Challenges in Healing Anal Fistula Post-Surgery: A Patient's Journey

Postoperative non-healing of anal fistula?

Hello, Doctor! Here is the background: My mother was diagnosed with rectal cancer around 2019 (very close to the anus).
The first physician mentioned that the tumor was too close to the anal sphincter, which would necessitate a permanent colostomy for bowel movements.
We found the colostomy to be very inconvenient, so we sought a second opinion from another physician to see if there was a chance to preserve the sphincter.
The second physician indicated that it was possible to remove the tumor without damaging the sphincter, so we proceeded with the surgery and subsequent radiation therapy.
It is possible that the radiation caused an anal fistula, leading to a temporary colostomy and fistula treatment surgery in 2020.
However, after more than six months, the fistula had not healed.
About nine months after the fistula surgery, the physician noted that the wound was somewhat large and the tissue had become established, indicating it would not heal.
We then underwent a second surgery with the placement of a rubber tube, but it still did not heal.
We have now given up hope of reversing the colostomy.
Additionally, my mother experiences yellow discharge from the vagina after some time (unsure if it is fecal fluid), causing discomfort, along with redness, swelling, and itching, which may last for about a month before returning to normal; then, after another month or two, the discharge reoccurs.
I would like to ask the physician: 1.
Are there cases like my mother's where a fistula wound never heals? 2.
If the fistula is not healing, why is there sometimes no discharge? 3.
Are there any treatment options available to prevent the yellow discharge from the vagina? 4.
If there are truly no other options, what can be done in daily life to alleviate discomfort? Thank you in advance for your responses, Doctor.

Miss Ke, 40~49 year old female. Ask Date: 2022/02/19

Dr. Ke Fangxu reply Surgery

1.
Low rectal cancer, after radiation therapy and surgery, has a high probability of developing a rectovaginal fistula.
Once formed, it is difficult to heal because radiation therapy can affect local blood circulation, making the fistula less likely to close.

2.
The discharge may vary in amount, sometimes being more or less, or it may accumulate to a certain volume before being expelled.

3.
Difficulties may arise.

4.
It is generally recommended to use pads or to perform frequent local cleaning.
If the discharge is substantial, the use of adult diapers may be necessary.

Reply Date: 2022/02/19

More Info

The situation you described regarding your mother's journey with anal fistula post-surgery is indeed complex and challenging. Anal fistulas can be a significant complication following surgeries related to rectal cancer, especially when the surgery involves delicate areas near the anal sphincter. Let's address your questions one by one.

1. Cases of Non-Healing Fistulas: Yes, there are indeed cases where anal fistulas do not heal despite multiple surgical interventions. Factors that contribute to non-healing include the complexity of the fistula's anatomy, the presence of infection, inadequate blood supply to the affected area, and the patient's overall health status. In some cases, the tissue may become fibrotic, making it less responsive to healing. Chronic inflammation from radiation therapy, as in your mother's case, can also hinder healing.

2. Intermittent Discharge: The presence of yellow discharge from the vagina could be due to several factors. It might be related to the fistula itself, where stool or other materials can intermittently leak through the fistula tract. However, the absence of discharge at times could indicate that the fistula is not constantly draining, possibly due to changes in pressure, body position, or the presence of a temporary blockage. It's also possible that the discharge is related to other gynecological issues, such as infections or discharge from the vaginal area unrelated to the fistula.

3. Treatment Options for Discharge: To address the yellow discharge and associated discomfort, it is crucial to consult with both a colorectal surgeon and a gynecologist. They can evaluate the situation comprehensively. Treatment options may include:
- Antibiotics: If there is an infection, antibiotics may help.

- Sitz Baths: Regular sitz baths can soothe the area and promote hygiene.

- Topical Treatments: Depending on the cause of the discharge, topical treatments may be prescribed to alleviate irritation.

- Surgical Options: If the fistula is still present and causing issues, further surgical options may need to be explored, such as advanced techniques like flap procedures or the use of bioprosthetic materials to close the fistula.

4. Managing Daily Life: If surgical options are limited, managing daily life with an anal fistula can be challenging but not impossible. Here are some tips:
- Hygiene: Maintain excellent hygiene to prevent infections. Gentle cleaning after bowel movements and using barrier creams can help.

- Diet: A high-fiber diet can help soften stools, making bowel movements easier and less traumatic for the area.

- Clothing: Wearing breathable, loose-fitting clothing can help reduce irritation.

- Pain Management: Over-the-counter pain relievers can help manage discomfort.

- Follow-Up Care: Regular follow-ups with healthcare providers are essential to monitor the condition and make necessary adjustments to the treatment plan.

In conclusion, your mother's case is indeed complex, and it requires a multidisciplinary approach involving colorectal surgeons, gynecologists, and possibly wound care specialists. Continuous communication with her healthcare team is vital to explore all possible treatment options and to manage her symptoms effectively. It's understandable to feel overwhelmed, but seeking support from healthcare professionals can provide guidance and relief.

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