Post-Surgery Concerns After Fistula Removal: Expert Q&A

Consultation on issues related to post-fistula surgery?

Hello Dr.
Chang, thank you for taking the time to read and respond.
I underwent a surgical procedure for removal on November 7th, and four days post-operation, I still experience slight pain and discomfort (which is manageable).
I can distinctly feel a cavity near the anal area (likely a sign of the fistula removal).
I have been diligent with sitz baths and changing the gauze, which consistently shows pink and yellow exudate.
After each sitz bath, I apply ointment, and I can also clearly feel the internal connective tissue (it feels like there is a boundary, and the area is quite swollen).
I would like to consult Dr.
Chang regarding the following questions: 1.
Based on the post-operative wound healing described, is this a normal sign? 2.
Generally, how long after surgery is it advisable to resume weight training (including spin classes and other aerobic activities)? 3.
Until when should I continue sitz baths and applying ointment? 4.
If I experience discomfort at work and cannot take sitz baths or rinse, is it acceptable to use wet wipes for cleaning instead? 5.
How long after surgery can I resume sexual activity with my same-sex partner?

Austin, 30~39 year old female. Ask Date: 2022/11/10

Dr. Zhang Shuhao reply Surgery

1.
Normally, most fistula surgeries result in an open wound that gradually heals as granulation tissue forms from the base of the wound.

2.
Light to moderate exercise can be resumed two weeks post-surgery, but activities that place weight on the perineum (such as cycling) may cause discomfort at the wound site and should be avoided as much as possible.

3.
Sitz baths and the application of ointments should continue until the wound has significantly reduced in size, is less prone to friction and irritation, and shows no discharge.

4.
If it is not feasible to take sitz baths or rinse during work hours, using moist wipes for cleaning is an alternative; care should be taken to avoid friction on the wound and to maintain cleanliness.

5.
Similar to point 3, it is advisable to wait until the wound is more stable before resuming activities, which typically takes four to six weeks depending on the size of the wound; however, if there is a tendency for bleeding or pain, caution should be exercised.

Reply Date: 2022/11/10

More Info

Post-surgery recovery, especially after a fistula removal, can be a complex process, and it's understandable to have concerns regarding your healing. Based on your description, let's address your questions one by one.

1. Is the post-operative healing process normal?
After a fistula removal, it is common to experience some discomfort and to notice drainage from the surgical site. The presence of a cavity where the fistula was removed is expected, as the body needs time to heal and fill in that space with new tissue. The pinkish-yellow fluid you are seeing is likely serous fluid, which is a normal part of the healing process. However, if the pain intensifies or if you notice an increase in drainage or any foul odor, it would be wise to consult your surgeon, as these could indicate an infection.

2. When can I resume weight training and aerobic exercises?
Generally, it is advisable to wait at least 4 to 6 weeks post-surgery before resuming any strenuous activities, including weight training and high-impact aerobic exercises like spinning. This timeframe allows your body to heal adequately and reduces the risk of complications such as reopening the surgical site or developing a hernia. However, this can vary based on individual recovery rates, so it’s best to follow your surgeon’s specific recommendations.

3. How long should I continue sitz baths and applying ointment?
Sitz baths are beneficial for promoting healing and reducing discomfort. Typically, you should continue these baths for at least 2 to 4 weeks post-surgery or until your doctor advises otherwise. The application of ointment should also continue as directed by your healthcare provider, usually until the wound has healed sufficiently and there is no longer any drainage.

4. Can I use wet wipes instead of sitz baths at work?
While wet wipes can be a convenient alternative when you cannot access a sitz bath, they should not completely replace the baths. If you find yourself in a situation where a sitz bath is not possible, using gentle, unscented wet wipes can help maintain hygiene. However, it’s important to ensure that you still take sitz baths regularly when you can, as they are more effective in promoting healing.

5. When can I resume sexual activity?
Resuming sexual activity after surgery can vary greatly among individuals. Generally, it is recommended to wait at least 4 to 6 weeks post-surgery or until you feel comfortable and have received clearance from your healthcare provider. This waiting period allows your body to heal and reduces the risk of complications. Communication with your partner about your comfort level and any concerns is also essential during this time.

In summary, while some discomfort and drainage are normal after fistula removal, it’s crucial to monitor your symptoms closely. If you experience any concerning changes, don’t hesitate to reach out to your healthcare provider. Following your surgeon's advice regarding activity levels, hygiene practices, and resuming sexual activity will help ensure a smooth recovery. Remember that healing is a gradual process, and taking care of your body during this time is paramount.

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