Post-Surgical Healing: Managing Skin Issues Around the Anus

Supplementary question: Depression of the perianal skin after healing?

Hello Dr.
Ke: I forgot to mention last time that after using hemorrhoid ointment for several months, I developed inflammation on the skin, resulting in a wound located in the triangular area near the perineal junction, not next to the anus.
The scar from the healing process is at this point, which has made it difficult for me to engage in normal activities like riding a bike.
Even when I consciously try to contract my anal sphincter while walking, it still causes discomfort.
Therefore, using suppositories here is no longer helpful.
When I walk, the slight contact with my underwear also causes discomfort, so I have to avoid irritation and minimize pressure from sitting to reduce pain.
If I sit for more than ten minutes, I need to soak in a sitz bath to alleviate the pain, which has made me reluctant to go out and unable to work! Should I slowly get used to the discomfort from pulling or slight friction? I didn't expect it to turn out this way, and the hospital believes no further treatment is necessary after the wound has healed...
I'm also concerned that using ointment again might irritate the area and cause dermatitis, so I can only rest at home lying on my side or stomach...
The current situation is more troublesome than when I had an open wound, and I don't know what else to do.
Additionally, I would like to ask: in the past, if I applied antibiotics to a wound, it would only itch for a bit or for a few hours.
At that time, it might have been an allergic reaction or inflammation of the outer skin, and I switched to zinc oxide due to persistent itching and stinging.
Recently, I have been scratching my arm, and after applying a new skin ointment, it itches all day (but not to the point of stinging).
Is it possible that I am allergic to this type of antibiotic ointment, or is this a normal reaction?

Niming, 40~49 year old female. Ask Date: 2023/01/04

Dr. Ke Fangxu reply Surgery

If skin inflammation is caused by the excessive use of an ointment, the hemorrhoid cream should no longer be used.
The focus should be on treating the dermatitis, which may include both oral and topical medications.
It is advisable to consult a physician for evaluation and prescription of appropriate medications.
Do not apply any ointments on your own to avoid worsening the condition.

Reply Date: 2023/01/04

More Info

Post-surgical healing, especially in sensitive areas such as around the anus, can be quite challenging. The discomfort you're experiencing, particularly in the perineal region, is not uncommon after surgeries related to hemorrhoids or other anal conditions. The inflammation and subsequent scarring can lead to a range of issues, including restricted movement and discomfort during daily activities like sitting or riding a bike.
Firstly, it’s important to understand that healing in this area can be complicated by several factors, including the type of surgery performed, the individual’s healing response, and any medications or topical treatments used during recovery. The fact that you are experiencing discomfort even when trying to minimize pressure suggests that the scar tissue may be affecting the surrounding tissues, leading to sensitivity and pain.

Managing Skin Issues Around the Anus
1. Avoid Irritants: Since you mentioned using a hemorrhoid cream that may have caused irritation, it’s crucial to avoid any products that can further inflame the area. This includes topical medications that contain strong active ingredients or fragrances. Instead, consider using gentle, hypoallergenic products designed for sensitive skin.

2. Moisturization and Barrier Creams: Using a barrier cream, such as zinc oxide ointment, can help protect the skin from irritation caused by friction from clothing or sitting. This can also help in maintaining moisture in the area, which is essential for healing.

3. Sitz Baths: Regular sitz baths can provide relief from discomfort. Soaking in warm water can help soothe the area, reduce inflammation, and promote healing. It’s advisable to do this several times a day, especially after bowel movements.

4. Gradual Exposure: As you heal, it might be beneficial to gradually increase your exposure to normal activities. This means slowly reintroducing sitting for longer periods, but always listening to your body. If you experience pain, it’s a sign to take a step back.

5. Physical Therapy: If the scar tissue is causing significant discomfort or limiting your range of motion, consulting with a physical therapist who specializes in pelvic floor therapy may be beneficial. They can provide exercises and techniques to help alleviate tension and improve mobility.

6. Follow-Up with Your Doctor: Since the hospital has indicated that no further treatment is necessary, it may be worthwhile to seek a second opinion, especially if your symptoms persist or worsen. A specialist in colorectal surgery or a dermatologist may offer additional insights or treatment options.

Allergic Reactions to Topical Treatments
Regarding your concerns about the antibiotic ointment causing itching or irritation, it’s possible to develop sensitivities or allergic reactions to topical medications over time. If you notice persistent itching or discomfort after applying a specific ointment, it may be wise to discontinue its use and consult with a healthcare provider. They can help determine whether you are experiencing an allergic reaction or if the symptoms are part of the normal healing process.

Conclusion
In summary, managing post-surgical healing around the anus requires a careful balance of protecting the area, minimizing irritation, and gradually reintroducing normal activities. If discomfort persists, seeking further medical advice is crucial. Your healing journey may take time, but with proper care and attention, you can work towards regaining comfort and normalcy in your daily life. Always prioritize communication with your healthcare providers to ensure that you receive the best possible care tailored to your specific situation.

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