Post-Surgery Bleeding: Is It Normal After Anal Fistula Repair?

It has been about six months since the anal fistula surgery, and there is still bleeding?

Hello, I underwent anal and fistula surgery around the end of October last year.
I have been recovering since then, and most of the wounds have healed.
However, I have a wound inside the anus that has not healed yet.
After using toilet paper to wipe after a bowel movement, I notice fresh blood about seven or eight times out of ten.
Sometimes, I also feel a dull pain in the wound inside the anus.
Is this situation normal considering the postoperative recovery timeline?

Mr. Wang, 20~29 year old female. Ask Date: 2023/04/27

Dr. Zhang Shuhao reply Surgery

Typically, the wound from a fistula surgery should have healed after six months.
However, if the anal area is tight or if there is straining during bowel movements, the initially healed wound may easily reopen or become irritated, leading to symptoms similar to anal fissures.
It is advisable to return for a follow-up appointment to assess the healing status of the surgical site.
If there are no signs of new inflammation or infection, applying medication and taking sitz baths usually lead to gradual improvement.

Reply Date: 2023/04/27

More Info

Post-surgery bleeding, particularly after an anal fistula repair, can be concerning for patients. It’s important to understand that while some bleeding can be normal during the healing process, persistent bleeding or pain should be evaluated by a healthcare professional.

In your case, having undergone anal fistula surgery about six months ago, it is not uncommon for some patients to experience delayed healing in the anal area. The anal region is a complex area with a rich blood supply, and the healing process can vary significantly from person to person. Factors such as the extent of the surgery, the presence of infection, and individual healing capabilities can all influence recovery time.

The fact that you are experiencing fresh blood on the toilet paper after bowel movements indicates that there may still be some irritation or a healing issue at the surgical site. It’s important to differentiate between normal postoperative bleeding and signs of complications. If the bleeding is minimal and occurs occasionally, it may be part of the normal healing process. However, if you are consistently seeing blood or if the pain is increasing, this could indicate a problem such as infection, incomplete healing, or even the formation of a new fistula.

Pain in the anal area post-surgery can also be a normal part of the healing process, especially if the surgical site is still sensitive. However, if the pain is sharp, persistent, or worsening, it is advisable to seek medical attention. Pain can sometimes be a sign of complications such as abscess formation or other issues that may require further intervention.

In terms of management, here are some general recommendations:
1. Follow-Up Appointments: Regular follow-ups with your surgeon or healthcare provider are crucial. They can assess the healing process and determine if any interventions are needed.

2. Hygiene: Maintaining good hygiene in the anal area is essential to prevent infection. Gentle cleansing with mild soap and water after bowel movements can help.

3. Dietary Considerations: A high-fiber diet can help prevent constipation and reduce straining during bowel movements, which can aggravate the surgical site. Staying hydrated is also important.

4. Pain Management: Over-the-counter pain relief medications can help manage discomfort, but consult your doctor before taking any medication.

5. Avoid Straining: Try to avoid straining during bowel movements, as this can put additional pressure on the healing area.

6. Watch for Signs of Infection: Be vigilant for signs of infection, such as increased redness, swelling, warmth, or discharge from the surgical site.

In conclusion, while some bleeding and discomfort can be part of the healing process after anal fistula surgery, persistent symptoms warrant further evaluation. It is always best to err on the side of caution and consult your healthcare provider to ensure that your recovery is progressing as expected and to rule out any complications. Your health and comfort are paramount, and your doctor can provide the most tailored advice based on your specific situation.

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