Post-Fistula Surgery: Persistent Discharge and Blood After Two Months

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 maintaining sitz baths four times a day.
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 comes out, and if I have a bowel movement earlier, it appears as light brown (possibly fecal fluid), but this is still coming from the anus.
During multiple follow-up visits, the doctor has only suggested continuing 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: 2022/03/28

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 fistulous tissue, the goal is for the wound to heal from the inside out, preventing the skin from closing over a cavity that remains internally.
Therefore, based on your description, it is unusual that the outer skin has healed but you still have symptoms.
Anal fistulas can range from simple to complex, so it is advisable to consult an experienced colorectal surgeon for evaluation.

Reply Date: 2022/03/28

More Info

After undergoing fistula surgery, it is not uncommon to experience some degree of discharge and minor bleeding for a period of time. However, persistent symptoms two months post-surgery, such as ongoing discharge and blood, warrant careful consideration and evaluation.

1. Is this a recurrence of the fistula?
The presence of discharge and blood could potentially indicate a recurrence of the fistula, but it is not definitive. Fistula surgery aims to create a permanent closure of the abnormal connection between the anal canal and the skin. However, in some cases, the healing process can be complicated by factors such as infection, inadequate closure, or the formation of new fistulous tracts. The discharge you describe, especially if it is mixed with blood or has a brownish tint, could suggest that there is still some inflammation or irritation in the area, which might be related to the healing process or a possible recurrence. It is essential to monitor the characteristics of the discharge. If it becomes purulent (pus-like), has a foul odor, or is accompanied by increased pain, these could be signs of infection or complications that require immediate medical attention.

2. Is it normal for the doctor to only examine the external wound?
It is somewhat standard practice for physicians to focus on the external examination of the surgical site, especially if the external wound appears to be healing well. However, it is equally important to assess the internal aspects of the surgery, particularly if the patient reports ongoing symptoms. If you feel that your concerns are not being adequately addressed, or if the doctor is not performing a thorough examination of the internal area, it may be reasonable to seek a second opinion. A different healthcare provider may offer a more comprehensive evaluation, including imaging studies or an internal examination, to ensure that there are no underlying issues contributing to your symptoms.

In terms of management, continuing with warm sitz baths is beneficial as it can help soothe the area and promote healing. However, if the discharge persists or worsens, it may be necessary to consider additional interventions. Antibiotics might be warranted if there is a suspicion of infection, and your healthcare provider should be made aware of any changes in your symptoms.

In summary, while some discharge and minor bleeding can be expected after fistula surgery, persistent symptoms two months post-operation should be evaluated thoroughly. If you feel that your current healthcare provider is not addressing your concerns adequately, seeking a second opinion may provide you with the reassurance and care you need. Always prioritize open communication with your healthcare provider about your symptoms and any changes you observe, as this is crucial for effective management and recovery.

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