Post-Surgery Pain Management: Complications and Next Steps

Postoperative wound pain

Hello, Dr.
Ke.
I discovered a hard lump about the size of a fingertip at the anal opening in May-June.
I don't feel it while walking, but there is an inflammatory pain when I press on it.
It feels deep, has not developed pus, and has not opened up.
I received two rounds of intravenous antibiotics and took oral antibiotics for 10 days without improvement.
After 1-2 months, I decided to undergo fistula surgery on July 22 at the hospital.
However, after the surgery, the doctor mentioned that it might not be a fistula but possibly a deep folliculitis, suggesting he may not have seen a tract.
The wound measures approximately 2.5 cm by 1.5 cm, with a depth of about 1.5 cm.
After the surgery, the doctor instructed me to cut small pieces of wet gauze (saline solution + 2.2 gauze cut to about 1/4 size) to pack the wound.
The first two days at home were fine, but by the third and fourth days, the wound started to feel increasingly painful.
I experience sharp pain when rinsing or soaking the wound (plus, on that day, the gauze got stuck and accidentally pulled off, causing bleeding).
I also wake up at night due to the pain.
Currently, if rinsing causes pain, I will rinse the wound again with saline solution.
It has been a week, and there is a lot of blood and discharge (which looks somewhat thick and light yellow), requiring a change approximately every two hours.
During my one-week follow-up, the doctor only prescribed pain medication and mentioned that my gauze was too large and suggested to make it smaller to fill the wound adequately.
No other anti-inflammatory or ointment medications were prescribed.
May I ask: 1.
Should I seek another hospital for a second opinion? 2.
Or should I observe for another week? 3.
Do you have any other suggestions? Thank you.

Chang, 30~39 year old female. Ask Date: 2021/07/30

Dr. Ke Fangxu reply Surgery

If it is a fistula incision surgery, the wound will take about a month to heal.
Based on your description, it seems that the wound is not sutured.
If the wound is close to the anal area, it is recommended to take warm sitz baths and monitor the wound for a month to see if it heals.
If it does not heal by then, it would be better to have a doctor evaluate it.
After all, it has only been a week since the surgery, and there is no immediate special treatment that can be done.

Reply Date: 2021/07/30

More Info

Post-surgery pain management can be a complex issue, especially when complications arise. Based on your description, it seems that you are experiencing significant pain and discomfort following your surgery for what was suspected to be a fistula but turned out to be a deep-seated folliculitis or similar condition. Here are some insights and recommendations based on your situation:

Understanding Your Pain and Symptoms
1. Nature of Pain: The pain you are experiencing could be attributed to several factors, including:
- Surgical Trauma: The incision and manipulation of tissues during surgery can lead to inflammation and pain as the body heals.

- Infection: The presence of purulent discharge (yellowish, thick fluid) suggests that there may be an infection or at least an inflammatory response occurring at the surgical site.

- Wound Healing Complications: If the wound is not healing properly, it can lead to increased pain and discomfort. The fact that you have experienced bleeding and significant discharge indicates that the healing process may not be proceeding as expected.

2. Post-Surgical Expectations: It's important to understand that pain is a common experience after surgery, but it should gradually improve over time. If pain worsens or does not improve, it may indicate complications such as infection or improper healing.

Recommendations for Pain Management and Next Steps
1. Follow-Up Care: Given that your pain has increased and you are experiencing significant discharge, it may be prudent to seek a second opinion or return to your surgeon for a thorough evaluation. It’s essential to ensure that there is no underlying infection or other complications that need to be addressed.

2. Wound Care:
- Dressing Changes: Ensure that you are changing your dressings regularly and using sterile techniques to avoid introducing bacteria into the wound. If the current dressing is too large and causing discomfort, follow your doctor's advice to adjust the size.

- Cleaning the Wound: Continue to clean the wound with saline as instructed. If you notice any signs of increased redness, swelling, or discharge, report these to your healthcare provider.

3. Pain Management:
- Medications: If the prescribed pain medications are not providing adequate relief, discuss this with your doctor. They may be able to adjust your medication or prescribe something stronger.

- Non-Pharmacological Approaches: Consider using ice packs on the area (if appropriate) to help reduce swelling and numb the pain. Additionally, gentle elevation of the affected area may help decrease discomfort.

4. Monitoring Symptoms: Keep a close eye on your symptoms. If you experience fever, increased swelling, or worsening pain, seek medical attention promptly. These could be signs of an infection that may require antibiotics or further intervention.

5. Patience and Observation: While it is frustrating to deal with ongoing pain, sometimes it is necessary to allow a little more time for healing. However, if after a week you do not see improvement, or if your symptoms worsen, do not hesitate to seek further medical advice.

Conclusion
In summary, your situation requires careful monitoring and possibly further evaluation by a healthcare professional. It is crucial to ensure that there are no complications from the surgery and that your pain is managed effectively. Do not hesitate to advocate for your health by seeking additional opinions or treatments if your current care does not meet your needs. Healing takes time, but with the right support and interventions, you can work towards recovery.

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