Post-Surgery Leakage: Fistula Repair Complications

Fistula surgery with postoperative leakage after bowel movement?

Hello doctor, I had a fistula surgery on September 26, and it has been almost two months since then.
I still have some yellowish discharge, and I’ve noticed a small amount of fecal leakage about half an hour after each bowel movement (I clean myself thoroughly with water afterward).
At other times, there is only a little yellowish discharge.
Is this due to the wound not healing yet, or could it be an injury to the sphincter? Is there any way to improve this situation?

Xiao Yu, 20~29 year old female. Ask Date: 2023/11/22

Dr. Zhang Shuhao reply Surgery

If the wound from the fistula surgery is relatively large, it is common to have some discharge before healing is complete.
As long as there are no signs of infection such as redness, swelling, heat, pain, or fever, it can be monitored.
It is also quite common to experience a slight leakage of stool after bowel movements; this is partly due to the difficulty in cleaning the area when there is a wound, and partly because the wound crosses the internal and external anal sphincters, which may lead to a feeling of incontinence during episodes of loose stools or bowel irritability.
This will improve once the wound has completely healed.
With advancements in modern surgical anatomy, complications related to insufficient sphincter function postoperatively are rare.

Reply Date: 2023/11/22

More Info

Post-surgery complications, particularly after a fistula repair, can be concerning and often require careful evaluation and management. Based on your description, it seems that you are experiencing some ongoing discharge and leakage after your fistula surgery, which can be indicative of several potential issues.

Firstly, the presence of yellow discharge could suggest that the surgical site is still healing. It is not uncommon for surgical wounds to produce some discharge as they heal, especially if there was significant tissue manipulation or if the wound was deep. However, if the discharge is persistent and has a foul odor, it could indicate an infection, which would require prompt medical attention.

The leakage of fecal matter after bowel movements is particularly concerning. This could suggest that the repair of the fistula was not entirely successful or that there may be some residual damage to the anal sphincter muscles. The anal sphincter is crucial for maintaining continence, and any injury or compromise to this structure can lead to fecal incontinence. If the sphincter was affected during the surgery, it might take time for it to heal, or additional interventions may be necessary.

To address your concerns, here are some steps you can take:
1. Consult Your Surgeon: It is essential to follow up with your surgeon or healthcare provider. They can assess the surgical site, evaluate the nature of the discharge, and determine if there is an infection or if the fistula repair has failed. They may recommend imaging studies or further examinations to assess the integrity of the sphincter.

2. Wound Care: Keeping the area clean is crucial. After bowel movements, gently clean the area with water and avoid harsh soaps or irritants. You may also consider using barrier creams to protect the skin from irritation caused by stool.

3. Dietary Adjustments: A diet high in fiber can help regulate bowel movements and reduce straining, which can be beneficial for healing. Staying hydrated is also important.

4. Pelvic Floor Exercises: If there is concern about sphincter function, pelvic floor exercises may help strengthen the muscles involved in bowel control. A physical therapist specializing in pelvic health can provide guidance on appropriate exercises.

5. Monitoring Symptoms: Keep track of any changes in your symptoms, including the amount and nature of the discharge, any new pain, or changes in bowel habits. This information will be valuable for your healthcare provider.

6. Possible Further Interventions: If the leakage continues or worsens, your surgeon may discuss additional surgical options or interventions to repair any damage to the sphincter or to address the fistula.

In summary, while some discharge and minor leakage can be part of the healing process after fistula surgery, persistent symptoms warrant a thorough evaluation by your healthcare provider. They can provide tailored advice and treatment options based on your specific situation. Early intervention can often lead to better outcomes, so do not hesitate to reach out for help.

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