Post-Surgery Concerns After Anal Fistula Procedure: Your Questions Answered

Post-anal fistula surgery

Hello Doctor, I apologize for bothering you multiple times.
I underwent a fistula micro-surgery in January, and it has been about four months since then.
I would like to ask the following questions:
1.
I still experience some pain at the surgical site after prolonged sitting.
I have consulted three colorectal specialists who indicated that the fistula should have healed, but one older doctor at a private clinic suggested that my surgery failed.
Should I go to a major hospital for further imaging studies, such as a CT scan?
2.
Occasionally, after bowel movements, there is slight bleeding from the scar site.
Is it sufficient to clean it with plain water? Should I apply antibiotic ointment to prevent infection?
3.
Since the surgery, I have been experiencing unexplained diarrhea from time to time.
The surgeon mentioned that it might be due to my anxiety about the recovery process, leading to irritable bowel syndrome.
However, I find that taking loperamide has limited effectiveness.
Should I see a psychiatrist or undergo a colonoscopy?
4.
I have chronic prostatitis and continue to soak in warm water daily to alleviate the inflammation.
Could this lead to excessive cleaning or cause eczema in the anal area?

jinmu, 30~39 year old female. Ask Date: 2023/05/08

Dr. Zhang Shuhao reply Surgery

1.
The size of the surgical wound for a fistula may take several months to heal completely.
A qualified colorectal surgeon's assessment of the fistula's condition is generally reliable.
If a more skilled surgeon believes the surgery has failed, it is advisable to consult them for potential solutions or improvements.
Complex fistulas may not be easily interpreted through computed tomography; in such cases, magnetic resonance imaging or contrast-enhanced fistulography may be necessary.
These specialized examinations may not always be covered by health insurance.

2.
After cleaning, a small amount of ointment can be applied to the wound.

3.
In addition to using mesalazine, there are other adjunctive medications available, but it is recommended to start with adjustments in diet and lifestyle.
Sleep quality and life stress can also have an impact.
If a consultation is needed, consider visiting a psychiatrist or a family medicine specialist, and further examinations can be arranged if necessary.

4.
Excessive cleaning can sometimes lead to itching or skin allergies; if there are no such symptoms, it is not a concern.

Reply Date: 2023/05/08

More Info

After undergoing anal fistula surgery, it's common to have a range of concerns regarding recovery and potential complications. Here’s a detailed response to your questions based on medical knowledge and practice.

1. Pain and Healing Concerns: It’s not unusual to experience some pain at the surgical site, especially with prolonged sitting. However, if multiple specialists have indicated that your fistula has healed, it may suggest that your pain is related to the healing process rather than a surgical failure. If you continue to have significant discomfort or if the pain worsens, it could be beneficial to seek further evaluation at a larger medical facility. Imaging studies, such as an MRI or CT scan, can help assess the area for any complications that might not be visible during a physical examination.

2. Post-Defecation Bleeding: Occasional minor bleeding from the surgical site after bowel movements can happen, especially if the area is still sensitive. Cleaning the area gently with water is appropriate. However, if you notice persistent bleeding or if the bleeding increases, it’s advisable to consult your doctor. Applying a topical antibiotic ointment can help prevent infection, but it’s best to discuss this with your healthcare provider to ensure it’s appropriate for your specific situation.

3. Bowel Changes and Anxiety: Experiencing diarrhea post-surgery can be distressing and may indeed be linked to anxiety about your recovery. Stress and anxiety can lead to gastrointestinal symptoms, including irritable bowel syndrome (IBS). If over-the-counter medications like loperamide (Imodium) are not effective, it may be worthwhile to consult with a gastroenterologist to rule out any underlying issues. Additionally, seeing a mental health professional could help address anxiety, which may improve your gastrointestinal symptoms.

4. Hygiene Practices: Using warm water to soothe the area is generally acceptable and can provide relief, especially for chronic conditions like prostatitis. However, excessive cleaning can lead to irritation or dermatitis, particularly if the skin becomes too moist or if harsh soaps are used. It’s essential to maintain a balance—clean the area gently and allow it to dry properly. If you notice any signs of rash or irritation, consider reducing the frequency of hot baths and consult a dermatologist if necessary.

In summary, while some discomfort and changes in bowel habits can be part of the recovery process after anal fistula surgery, persistent or worsening symptoms warrant further investigation. Maintaining open communication with your healthcare providers and addressing both physical and mental health aspects of your recovery is crucial for optimal healing. Always prioritize follow-up appointments and don’t hesitate to seek a second opinion if you feel uncertain about your recovery.

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