Post-Anal Abscess Surgery: Pain, Healing, and Fistula Risks

Post-anal abscess surgery, anal fistula?

Hello Dr.
Ke, I previously had an anal abscess incision and drainage performed by you, and I returned for a follow-up appointment where you mentioned that there was no swelling or pain, so I should continue with sitz baths and observation.
It has now been over a month, and I have been experiencing some issues.
My bowel movements are generally normal with minimal bleeding and discharge, but whenever I have diarrhea, I feel a sharp pain from the inside out at the site of the wound.
If I apply slight pressure with toilet paper, I notice a small amount of pink discharge.
When I am not experiencing diarrhea, everything seems normal (the issues only arise during diarrhea).
It feels like the internal wound has not fully healed? The external wound seems to be healing, but it might be getting stretched or disrupted? Is this situation normal? Should I continue with sitz baths and observe for a while longer? Is there a possibility of a fistula? I would like to ask for your advice regarding my current condition.
If surgery is necessary, is there a minimally invasive option that would not damage the sphincter muscle? Thank you.

Axiang, 30~39 year old female. Ask Date: 2023/02/26

Dr. Ke Fangxu reply Surgery

If such a situation occurs, it may indicate the formation of an anal fistula.
To completely cure an anal fistula, surgical treatment is required.
Some hospitals perform fistula surgery using minimally invasive techniques.
Personally, I do not have experience with this approach because I believe the recurrence rate may be higher; however, this could just be my personal bias.
You might want to consult other physicians for their opinions.

Reply Date: 2023/02/26

More Info

Post-anal abscess surgery recovery can be a complex process, and it is understandable to have concerns about pain, healing, and the potential for complications such as fistula formation. After an anal abscess drainage procedure, it is common for patients to experience some discomfort and changes in bowel habits, especially if they encounter episodes of diarrhea.
Firstly, the pain you are experiencing, particularly during bowel movements or when you have diarrhea, can be attributed to the sensitivity of the surgical site. The anal region is rich in nerve endings, and any irritation or increased pressure from bowel movements can lead to discomfort. The presence of a small amount of pinkish blood or discharge, especially after straining, can indicate that the area is still healing. It is not unusual for the internal wound to take longer to heal than the external incision, and this can lead to sensations of pain or discomfort during bowel movements.

Regarding your question about whether this situation is normal, it is essential to recognize that while some discomfort can be expected, persistent pain or bleeding should not be ignored. The fact that you experience pain specifically during episodes of diarrhea suggests that the increased pressure and irritation may be exacerbating your symptoms. It is advisable to continue with sitz baths, as they can help soothe the area and promote healing. Sitz baths can also help reduce inflammation and provide relief from pain.

As for the concern about a potential fistula, this is a complication that can occur after an anal abscess. A fistula is an abnormal connection between the anal canal and the skin, which can develop if the abscess does not heal properly. Symptoms of a fistula may include persistent drainage, pain, or recurrent abscess formation. If you notice any signs of a fistula, such as continuous drainage or pain that does not improve, it is crucial to consult your healthcare provider for further evaluation.

If you are worried about the possibility of needing additional surgery, it is worth discussing your concerns with your doctor. Minimally invasive techniques for treating anal fistulas do exist, and they aim to preserve the anal sphincter function while effectively addressing the issue. Procedures such as fistulotomy, seton placement, or the use of advancement flaps can be considered, depending on the complexity and location of the fistula. Your surgeon will be able to provide you with the best options based on your specific situation.

In summary, while some pain and discomfort during the healing process after anal abscess surgery can be normal, it is essential to monitor your symptoms closely. If you experience persistent pain, bleeding, or any new symptoms, it is crucial to follow up with your healthcare provider. They can assess your healing progress and determine if further intervention is necessary. Remember, open communication with your healthcare team is vital to ensure a smooth recovery and address any concerns you may have.

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