Managing Post-Surgery Itching and Skin Issues After Fistula Repair

Post-fistula surgery, patients may experience anal itching and a tendency for the wound to become easily irritated or break down?

Hello Doctor, I underwent minimally invasive surgery to remove a fistula on January 2nd of this year.
During my follow-up appointment last week (February 21st), the surgeon indicated that the wound has mostly healed, with only a shallow small wound remaining near the groin area.
He advised that if the small wound does not heal within a month, I should return for a follow-up.
As a result, I have started to resume exercise (running, hiking, stretching), but I have noticed that after running or hiking, the surgical site near the anal area becomes itchy.
Additionally, when I clean the area with wet wipes after a bowel movement, I notice a small spot of blood, which feels like a minor abrasion, but there is no pain upon touching it.

(1) Should I return for an earlier follow-up appointment?
(2) Since I have irritable bowel syndrome and typically go to the bathroom 3 to 4 times a day, what measures can I take to prevent the recurrence of the fistula? I apologize for asking so many questions.
Thank you for your assistance.

Joey, 30~39 year old female. Ask Date: 2023/02/27

Dr. Zhang Shuhao reply Surgery

1.
Fistula wounds produce granulation tissue during the healing process, which can easily bleed or cause a stinging sensation due to friction.
It is advisable to continue warm water sitz baths and apply ointment for dressing changes to avoid frictional irritation of the wound.
If there is swelling, pain, or purulent blood discharge, a follow-up appointment is recommended for evaluation.
2.
Diarrhea is also a risk factor for fistula recurrence; therefore, it is important to avoid irritating or allergenic foods in the diet, refrain from smoking, ensure adequate sleep, and reduce life stress.
If symptoms of diarrhea or irritable bowel syndrome occur, medical consultation for pharmacological management is recommended.

Reply Date: 2023/02/27

More Info

After undergoing a fistula repair surgery, it is not uncommon to experience some post-operative itching and skin issues, particularly around the surgical site. Based on your description, it seems that you are dealing with a few concerns: the itching sensation near the surgical site, minor bleeding when cleaning, and the need for ongoing care to prevent recurrence of the fistula, especially given your history of irritable bowel syndrome (IBS).

1. Itching and Minor Bleeding
Itching around the surgical site can be attributed to several factors, including the healing process itself, irritation from clothing, or even the use of certain hygiene products. The fact that you are experiencing minor bleeding when cleaning the area may indicate that the skin is still sensitive and healing. It is crucial to avoid any aggressive cleaning methods that could further irritate the area. Instead, consider using gentle, hypoallergenic wipes or soft cloths to clean the area, and avoid any products that contain fragrances or harsh chemicals.

If the itching becomes severe or if you notice increased bleeding, it would be wise to consult your surgeon sooner than the scheduled follow-up. While some itching is normal, it should not be accompanied by significant discomfort or bleeding.

2. Post-Surgery Care and Prevention of Recurrence
Given your history of IBS, managing bowel habits is essential to prevent any strain that could affect the surgical site. Here are some recommendations:
- Dietary Management: Focus on a high-fiber diet to promote regular bowel movements and reduce the risk of constipation, which can lead to straining during bowel movements. Foods rich in fiber include fruits, vegetables, whole grains, and legumes. Staying hydrated is equally important.

- Gentle Hygiene Practices: After bowel movements, use soft, unscented wipes or a bidet to clean the area gently. Avoid scrubbing the surgical site, and pat it dry instead of rubbing.

- Monitoring Symptoms: Keep an eye on any changes in your bowel habits or the condition of the surgical site. If you notice any signs of infection (increased redness, swelling, warmth, or discharge), or if the itching and bleeding persist, do not hesitate to reach out to your healthcare provider.

- Regular Follow-ups: Attend all scheduled follow-up appointments with your surgeon. If you have concerns before your next appointment, such as persistent itching or bleeding, it is advisable to contact your surgeon for guidance.

Conclusion
In summary, while some itching and minor bleeding can be part of the healing process after fistula repair surgery, it is essential to monitor these symptoms closely. Gentle care, dietary management, and regular follow-ups with your healthcare provider will be crucial in ensuring proper healing and preventing recurrence of the fistula. If you have any doubts or if your symptoms worsen, do not hesitate to seek medical advice sooner than planned. Your health and comfort should always come first.

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