Post-Surgery Pain and Care for Anal Fistula Repair

Will anal fistula surgery damage the anus?

Dr.
Ko: Hello! The surgeon who performed my operation is very quiet and serious, making it difficult for me to ask him questions, so I’m here to consult you.
Thank you!
1.
The surgeon mentioned that my fistula can only be resolved through surgery.
It has been 4 days post-operation, and I have been home for a day now, but my anus is still very painful.
I’ve been lying in bed all day, and my thighs are numb.
What should I do?
2.
I am taking pain medication after each meal and before bed.
Can I take an additional dose if I wake up in the middle of the night? I usually wake up around 4 to 5 AM, but there is still some time until breakfast (8 AM), and the pain becomes increasingly unbearable, making it hard to sit still.

3.
I noticed that the area where the fistula was swollen has turned into a groove, but since my anus is very painful, I don’t feel much discomfort at the fistula site.
I asked the surgeon if it was a fistula surgery, and he confirmed it.
He also mentioned that treating the fistula usually involves scraping away some hemorrhoids, which is why my anus hurts.
Is this correct?
4.
Is it acceptable to defecate directly into the sitz bath? Wouldn’t that be very unsanitary?
5.
I find it difficult to sit for long periods, even with a donut cushion.
How long will it take for this to improve? Otherwise, I’m unsure how I will manage to go back to work.
Thank you for your patience and kindness!

Liu Xiansheng, 50~59 year old female. Ask Date: 2021/09/03

Dr. Ke Fangxu reply Surgery

1.
Postoperative pain after anal fistula surgery is a normal phenomenon, and the pain typically lasts for 1-2 weeks.
If the pain is severe, you can ask your physician to prescribe pain medication.
Taking warm sitz baths can also be helpful.

2.
It should be possible, but without knowing the medication's components and dosage, it cannot be determined.
It is best to consult the prescribing physician for safety.

3.
If there are hemorrhoidal tissues near the anal fistula, they are usually excised as well.
However, even if only the fistula surgery is performed, there will still be pain.

4.
Yes, I also recommend to my patients to clean themselves with water after bowel movements and then take another sitz bath.

5.
Please discuss changing oral medications with the surgeon.

Reply Date: 2021/09/03

More Info

After undergoing anal fistula repair surgery, it is common to experience significant discomfort and pain during the recovery period. Here’s a comprehensive overview of what you might expect and how to manage your symptoms effectively.

1. Post-Surgery Pain Management: It is not unusual to experience pain four days post-surgery, especially in the anal region. This pain can be exacerbated by sitting or moving, which may lead to feelings of discomfort and even numbness in the legs due to prolonged bed rest. It is crucial to follow your physician's recommendations regarding pain management. If you find that the prescribed pain medication is not sufficient, you should contact your healthcare provider to discuss your symptoms. It is generally acceptable to take pain medication as needed, even if it means taking it outside of the scheduled times, especially if you are experiencing significant pain. However, be cautious not to exceed the recommended dosage.

2. Understanding the Surgical Procedure: Your surgeon's comments about the surgery involving the removal of some hemorrhoids are not uncommon. Many times, anal fistula repairs can involve addressing other issues in the area, such as hemorrhoids, which can contribute to postoperative pain. The "groove" you are noticing where the fistula was located is likely part of the healing process, and it may take some time for the area to return to normal.
3. Sitz Baths: Sitz baths can be very beneficial for pain relief and promoting healing after anal surgery. They can help soothe the area and reduce discomfort. It is generally acceptable to have a bowel movement while in a sitz bath, but it is essential to maintain hygiene. If you are concerned about cleanliness, you may want to use a separate container for bowel movements or ensure that the sitz bath is cleaned thoroughly afterward.

4. Sitting Comfortably: It is understandable that sitting for extended periods can be challenging after this type of surgery. Using a donut cushion can help alleviate pressure on the surgical site, but if you find it uncomfortable, you might need to experiment with different seating arrangements or cushions. Gradually increasing the time you spend sitting can help your body adjust, but listen to your body and take breaks as needed.

5. Recovery Timeline: The recovery period can vary significantly from person to person. Generally, you can expect some discomfort for several weeks post-surgery, with gradual improvement. Most patients find that their pain decreases significantly within 2 to 4 weeks, but complete healing can take longer. If you are concerned about your recovery or if your pain worsens, it is essential to follow up with your surgeon.

In summary, managing pain after anal fistula repair involves a combination of medication, proper hygiene, and gradual adjustments to your daily activities. If you have any concerns about your recovery or if your pain persists or worsens, do not hesitate to reach out to your healthcare provider for further evaluation and guidance. Your comfort and health are paramount, and your doctor can provide tailored advice based on your specific situation.

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