Anal Fistulas: Symptoms and Post-Surgery Concerns

Anal fistula

Hello Doctor, I have a few questions to ask you: 1.
I had an abscess drainage procedure last Wednesday, and the wound is about 2 cm in size, located approximately 2 cm behind the anus.
However, during my last two bowel movements, even though I made sure the area was clean, there was still feces in the wound.
Does this indicate that I have developed a fistula? Is it possible for the feces to exit through both openings? I am very concerned because I also feel this sensation when passing gas.
Isn't it normal to observe for 4 to 6 weeks? Why do I seem to have developed this so soon, just over a week later? I would appreciate your response, thank you!

Wu Xiaobao, 30~39 year old female. Ask Date: 2022/03/31

Dr. Zhang Shuhao reply Surgery

During the formation of an abscess, there is often already an internal opening (an opening leading to the rectum), but at this stage, inflammation and infection are still present.
During the healing process, there is an opportunity for reshaping, and it may not necessarily remain patent.
The formation of a fistula four to six weeks later indicates that the wound has stabilized and the internal lining of the fistula has undergone epithelialization.
At this point, the epithelialized inner wall of the fistula will not heal spontaneously, indicating a mature fistula.
It is recommended to keep the wound clean, continue sitz baths and topical treatment to improve inflammation and infection, and to have regular follow-up visits for assessment.

Reply Date: 2022/03/31

More Info

Understanding anal fistulas can be quite complex, especially after undergoing a procedure like an abscess drainage. Let's break down your concerns and provide some clarity on the symptoms and potential post-surgery issues you may be experiencing.

1. What is an Anal Fistula?
An anal fistula is an abnormal connection between the anal canal and the skin surrounding the anus. It often develops as a complication of an anal abscess, which is a collection of pus that can occur due to infection. When the abscess is drained, a fistula may form if the tract does not heal properly.
2. Symptoms of an Anal Fistula:
Common symptoms include:
- Pain and discomfort around the anus, especially during bowel movements.

- Swelling or redness in the area.

- Discharge of pus or blood from the opening near the anus.

- The sensation of a lump or bump near the anus.

- In some cases, you may notice fecal matter in the discharge, which could indicate that the fistula is connecting the anal canal to the skin.

3. Your Concerns:
You mentioned that after your drainage procedure, you are noticing fecal matter in the wound area, which raises concerns about the formation of a fistula. While it is normal to have some discharge post-surgery, the presence of fecal matter could suggest that there is a connection between the anal canal and the skin, which is characteristic of a fistula.

It’s important to note that the development of a fistula is not something that typically occurs within just a week after surgery. The healing process can vary significantly from person to person, and while some may develop complications sooner, others may not experience issues for weeks or even months.
4. Post-Surgery Monitoring:
After an anal abscess drainage, it is standard practice to monitor the surgical site for 4 to 6 weeks for signs of healing or complications. During this time, you should keep the area clean and dry, and follow any specific care instructions provided by your surgeon.
5. What to Do Next:
Given your symptoms and concerns, it is crucial to follow up with your healthcare provider. They may recommend:
- A physical examination to assess the surgical site.

- Imaging studies, such as an MRI or ultrasound, to evaluate the extent of any potential fistula.

- Further treatment options if a fistula is confirmed, which may include surgical intervention to repair the fistula.

6. Managing Symptoms:
In the meantime, to manage discomfort:
- Maintain good hygiene by gently cleaning the area after bowel movements.

- Consider sitz baths to soothe the area.

- Use over-the-counter pain relief if necessary, but consult your doctor before taking any medication.

7. Emotional and Psychological Impact:
It’s also worth noting that dealing with anal conditions can be emotionally taxing. It’s normal to feel anxious about your symptoms and the potential for complications. Don’t hesitate to reach out to your healthcare provider for support and guidance.

In summary, while your symptoms may raise concerns about an anal fistula, it’s essential to consult with your healthcare provider for a thorough evaluation. They can provide the best course of action based on your specific situation and help alleviate your worries. Remember, timely intervention can often lead to better outcomes, so don’t hesitate to seek help.

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