Post-Surgery Concerns: Pain and Healing After Fistula Removal

Post-fistula surgery

Hello doctor, I had a fistula excision surgery in mid-November, located from the anal opening up to the perineum.
The physician mentioned it was a superficial fistula.
It has been over five weeks since the surgery, and there has been no discharge, but I occasionally feel a sharp pain when sitting.
Is this normal? When I look at the area with a mirror and feel it with my hand, the area above the incision feels slightly raised, and I suspect that the source of the occasional sharp pain is from this spot.
Could this indicate that the fistula was not completely excised? If the wound near the anal opening has healed but there is residual fistula tissue left, could this develop into a high anal fistula? I am a bit concerned because the surgery only took 1 to 2 minutes.
What tests can be done to confirm whether the fistula has been completely removed? Should I consider an MRI (with or without contrast), a CT scan, or an X-ray? Would a colonoscopy be appropriate, or is it only possible to rely on a digital examination or wait for the fistula to become inflamed and rupture again?

jk, 30~39 year old female. Ask Date: 2021/12/23

Dr. Ke Fangxu reply Surgery

1.
A slight tingling sensation is normal.

2.
It should be scar tissue formed after the wound has healed.

3.
Whether it develops into a high anal fistula is related to the position of the internal opening of the fistula and the pathway it follows; it does not necessarily evolve into this condition.

4.
If the fistula is not completely excised, it may recur.
If there are symptoms of swelling, pain, or pus discharge, it is likely a recurrence.
Such a small lesion is best evaluated through a digital rectal exam, as imaging studies may not detect it unless it is a high, complex fistula; otherwise, MRI may not be helpful.

Reply Date: 2021/12/23

More Info

After undergoing a fistula removal surgery, it is common to experience some discomfort and pain during the healing process. In your case, five weeks post-surgery, experiencing occasional sharp pain while sitting can be considered normal as your body is still healing. The presence of a slight bump in the area above the surgical site, along with intermittent sharp pain, raises some concerns but does not necessarily indicate that the fistula was not completely excised.

Fistula surgeries can sometimes leave residual tissue or scarring that may cause discomfort as the area heals. The fact that you have no discharge is a positive sign, indicating that there is likely no active infection. However, if the pain persists or worsens, or if you notice any unusual changes in the area, it is essential to consult your surgeon for a thorough evaluation.

Regarding your concern about the possibility of a high fistula developing if remnants of the original fistula remain, it is crucial to understand that incomplete removal can lead to complications. A high fistula refers to a fistula that originates higher up in the anal canal or rectum, which can be more complex to treat. If you are worried about the completeness of the fistula removal, there are several diagnostic options available:
1. MRI (Magnetic Resonance Imaging): This imaging technique can provide detailed images of soft tissues and may help visualize any remaining fistulous tracts. An MRI with contrast can enhance the visibility of the fistula and surrounding structures.

2. CT Scan (Computed Tomography): A CT scan can also be useful in assessing the anatomy of the area and identifying any residual fistulous tracts. A CT scan with contrast may provide better detail.

3. X-ray: While X-rays are not typically used for evaluating fistulas, they can sometimes be helpful in assessing the overall structure of the pelvic area.

4. Colonoscopy: This procedure allows direct visualization of the colon and rectum, which can help identify any internal issues related to the fistula.

5. Digital Rectal Examination: Your healthcare provider may perform a physical examination to assess the area for any abnormalities.

It is essential to communicate your concerns with your surgeon, who can recommend the most appropriate imaging study based on your symptoms and clinical findings. If there is any suspicion of a residual fistula or if you experience recurrent symptoms, further intervention may be necessary.

In the meantime, managing your pain with over-the-counter pain relievers, applying warm compresses to the area, and avoiding prolonged sitting may help alleviate discomfort. Additionally, maintaining good hygiene and following any post-operative care instructions provided by your surgeon will support the healing process.

In summary, while some discomfort is expected after fistula surgery, persistent or worsening symptoms warrant further evaluation. Diagnostic imaging can help determine if the fistula was completely removed and guide any necessary follow-up treatment. Always consult your healthcare provider for personalized advice and treatment options.

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