Post-Surgery Symptoms: Anal Fistula and Blister Concerns

Issues related to the presence of blisters at the anal opening and fistula surgery?

Hello, doctor.
I underwent anal fistula surgery two years ago, and this year I had two more surgeries at the end of July and the beginning of October.
The surgical area is from the anal opening towards the scrotum.
The first surgery this year was approximately 10 centimeters long (located about 2 centimeters above the anal opening extending towards the scrotum), and the second debridement surgery was about 4 to 5 centimeters long (from the anal opening towards the scrotum).
Treatment continued until mid-November (the original doctor said no further follow-up was needed).
Currently, the appearance shows no wounds, and there is no pain, but I still need to use a pad because there is a yellowish discharge every day, though the amount is small.
I change it after showering at night and again in the morning before using the restroom.
The discharge appears to be about 2 centimeters long and 2 to 3 millimeters wide, somewhat like pus, but when I look in the mirror with a flashlight, I see no wounds, and pressing does not cause pain.
Last night, while showering, I intentionally checked the anal area and noticed a translucent blister located just inside the anal opening, which required some effort to see.
It is about half the size of a small fingernail, and pressing it does not cause pain nor does it burst.
Could this indicate a recurrence of the fistula? How long is the discharge expected to last? Is this considered normal? Should I undergo further debridement? During the recovery period, I maintained a light diet and performed sitz baths more than four times a day (I kept this routine for the month I was on leave after surgery).
During work, I only do it in the morning before leaving and after getting home in the evening.
Thank you, doctor.

Mr. Chen, 40~49 year old female. Ask Date: 2023/11/29

Dr. Zhang Shuhao reply Surgery

There are no visible wounds on the surface, but as long as the inside of the anus has not fully healed, there may still be some discharge.
If ointment is still being used, the discharge may appear to be more abundant.
If there is no swelling, pain, or bleeding, there is likely no major issue.
As for blisters, they are less common; based on your description, it seems like the tissue around the wound is more swollen, which does not resemble signs of a fistula recurrence.
It is recommended to continue sitz baths and change the dressings.
If the discharge increases or if there is swelling or pain, a follow-up appointment should be made for evaluation.

Reply Date: 2023/11/29

More Info

After undergoing multiple surgeries for anal fistula, it is understandable to have concerns about ongoing symptoms such as discharge and the presence of a blister-like formation. Based on your description, it appears that you are experiencing some post-operative effects that warrant further discussion.

Firstly, the yellow discharge you are observing is not uncommon after anal fistula surgery. This discharge can be a result of the healing process, as the body may still be expelling remnants of infection or inflammation. However, the persistence of this discharge, especially if it resembles pus, could indicate that there is still some underlying issue that needs to be addressed. It is essential to monitor the characteristics of the discharge; if it becomes more profuse, changes in color, or is accompanied by increased pain or fever, it would be advisable to seek medical attention promptly.

Regarding the blister you have noticed, it is crucial to differentiate between a normal post-surgical finding and a potential sign of recurrence. Blisters can sometimes form as a result of irritation or friction in the area, especially if there is ongoing moisture or if the skin is healing. However, if the blister is filled with fluid and is located near the surgical site, it could be indicative of a recurrence of the fistula or an abscess formation. The fact that it is not painful and does not appear to have broken is a positive sign, but it still warrants careful observation.

In terms of the duration of the discharge, it can vary significantly from person to person. Some patients may experience discharge for several weeks to months post-surgery, while others may see it resolve more quickly. Factors such as the extent of the surgery, individual healing rates, and adherence to post-operative care can all influence recovery times. Maintaining good hygiene, as you have been doing, is crucial in promoting healing and preventing infection.

As for whether you need further debridement or surgical intervention, this decision should be made in consultation with your surgeon or a colorectal specialist. They can assess the area more thoroughly, possibly with imaging studies if necessary, to determine if there is any residual fistulous tract or other complications that need to be addressed.

In summary, while some discharge and minor skin changes can be part of the healing process after anal fistula surgery, it is essential to remain vigilant for any signs of complications. Regular follow-ups with your healthcare provider are crucial in ensuring that you are healing properly and to address any concerns that may arise. If you have not already done so, consider scheduling a follow-up appointment to discuss your symptoms in detail and to receive personalized medical advice tailored to your situation.

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