Post-Surgery Care for Anal Abscess: Common Concerns and Solutions

Postoperative care for anal abscess?

I was diagnosed with an abscess around mid-August, estimated to be 3-4 cm in size.
When I went for a consultation, Doctor A used a needle to drain the pus and prescribed medication, saying that taking the medication and applying topical treatment would suffice.
The doctor mentioned that if it did not improve, surgery would be necessary next time.
A week later, with no improvement, I returned for a follow-up, and the doctor still recommended medication and topical treatment, thus no surgical intervention was performed.

In September, I was diagnosed with a Helicobacter pylori infection at the same clinic, and the doctor prescribed a month-long course of medication, suggesting that the abscess might heal with this treatment.
A month later, although the H.
pylori infection had resolved, the abscess had not healed, and the doctor still did not recommend surgical drainage.

On November 26, I noticed that the abscess was very close to the skin and felt like it was about to burst, which made me anxious.
I went to a private clinic B, which had good online reviews.
The doctor there immediately suggested surgery for drainage.
Following that, I returned daily for wound care, where the doctor would completely open the wound, clean it with a cotton swab, and pack it with gauze.
The pain increased over the following week.
On December 6, the doctor decided to enlarge the wound for debridement, and I underwent a second surgery.
The doctor indicated that the pus had spread deeper, approximately 15 cm.
After surgery, each visit involved removing the gauze from inside the wound, cleaning the surface with a cotton swab, applying medication, and then repacking the entire cavity with gauze.
The pain continued to worsen, and Doctor B suggested another debridement under general anesthesia.

I was extremely anxious; the wound had now grown to 10 cm, and my daily life was affected, causing more pain than before the surgeries.
On December 13, I decided to transfer to Hospital C for a consultation.
Doctor C stated that the wound did not need to be packed tightly with gauze; only the surface of the skin needed medication, and a small amount of gauze should be inserted, leaving part of it outside.
The area that initially appeared to be an internal opening had already healed.
Doctor C felt that Doctor B's surgical approach was completely incorrect and advised me to wait until the wound fully healed before considering further surgery.
I have several questions for the doctor:
1.
Was Doctor B's method of treatment correct?
2.
Is it normal to have pus discharge from the rectum as of December 14?
3.
Is it normal to experience pain and have a hard lump near the incision site, and to see pus each time I change the gauze? Should I return for a follow-up immediately?
4.
When I soak in a sitz bath and move my hips and the wound, there is white, fluffy material in the basin (which feels like pus).
Is this a sign of healing?
5.
Does a vegetarian diet help with wound healing? Is it necessary? Doctor B said I must eat vegetarian.
Thank you for your response, as my questions have been prolonged, I provided a more detailed account.
I appreciate the time taken to read and respond to my concerns.
Thank you.

Niming, 20~29 year old female. Ask Date: 2023/12/14

Dr. Zhang Shuhao reply Surgery

1.
Dr.
B hopes to pack the wound with gauze to keep it cleaner, but excessive packing can prevent the drainage of tissue fluid and may cause the wound to expand, making Dr.
C's suggestion more reasonable.

2.
An anal abscess may lead to the formation of an anal fistula, which is a connection from the abscess to the anal canal.
It is advisable to wait for the soft tissue inflammation to subside and for the abscess to drain completely before assessing the need for surgical intervention to remove the fistula.

3.
Pain and a hard lump near the incision indicate that the soft tissue is still inflamed, requiring oral anti-inflammatory medication and antibiotics.
It is normal to see pus when changing the gauze, and it will gradually become cleaner over time.

4.
During sitz baths, pus and blood-tinged tissue fluid may drain out, which helps clean the wound and aids in healing; this is a normal occurrence.

5.
A vegetarian diet is not necessary, but a light diet, increased fluid intake, and the reduction of irritating foods, along with the avoidance of tobacco and alcohol, can help decrease inflammation in the body.
It is recommended to follow Dr.
C's plan and reassess the need for further treatment after the abscess has healed.

Reply Date: 2023/12/14

More Info

Post-surgery care for an anal abscess can be quite complex, especially when complications arise during the healing process. Based on your detailed account, it seems you have experienced a challenging journey with your abscess treatment. Let's address your concerns systematically.

1. Was Dr. B's approach correct?
It appears that Dr. B's management of your abscess may not have been optimal. The repeated surgeries and aggressive packing of the wound with gauze can sometimes lead to more pain and complications rather than facilitating healing. In cases of anal abscesses, the primary goal is to ensure proper drainage and to allow the wound to heal without excessive packing, which can cause discomfort and may lead to further complications. Dr. C's approach, which involves less aggressive packing and focusing on surface care, seems more aligned with standard practices for managing such wounds.

2. Is it normal to have pus from the anus?
Experiencing pus drainage from the anus post-surgery can be concerning, but it can also be a part of the healing process, especially if the abscess was deep and there is still some infection present. However, if the pus is persistent or increasing in volume, it may indicate that the infection has not fully resolved or that there is still a pocket of infection that needs to be addressed. It’s essential to monitor this closely.

3. Is it normal to have pain and hard lumps near the incision?
Pain and the presence of hard lumps near the surgical site can be common after such procedures, especially if there is inflammation or if the body is still fighting an infection. However, if the pain is severe or if the lump is increasing in size, it would be prudent to return to your healthcare provider for an evaluation. Persistent pain and drainage may require further intervention.

4. Is the white, fluffy substance in the sitz bath a sign of healing?
The white, fluffy material you observe in the sitz bath could be pus or necrotic tissue, which may indicate that the area is still infected or that the body is expelling dead tissue. While some drainage can be expected, especially in the early stages of healing, it’s important to ensure that this does not signify a worsening infection. If the drainage continues or worsens, you should seek medical advice.

5. Does a vegetarian diet help with wound healing? Is it necessary?
A balanced diet is crucial for wound healing, and while a vegetarian diet can provide many essential nutrients, it is not strictly necessary unless you have specific dietary restrictions or preferences. Focus on a diet rich in vitamins (especially Vitamin C and A), proteins, and minerals that support healing. If Dr. B suggested a vegetarian diet, it may have been to ensure you consume more fruits and vegetables, which are beneficial for overall health. However, it’s important to ensure you are getting adequate protein and other nutrients, regardless of your dietary choices.

In conclusion, your situation requires careful monitoring and possibly a reassessment of your treatment plan. It is crucial to maintain open communication with your healthcare providers and to advocate for your health. If you experience worsening symptoms, do not hesitate to seek immediate medical attention. Healing from an anal abscess can take time, and it is essential to ensure that you are on the right path to recovery.

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