Anal Fistula Surgery: When Recovery Goes Wrong

Anal fistula

Hello doctor, I underwent a fistula excision surgery on September 21 of last year, and to this day, the wound is still bleeding.
After the fistula excision in October, I returned for a follow-up, and the doctor said everything was fine.
In November, the doctor again said everything was fine.
However, during my December visit, the doctor mentioned that the surgery had failed.
At that time, I didn’t understand to ask the doctor what the reason for the failure was; I only asked what to do next and if I needed another surgery.
The doctor told me to "make peace with the wound."
In the meantime, the wound has not healed, and I experience bleeding during bowel movements.
When I mentioned the persistent bleeding to the doctor during my follow-up, he seemed to think I was overreacting, saying the wound would heal on its own and advised me not to worry.
He also said another surgery was unnecessary, as it could cause the anal opening to become smaller due to the prolonged recovery from this surgery.

I feel mentally and physically exhausted because this has severely impacted my daily life and even my work.
I am unsure whether there was an issue with the surgery or if my recovery ability is weak.
Now, even applying medication to the anal area is painful, and it feels like I’m losing half my life.
A friend of mine has similar symptoms, and he was able to walk freely less than a month after his surgery, with his wound healing well.

I wonder if this is a personal health issue.
I weigh 135 kilograms, and during the surgery, the doctor mentioned concerns about the risks of general anesthesia, so he opted for spinal anesthesia.
However, I felt no effect from the anesthesia and was fully aware during the surgery, which has left me very fearful.

What seems like a simple anal fistula symptom feels to me like an incurable condition.
I am unsure what to do now.
Should I return to the same doctor, whose only response was to go home and take care of the wound, or should I seek another doctor?

Koan, 30~39 year old female. Ask Date: 2012/03/05

Dr. Ke Fangxu reply Surgery

For simple fistula surgeries, the wound should heal in about a month.
The recovery time for complex fistulas depends on the complexity and the surgical method used; however, it generally does not exceed three months.
It is unusual for you to still have not healed nearly six months post-surgery.
Another factor complicating the situation is your weight; obese patients may find it more challenging to keep the wound clean, which can prolong the healing process.
However, if it has already taken this long, rather than waiting indefinitely, I recommend consulting another physician for a second opinion, as there may be different insights or approaches.

Reply Date: 2012/03/05

More Info

It sounds like you are going through a very challenging recovery process after your anal fistula surgery, and I can understand how frustrating and concerning this situation must be for you. Let's break down your concerns and explore what might be happening, as well as potential next steps.

First, it's important to acknowledge that recovery from anal fistula surgery can vary significantly from person to person. Factors such as the complexity of the fistula, the surgical technique used, your overall health, and even your body weight can all influence healing. In your case, it seems that you have been experiencing prolonged bleeding and pain at the surgical site, which is not typical for most patients after this type of surgery.

When your doctor mentioned that the surgery was a "failure," it likely means that the fistula has not healed properly, and there may be residual issues that need to be addressed. The fact that you are still experiencing bleeding and pain, especially during bowel movements, suggests that there may be complications such as infection, incomplete closure of the fistula, or even the formation of a new fistula. It's also possible that the healing process is taking longer due to your body’s response to the surgery, which can be influenced by factors like your weight and overall health.

Your feelings of fear and frustration are completely valid. It’s not uncommon for patients to feel overwhelmed when recovery does not go as expected, especially when it impacts daily life and work. The pain you describe when trying to care for the area is concerning, and it’s crucial to address this with your healthcare provider.

Here are some steps you might consider taking:
1. Seek a Second Opinion: If you feel that your current doctor is not addressing your concerns adequately, it may be beneficial to seek a second opinion from another colorectal surgeon. A fresh perspective can provide new insights into your condition and recovery.

2. Discuss Pain Management: Pain during recovery can be debilitating. Make sure to communicate openly with your doctor about the level of pain you are experiencing. There may be options for pain management that can help you feel more comfortable.

3. Consider Wound Care: Proper wound care is essential for healing. If you haven't already, ask your doctor about specific wound care techniques that can help minimize pain and promote healing. Sometimes, specialized dressings or topical treatments can make a significant difference.

4. Evaluate Dietary Changes: Since bowel movements are painful, consider discussing dietary changes with your healthcare provider. A diet high in fiber can help soften stools, making bowel movements less painful. Staying well-hydrated is also crucial.

5. Monitor for Signs of Infection: Keep an eye out for any signs of infection, such as increased redness, swelling, or discharge from the wound. If you notice any of these symptoms, contact your doctor immediately.

6. Mental Health Support: The emotional toll of chronic pain and recovery challenges can be significant. Consider speaking with a mental health professional who can help you cope with the stress and anxiety related to your recovery.

7. Follow-Up Appointments: Continue to attend follow-up appointments with your surgeon, and don’t hesitate to voice your concerns. If you feel that your recovery is not progressing, advocate for further evaluation or intervention.

In summary, while it is concerning that you are still experiencing symptoms after your surgery, there are steps you can take to address your situation. Seeking a second opinion, discussing pain management, and ensuring proper wound care are all important components of your recovery. Remember, you are not alone in this, and there are healthcare professionals who can help you navigate these challenges.

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