Anal Bleeding and Chronic Wound Healing After Fistula Surgery

Rectal bleeding and non-healing wounds after fistula surgery?

Hello, Doctor.
I would like to ask you a few questions.
(1) On March 29, after wiping, I felt a swelling sensation in my buttocks.
Although the swelling sensation disappeared the next day, as of today (March 31), I still notice faint pink streaks of blood when wiping, but there is no pain, and it feels like a skin tear.
Should I purchase an ointment to apply, or is it better to leave it alone? Additionally, I take sitz baths every morning and evening; will this affect the healing process? (2) I underwent minimally invasive surgery for a fistula on January 2, and it has been nearly three months, but there is still a small wound at the end of the incision that has not healed.
Currently, there is no swelling, bleeding, or discharge.
The surgeon advised me to continue monitoring and let the wound heal gradually.
Would this be considered a chronic wound? Would self-paying for hyperbaric oxygen therapy be beneficial? I apologize for the trouble.

Joey, 30~39 year old female. Ask Date: 2023/03/31

Dr. Zhang Shuhao reply Surgery

(1) You can apply hemorrhoid ointment and also take warm sitz baths to help reduce swelling; sitz baths will not affect wound healing.
(2) If there is no swelling or pain, and no discharge that disrupts daily life, then it is not a concern.
Hyperbaric oxygen therapy is more suitable for large wounds, and it may not be very effective for your condition.

Reply Date: 2023/03/31

More Info

Thank you for your questions regarding anal bleeding and chronic wound healing after fistula surgery. It’s understandable to feel concerned about these issues, especially after undergoing surgery. Let’s address your questions one by one.

1. Regarding the Pink Blood Streaks: The presence of a faint pink blood streak when wiping after using the bathroom could indicate a minor irritation or superficial injury to the skin in the anal area. Since you mentioned that there is no pain associated with it, it is likely not a serious issue. However, it is essential to keep the area clean and avoid any further irritation. Applying a gentle, non-irritating ointment, such as a barrier cream or a healing ointment, may help protect the area and promote healing. It is advisable to avoid any ointments that contain steroids, as they can thin the skin and may delay healing.

As for the sitz baths you are taking, they can be beneficial for promoting cleanliness and comfort in the anal area. However, if you notice that the area becomes more irritated or if the bleeding persists, you may want to reduce the frequency or duration of the baths. Always ensure that the water is warm, not hot, and avoid any harsh soaps or irritants during your cleansing routine.

2. Chronic Wound After Fistula Surgery: The small wound at the tail end of your surgical site that has not healed after nearly three months may indeed be classified as a chronic wound, especially if it has not shown signs of improvement. Chronic wounds can occur for various reasons, including inadequate blood supply, infection, or persistent pressure on the area. It’s good to hear that there is no swelling, bleeding, or discharge, as these are positive signs.

Your surgeon’s recommendation to continue observing the wound is common in cases where the wound is not showing signs of infection or other complications. However, if you feel that the wound is not healing or if you notice any changes, it would be wise to follow up with your healthcare provider. They may consider additional treatments, such as advanced wound care options.

Regarding hyperbaric oxygen therapy (HBOT), it can be beneficial for certain types of chronic wounds, particularly those with poor blood supply or those that are infected. However, it is essential to consult with your healthcare provider to determine if this treatment is appropriate for your specific situation. They can evaluate the wound and discuss the potential benefits and risks of HBOT based on your overall health and the characteristics of your wound.

In summary, for the minor bleeding, consider using a gentle ointment and continue your sitz baths while monitoring for any changes. For the chronic wound, keep in touch with your healthcare provider and discuss any concerns you have about healing and treatment options. It’s crucial to maintain open communication with your medical team to ensure the best possible outcome for your recovery. If you have any further questions or concerns, please don’t hesitate to reach out. Your health and well-being are important, and seeking guidance is always a good step.

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