Post-Surgery Concerns: Pain and Scarring After Fistula Removal

Post-fistula surgery

Hello doctor, I had a fistula excision surgery in mid-November last year, located between the anus and perineum, approximately in the circled area (https://imgur.com/a/6ilEKrR).
I had follow-up visits with my surgeon at the end of December and again yesterday.
The doctor performed a digital examination and confirmed that there are no wounds or fistula issues inside the anus.
Additionally, since early December, which is about a month post-surgery, I have not had any discharge.
However, it has been two months since the surgery, and occasionally I experience a sharp pain when sitting.
Could you please tell me what the white line in the circled area is? Is it a surgical scar or could it be folliculitis? Should I see a dermatologist? Here is the original image: https://imgur.com/a/2MlLaVt.

Lph, 30~39 year old female. Ask Date: 2022/01/15

Dr. Ke Fangxu reply Surgery

Due to the unclear focus of the three photos and the lack of a personal examination, I cannot provide a definitive answer.
However, it does not appear to be a recurrence or folliculitis; it may simply be pain from scar tissue after surgery.
If there is no redness, swelling, heat, pain, or discharge, and it is not affecting your daily activities, I suggest monitoring the situation.
You may also consider consulting the surgeon or a dermatologist for further evaluation.

Reply Date: 2022/01/15

More Info

After undergoing a fistula removal surgery, it is common to experience various sensations and discomforts as part of the healing process. The concerns you have regarding pain, scarring, and the appearance of the surgical site are valid and deserve thorough discussion.

Firstly, the white line you are observing around the surgical site is likely a scar from the incision made during the surgery. Scarring is a natural part of the healing process, and it can take several months to a year for scars to mature and fade. The appearance of scars can vary based on several factors, including the individual's skin type, the depth of the incision, and how well the wound was cared for post-surgery. It is important to note that while some scarring is normal, any changes in color, texture, or the presence of unusual symptoms (like increased pain or discharge) should be evaluated by a healthcare professional.

The occasional sharp pain you experience while sitting could be attributed to several factors. It may be related to the healing of the tissues around the surgical site, nerve regeneration, or even muscle tension in the pelvic area. The area around the anus and perineum is sensitive, and as the tissues heal, it is not uncommon to experience intermittent discomfort. If the pain persists or worsens, it would be advisable to consult with your surgeon or a pain management specialist to rule out any complications, such as nerve entrapment or scar tissue formation that could be contributing to your discomfort.

Regarding your question about whether to see a dermatologist for the white line, it may not be necessary at this stage unless you notice signs of infection (such as redness, warmth, swelling, or discharge) or if the area becomes painful to the touch. If you have concerns about the appearance of the scar or if you suspect it may be related to a skin condition like folliculitis (inflammation of hair follicles), a consultation with a dermatologist could provide additional insights and treatment options.

In terms of managing pain and discomfort post-surgery, here are some recommendations:
1. Pain Management: Over-the-counter pain relievers, such as ibuprofen or acetaminophen, can help manage pain. If your pain is severe, your doctor may prescribe stronger medications.

2. Sitz Baths: Taking warm sitz baths can help soothe the area, promote blood flow, and aid in healing. This can be particularly beneficial after bowel movements.

3. Avoiding Strain: Be mindful of your posture while sitting and avoid prolonged sitting if it exacerbates your pain. Using a cushion or a specially designed seat can help alleviate pressure on the surgical site.

4. Physical Therapy: If pain persists, consider consulting a physical therapist who specializes in pelvic floor rehabilitation. They can provide exercises and techniques to help alleviate discomfort and improve function.

5. Follow-Up Care: Regular follow-ups with your surgeon are crucial. They can monitor your healing progress and address any concerns you may have.

6. Healthy Lifestyle: Maintaining a balanced diet, staying hydrated, and engaging in gentle physical activity can support your overall healing process.

In conclusion, while some discomfort and scarring are expected after fistula removal surgery, it is essential to remain vigilant about any changes in your symptoms. If you have ongoing concerns or if your pain intensifies, do not hesitate to reach out to your healthcare provider for further evaluation and guidance. Your recovery is important, and addressing these issues proactively can lead to better outcomes.

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