nodules. The presence of a bump that resembles a pimple on the scar, along with localized pain and hardness around the scar tissue, can be attributed to several factors related to the healing process and the nature of scar formation.

Firstly, it is essential to understand that scar tissue is different from normal skin. When the body heals from surgery, it produces collagen to repair the damaged tissue. This collagen can sometimes form in a disorganized manner, leading to the development of thickened areas or nodules in the scar tissue. These areas can be sensitive or painful, especially if they are under tension or if there is any irritation to the scar.

The hardness around the scar is also a typical response to surgery. This hardness is often due to the accumulation of collagen fibers and other extracellular matrix components as the body attempts to strengthen the area. Over time, this hardness may decrease as the scar matures, which can take several months to years. However, if the hardness is accompanied by significant pain, swelling, or changes in color, it may indicate an issue that requires further evaluation.

In your case, the bump you described could be a few different things. It might be a keloid or hypertrophic scar, which are types of raised scars that can develop after surgery. Keloids extend beyond the original wound site and can be itchy or painful, while hypertrophic scars remain within the boundaries of the original incision but can also be raised and uncomfortable. Another possibility is that the bump could be a cyst or an area of localized inflammation, particularly if there was any infection or irritation during the healing process.

Given that you have had multiple surgeries, it is crucial to monitor the bump and the surrounding area closely. If the pain increases, the bump grows larger, or if you notice any signs of infection (such as increased redness, warmth, or discharge), you should contact your healthcare provider for an evaluation. They may recommend imaging studies or a biopsy to determine the exact nature of the bump and to rule out any complications.

In terms of management, if the bump is determined to be a keloid or hypertrophic scar, treatments may include silicone gel sheets, corticosteroid injections, or laser therapy to help flatten the scar and reduce discomfort. Physical therapy or massage may also be beneficial in improving the flexibility of the scar tissue and reducing hardness.

In conclusion, while some discomfort and changes in the scar tissue are normal after surgery, it is essential to remain vigilant and consult with your healthcare provider if you have concerns about the bump or any other symptoms. Proper assessment and management can help ensure optimal healing and minimize any long-term complications related to scar formation.

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