Anal Fistula Healing: Managing Complications and Care

The wound from the healing anal fistula has reopened?

Hello Doctor, I have undergone three surgeries for anal fistula within five months: the first surgery on November 8, the second due to recurrence on December 1, and the third on January 17 of the following year.
During my follow-up on January 17, the doctor found no abnormalities.
At that time, the healing status of the wound was that one-third near the anal area had not healed.
On the night of January 18, I experienced severe itching at the healing site.
To avoid scratching, I used a disinfected cotton swab to apply "Mupirocin ointment" to relieve the itching.
On January 19, the touched area of the healed site was very painful (where I scratched).
On January 20, I took pain and anti-inflammatory medication in the afternoon.
After returning home from work, I prepared to change the dressing after a sitz bath when I suddenly noticed a large amount of fresh blood oozing from the wound.
After stopping the bleeding, I found that the previously healed area had split and was oozing blood.
The bleeding stopped after five minutes.
After gently probing with a cotton swab, the thin, translucent white area (originally healed) was broken, resembling the depth and length of a fresh surgical wound, with a bright red color as shown in the image: https://i.imgur.com/3kuevLA.jpg.

I have the following questions:
1.
Should I return for a follow-up to have the wound cleaned?
2.
Can I continue using Mupirocin while waiting for the tissue to grow?
3.
What could have caused this situation? Is it due to the healing process being unsuccessful in the past few weeks, with skin growing faster than the tissue?
4.
How can I prevent this from happening again?

Jia, 30~39 year old female. Ask Date: 2022/01/21

Dr. Zhang Shuhao reply Surgery

This is an initial healing epidermal tear that has reopened, exposing the underlying granulation tissue and causing bleeding.
If the bleeding stops, you can continue to apply ointment and change the dressing to allow it to heal gradually.
Although this is not an emergency situation, it is still advisable to return for a follow-up to assess the wound.
Sometimes, multiple surgeries can lead to insufficient epidermal tissue, and excessive tension on the wound can hinder healing; however, the epidermis on both sides will gradually cover the area, so there is no need for concern.
It is recommended to keep the wound clean and avoid friction.
Wishing you a speedy recovery.

Reply Date: 2022/01/21

More Info

Understanding anal fistula healing and managing complications is crucial for patients who have undergone multiple surgeries. An anal fistula is an abnormal connection between the anal canal and the skin surrounding the anus, often resulting from an infection or abscess. The healing process can be complicated, especially after multiple surgical interventions, as you've experienced.

1. Should you return for debridement? Given your symptoms of significant bleeding from the previously healed area, it is advisable to return to your healthcare provider for evaluation. The sudden onset of bleeding, especially after a period of healing, may indicate that the tissue has become fragile or that there is an underlying issue, such as infection or improper healing. Your doctor may need to assess the wound, possibly perform debridement, and ensure that there are no complications such as abscess formation or necrotic tissue.

2. Can you continue using the topical treatment? While "使皮新乳膏" (which translates to a skin protective ointment) may provide some relief from itching, it is essential to consult your healthcare provider before continuing its use. If the ointment contains ingredients that could irritate the wound or delay healing, it may not be advisable. Your doctor might recommend alternative treatments that are more suitable for open wounds or suggest a different approach to manage itching without compromising the healing process.

3. What caused the complications? The issues you are experiencing could stem from several factors. The healing process of anal fistulas can be unpredictable, and sometimes the skin may heal faster than the underlying tissue, leading to tension and eventual breakdown of the newly formed skin. Additionally, factors such as excessive moisture, friction from clothing, or even scratching can contribute to the disruption of healing. It’s also possible that the initial surgical site was not adequately closed, leading to a recurrence of the fistula or complications.

4. How to prevent recurrence? To avoid further complications, consider the following strategies:
- Maintain proper hygiene: Regularly clean the anal area with mild soap and water, and avoid harsh chemicals or scrubs that could irritate the skin.

- Avoid scratching: As difficult as it may be, try to refrain from scratching the area. If itching persists, discuss with your doctor about safe anti-itch treatments.

- Wear breathable clothing: Opt for loose-fitting, breathable fabrics to reduce friction and moisture accumulation around the anal area.

- Follow a high-fiber diet: This can help prevent constipation and straining during bowel movements, which can put pressure on the surgical site.

- Stay hydrated: Adequate hydration can help maintain soft stools, reducing the risk of straining.

- Regular follow-ups: Keep up with your scheduled appointments to monitor healing and address any concerns promptly.

In summary, your situation requires careful management and close communication with your healthcare provider. The healing process for anal fistulas can be complex, and it’s essential to address any complications early to promote optimal recovery. Always prioritize professional medical advice over self-treatment, especially after multiple surgeries.

Similar Q&A

Post-Surgery Recovery: Understanding Anal Fistula Healing Process

Hello Dr. Ke, I had a bit of a lapse in memory around the end of June when I developed an "anal abscess" due to frequent wiping from diarrhea. Initially, I was unaware of the condition and visited a small clinic where I was prescribed painkillers and anti-inflammatory m...

Dr. Ke Fangxu reply Surgery
If an anal abscess is left untreated for too long, there is a higher chance that it will develop into a fistula. This type of fistula is generally more complex to manage and has a higher likelihood of recurrence. Currently, you have undergone drainage of the abscess and a fistulo...

Understanding Anal Fistulas: Causes, Treatment, and Prevention

Will anal fistulas continue to occur?

Dr. Ke Fangxu reply Surgery
Hello: In response to your question, an anal fistula is a complication that arises after inflammation of the anus. The only definitive treatment is surgery; without surgical intervention, the anal fistula will not heal on its own.

Understanding Anal Fistulas: Surgical Options and Care Tips

Question: Asking person: Ah Xiang / Male / 29 Hello, doctor: Sometimes when I have a bowel movement, I notice blood when I wipe with toilet paper, and sometimes I don’t. I thought it was hemorrhoids, and I also experience itching at times. I previously saw a doctor who to...

Dr. Ke Fangxu reply Surgery
Hello, in response to your question: If an anal fistula is left untreated, it may lead to a bacterial infection, resulting in the formation of an abscess, which can cause swelling and pain. In such cases, an incision and drainage procedure is necessary, which is considered an out...

Understanding Anal Fistula Surgery: Healing Complications and Concerns

Hello doctor, I had a fistula surgery on January 11 due to an abscess that formed a fistula. It has been three weeks since the surgery, and I recently noticed that the skin around the surgical site is very thin and painful when pressed. I felt a hole in that area. This morning, I...

Dr. Ke Fangxu reply Surgery
The wound from anal fistula surgery typically takes about a month to fully heal. The current situation likely indicates that the wound has not completely healed, resulting in slight bleeding. It is recommended to take warm sitz baths and monitor the situation. If this condition p...