Post-Appendectomy Concerns: Healing, Discharge, Diet, and Activity

Post-operative issues following appendectomy?

Hello, Doctor.
I underwent laparoscopic appendectomy on November 3rd.
The doctor mentioned that my appendix was swollen and purulent but not ruptured, so it did not reach the level of peritonitis.
I had the drainage tube removed on November 6th and returned for suture removal on November 11th.
My recovery has been generally good so far, but I have four questions:
1.
On the night after the sutures were removed, I noticed that one of the wound surfaces was open with a small amount of serous fluid.
After applying a silicone adhesive strip for four days, I found that about one-third of the wound had healed, but the remaining two-thirds was still open and had a little serous fluid.
The wound itself does not feel red, swollen, hot, or painful.
Is this healing status considered normal (since it remains open, I am a bit concerned)? Should I continue using the silicone adhesive strip, or should I switch to applying iodine until the wound closes?
2.
The drainage site has had a small amount of brownish discharge from November 6th to November 15th, which occasionally adheres to the gauze.
There is no redness or swelling, but I sometimes feel a slight pain in the area during daily activities.
Is it normal to have this ongoing discharge?
3.
I have maintained a normal diet post-surgery, focusing on low-oil, whole foods, and I have recently stopped taking pain medication.
However, I have been experiencing diarrhea daily (1-2 times a day).
Is this also considered normal?
4.
How long after the surgery can I engage in sexual intercourse? Is there a risk of causing an intra-abdominal infection from sexual activity?
Thank you!

Sherry, 20~29 year old female. Ask Date: 2021/11/16

Dr. Chen Jiaming reply Surgery

1.
For wounds that have not healed for an extended period, it is recommended to change the dressing or care regimen; you might try applying povidone-iodine first.

2.
Drainage tube wounds generally do not heal as easily as sutured wounds.
After the drainage tube is removed, there may be blood and small openings, which can easily adhere to the dressing during each change.
It is advisable to apply povidone-iodine and an antibiotic ointment, then cover it with a gauze pad.

3.
As time passes since the surgery, you can gradually return to your normal diet.
However, bowel movements can be unpredictable because antibiotics used during appendicitis treatment may disrupt the balance of beneficial bacteria in the gut.
If this issue persists, you might consider trying commercially available probiotic yogurt or directly purchasing probiotics to help restore balance.

4.
The recovery of the abdominal wound can be assessed by checking for tenderness upon palpation.
If there is no pain, you can gradually resume normal activities.
If there is still slight discomfort, you can try different positions or take a pain reliever to alleviate abdominal discomfort.
This behavior will not cause intra-abdominal infections (gynecological infections or recurrent urinary tract infections are more likely to lead to pelvic inflammation).
It is recommended to urinate after sexual activity to prevent the retrograde movement of bacteria that could lead to urinary tract infections.

Reply Date: 2021/11/16

More Info

Post-appendectomy recovery is a critical phase that requires careful attention to wound healing, dietary choices, and activity levels. Based on your questions, let’s address each concern systematically.

1. Wound Healing: It is not uncommon for surgical wounds to take time to heal, especially after laparoscopic appendectomy. The presence of some blood-tinged fluid is generally not alarming, particularly if there are no signs of infection such as redness, swelling, or increased pain. The fact that one-third of your wound has healed is a positive sign. You can continue to use the adhesive strips (often referred to as Steri-Strips) as they can help support the wound edges. However, if the wound remains open and continues to ooze, it may be beneficial to clean the area gently with saline or a mild antiseptic like Betadine (iodine solution) and cover it with a sterile dressing. If the wound does not show signs of improvement in a few days, or if you notice any signs of infection, it is advisable to consult your healthcare provider.

2. Drain Site Discharge: A small amount of discharge from the drain site can be normal, especially if it is not accompanied by redness or significant pain. The coffee-colored discharge suggests that it may be old blood, which can occur as the body continues to heal. However, if the discharge increases in volume, changes color, or if you develop fever or increasing pain, you should seek medical attention. It’s essential to keep the area clean and dry, and to monitor for any changes.

3. Diet and Gastrointestinal Symptoms: Post-operative diarrhea can occur for several reasons, including the stress of surgery, changes in diet, or even the effects of anesthesia. Since you are focusing on a low-oil, whole-food diet, this is generally a good approach. However, if the diarrhea persists or worsens, it may be worth considering if any specific foods are triggering this response. Staying hydrated is crucial, so ensure you are drinking plenty of fluids. If the diarrhea continues for more than a few days or is accompanied by other symptoms like fever or severe abdominal pain, you should consult your doctor.

4. Resuming Sexual Activity: Generally, it is recommended to wait at least 2 to 4 weeks after surgery before resuming sexual activity. This allows your body time to heal and reduces the risk of complications. Engaging in sexual activity too soon can potentially lead to increased abdominal pressure, which might affect your healing process. If you have any concerns about the risk of infection or if you experience any discomfort during sexual activity, it is best to discuss this with your healthcare provider.

In summary, while some of your concerns are within the realm of normal post-operative experiences, it is essential to monitor your symptoms closely. If you notice any significant changes or worsening of your condition, do not hesitate to reach out to your healthcare provider for further evaluation. Recovery is a gradual process, and maintaining open communication with your medical team will help ensure a smooth healing journey.

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