Post-Surgery Concerns: Managing Pain and Healing After Anal Fistula Surgery

Postoperative care after anal fistula surgery?

Hello Doctor, I had a fistula surgery on April 24th of this year, and I would like to ask the following questions:
1.
The wound from the anal fistula has been painful and I have been experiencing significant itching in the anal area due to multiple episodes of diarrhea over the past two days.
When I returned to the hospital for a follow-up, the doctor only examined the external appearance and performed a digital rectal exam, confirming that everything was fine without using an anoscope to check internally.
Is this the correct approach? I am currently experiencing more pain and itching internally than last week; shouldn't the wound be healing instead of worsening?
2.
I have been experiencing loose, unformed stools for over 10 months.
Could diarrhea be a contributing factor to the development of the anal fistula? What tests should I undergo or what dietary adjustments should I make to help improve this situation?
3.
Additionally, if I want to ensure that the internal wound of the fistula heals before the external wound, is there anything I can do? The surgeon mentioned that this aspect does not require attention, but since they did not use instruments to examine the internal wound, I am quite concerned.
4.
Furthermore, I am currently working as a police officer and need to carry approximately five kilograms of equipment on my waist while standing or sitting for extended periods.
Will this have any impact on the wound?
5.
Thank you, Doctor, for your responses and for your hard work.

n, 20~29 year old female. Ask Date: 2021/05/17

Dr. Ke Fangxu reply Surgery

1.
The poor wound healing may be due to diarrhea; at this time, constipation or diarrhea should be avoided.
If the physician has prescribed laxatives, they should be discontinued.

2.
It is possible that at this age, it is primarily caused by irritable bowel syndrome; you can consult a gastroenterologist for diagnosis and medication.

3.
Using instruments to examine the wound at this time will guarantee excruciating pain; an experienced physician's manual examination is more accurate than instruments, so trust the expertise of the specialist.

4.
It should not be a problem.

Reply Date: 2021/05/17

More Info

After undergoing anal fistula surgery, it is common to have concerns regarding pain, healing, and overall recovery. Let's address your questions one by one, providing clarity and guidance based on medical knowledge.

1. Post-Surgery Pain and Itching: It is not unusual to experience pain and itching in the anal area after surgery, especially if you have had diarrhea. The irritation from frequent bowel movements can exacerbate discomfort and lead to inflammation around the surgical site. While your doctor performed a visual examination and a digital rectal exam, it is also reasonable to expect a more thorough evaluation, such as an anoscopy, to assess the internal condition of the anal canal. If your pain and itching have increased, it may indicate inflammation or irritation that requires further investigation. If symptoms persist or worsen, seeking a second opinion or further evaluation may be warranted.

2. Causes of Fistula and Dietary Adjustments: Chronic diarrhea can contribute to the development of anal fistulas, as it can lead to increased pressure and irritation in the anal region. To improve your bowel habits, consider dietary adjustments that include increasing fiber intake through fruits, vegetables, and whole grains, which can help form more solid stools. Additionally, staying hydrated is crucial. If diarrhea persists, it may be beneficial to consult a gastroenterologist for further evaluation, including tests for underlying conditions such as inflammatory bowel disease or infections.

3. Healing of Internal vs. External Wounds: Ensuring that the internal wound heals properly is essential for recovery. While your surgeon may have indicated that there is no need for special attention, it is important to maintain good hygiene and follow post-operative care instructions. Avoiding straining during bowel movements, using stool softeners if necessary, and practicing gentle cleaning techniques can help promote healing. If you have concerns about the healing process, discussing them with your surgeon or seeking a follow-up appointment for a more detailed examination may provide peace of mind.

4. Impact of Job on Recovery: Engaging in a job that requires carrying weight and prolonged sitting or standing can impact your recovery. The pressure and strain on the pelvic area may exacerbate pain or delay healing. It is advisable to discuss your work conditions with your healthcare provider. They may recommend modifications, such as taking breaks to relieve pressure, using supportive cushions when sitting, or adjusting your workload to facilitate recovery.

5. Final Thoughts: Recovery from anal fistula surgery can be a gradual process, and it is important to listen to your body. If you experience increased pain, changes in bowel habits, or any new symptoms, do not hesitate to reach out to your healthcare provider. They can provide guidance tailored to your specific situation and ensure that you are on the right path to recovery. Remember, maintaining open communication with your medical team is key to addressing any concerns and achieving a successful recovery.
In summary, while some discomfort and itching can be expected post-surgery, persistent or worsening symptoms should be evaluated further. Dietary changes may help improve bowel regularity, and attention to your work conditions can aid in recovery. Always prioritize your health and seek medical advice when in doubt.

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