Persistent Discharge and Blood Two Months After Fistula Surgery: What to Do?

Two months after the fistula surgery, there is still discharge and blood?

It has been two months since the fistula surgery, and I have been taking sitz baths four times a day during this period.
However, I still have discharge and some blood.
It has been confirmed that the external wound has healed, but the discharge and blood are coming from the anus.
Sometimes, a clear fluid also flows out, and if I have a bowel movement earlier, it appears to be light brown (possibly fecal fluid), but this is still coming from the anus.
During multiple follow-up visits, the doctor has only suggested continuing the sitz baths and has not prescribed any antibiotics.
I have two questions: 1.
Am I experiencing a recurrence? 2.
Each time I visit, the doctor only examines the external wound, but does not check the internal opening.
Is this normal? If not, should I consider switching to another hospital? Thank you for your response.

Huang, 20~29 year old female. Ask Date: 2022/03/27

Dr. Zhang Shuhao reply Surgery

In general, fistula surgery creates an open wound both inside and outside the anus.
In addition to completely excising the fistula tissue, the goal is for the wound to heal from the inside out, preventing the skin from healing over while leaving a cavity inside.
Therefore, based on your description, it is unusual that the external skin has healed but you are still experiencing symptoms.
Anal fistulas can range from simple to complex, so it is advisable to consult an experienced colorectal surgeon for evaluation.

Reply Date: 2022/03/27

More Info

After undergoing fistula surgery, experiencing persistent discharge and blood two months post-operation can be concerning. It is important to address your questions and provide some context regarding the healing process and potential complications following such a procedure.

1. Is this a recurrence of the fistula?
While it is possible that the discharge and blood could indicate a recurrence of the fistula, it is not definitive. Fistula surgeries can sometimes lead to complications such as abscess formation, incomplete healing, or even the development of new fistulas. The presence of clear fluid and occasional brownish discharge could suggest that there is still some healing taking place or that there is residual fluid from the surgical site. It is essential to monitor the characteristics of the discharge. If it becomes foul-smelling, increases in volume, or is accompanied by fever or increased pain, these could be signs of infection or other complications that warrant immediate medical attention.

2. Is it normal for the doctor to only examine the external wound?
It is not uncommon for surgeons to focus on the external aspect of the wound during follow-up appointments, especially if the external site appears to be healing well. However, if you are experiencing ongoing symptoms, it is reasonable to expect a more thorough examination, which may include checking the internal opening of the fistula. If your doctor is not addressing your concerns adequately or performing a comprehensive evaluation, it may be advisable to seek a second opinion. A different healthcare provider might offer a fresh perspective and potentially more thorough diagnostic measures, such as imaging studies or an internal examination.

Additional Considerations:
- Sitz Baths: Continuing with sitz baths is a good practice as they can help soothe the area and promote healing. However, if the discharge persists, it may not be sufficient on its own to resolve the issue.

- Antibiotics: If there is any suspicion of infection, antibiotics may be warranted. If your doctor has not prescribed them despite ongoing symptoms, it could be beneficial to discuss this further or seek another opinion.

- Follow-Up Care: Regular follow-up is crucial after fistula surgery. If your symptoms do not improve or worsen, it is essential to advocate for yourself and ensure that your concerns are taken seriously.
- Potential Complications: Be aware of signs that may indicate complications, such as increased pain, swelling, fever, or changes in the discharge's color or odor. These symptoms should prompt immediate medical evaluation.

In conclusion, while some discharge can be normal during the healing process, persistent symptoms two months after surgery warrant further investigation. It is essential to communicate openly with your healthcare provider about your concerns and consider seeking a second opinion if you feel your needs are not being met. Proper follow-up care is vital to ensure complete healing and to address any potential complications early on.

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