Post-Surgery Pain Management: Recovery After Fistula Surgery

Post-fistula surgery

I would like to ask the doctor, I underwent a fistula incision surgery on February 7th, and as of today, March 25th, I am still experiencing significant pain in the anal area.
The pain worsens after standing for a long time or after using the restroom.
The external wound feels fine, and when I consulted the surgeon, he mentioned that the internal opening might not have healed yet and that I should continue to rest and observe.
However, he noted that the external wound is healing well and is forming granulation tissue.
1.
I would like to ask if my recovery time is considered a bit prolonged.
The external opening seems to be nearly healed, but the skin has not yet closed.
During the surgery, both sides of my buttocks were operated on, with the right side being more severe due to the presence of fascia.
I have noticed some skin gradually forming from the outside, but it is minimal.
2.
I later consulted another physician who performed a digital examination and also suggested that the internal wound might not have healed yet.
However, he mentioned that the wound is somewhat distant from the anus and that it could be a complex fistula.
He expressed concern that the healing process seems slow and that there is a possibility of recurrence.
The differing opinions from both doctors have made me quite anxious.
3.
I have noticed that most responses on the forum do not mention significant pain related to internal anal wounds, which makes me worry that it is unlikely for the internal opening to be unhealed.
Could it simply be a matter of time? Thank you for your assistance, doctor.

Lin Fu-Fu, 30~39 year old female. Ask Date: 2023/03/25

Dr. Ke Fangxu reply Surgery

1.
If both sides have undergone surgery, you may be classified as having a complex fistula, which could result in a longer healing time.

2.
It is true that complex fistulas have a higher recurrence rate, but this is not inevitable.
It is still too early to draw conclusions; we need to observe the healing progress.

3.
Due to the larger and deeper wounds associated with complex fistulas, prolonged pain is also considered normal.
It is recommended that you return for regular follow-up appointments to monitor the healing of the wound.
If necessary, you can also ask your physician to prescribe medication for pain management.

Reply Date: 2023/03/25

More Info

Post-surgery recovery, especially after a fistula surgery, can be a complex and often uncomfortable process. It’s not uncommon for patients to experience pain and discomfort during the healing phase, particularly in sensitive areas like the anal region. Based on your description of the situation, let’s address your concerns systematically.

1. Recovery Time: The healing process after fistula surgery can vary significantly from person to person. Generally, the external wounds may heal relatively quickly, but internal healing can take longer. It’s not unusual for patients to experience discomfort for several weeks or even months post-surgery. If your external wound appears to be healing well, that is a positive sign. However, the persistent pain you are experiencing, especially after standing for long periods or after using the restroom, suggests that the internal site may still be healing or could be experiencing complications.

2. Differing Opinions from Doctors: It’s understandable to feel anxious when you receive differing opinions from healthcare providers. The fact that one physician mentioned the possibility of a complex fistula and the other did not can be confusing. Complex fistulas can indeed take longer to heal and may require additional interventions. It’s essential to communicate your concerns and symptoms clearly with your healthcare team. If you feel uncertain about the diagnosis or treatment plan, seeking a third opinion from a specialist in colorectal surgery may provide further clarity.

3. Pain Management and Healing: Pain in the anal region post-surgery can be attributed to several factors, including inflammation, nerve irritation, or incomplete healing of the internal fistula tract. It’s crucial to manage this pain effectively, as it can significantly affect your quality of life. Over-the-counter pain relievers, such as ibuprofen or acetaminophen, can help alleviate discomfort. Additionally, sitz baths can provide relief by soothing the area and promoting blood flow, which can aid in healing.
4. Monitoring Symptoms: Keep a close eye on your symptoms. If the pain worsens, or if you notice any signs of infection (such as increased redness, swelling, or discharge), it’s vital to seek medical attention promptly. Regular follow-ups with your surgeon are essential to monitor the healing process and to address any complications early on.

5. Lifestyle Adjustments: During your recovery, consider making some lifestyle adjustments to ease discomfort. This includes maintaining a high-fiber diet to prevent constipation, which can exacerbate pain during bowel movements. Staying hydrated and possibly using stool softeners can also be beneficial.

6. Psychological Impact: The psychological aspect of recovery should not be overlooked. Chronic pain can lead to anxiety and depression, which can further complicate recovery. Engaging in relaxation techniques, such as mindfulness or gentle yoga, may help manage stress and improve your overall well-being.

In conclusion, while it is not uncommon to experience prolonged pain after fistula surgery, it is essential to stay vigilant about your symptoms and maintain open communication with your healthcare providers. If your pain persists or worsens, do not hesitate to seek further evaluation. Recovery can be a gradual process, and with the right support and management, you can work towards a more comfortable and healthy outcome.

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