Anal Fistula: Symptoms, Surgery, and Post-Operative Care

Anal fistula

The symptoms began around August of last year, with intermittent yellow-green discharge from the anus that is odorless.
Bowel movements are normal and painless, but occasionally there is some blood.
In early March of this year, I underwent surgery at the hospital; the location was just above the anus, near the tailbone.
Post-surgery, there were no pain, blood, or discharge during bowel movements (the doctor informed me that there were stitches, but isn't a fistula supposed to be left unstitched?).

Starting in June, the yellow-green discharge reappeared, and bowel movements became painful with tearing sensations, accompanied by a significant amount of blood.
After bowel movements, there is a persistent feeling of swelling and pain in the anus, and sometimes foul-smelling liquid resembling stool leaks onto my underwear.
Even without bowel movements, there have been instances of significant bleeding while sitting or squatting, which has soaked through my pants and onto the chair and mattress.
When squatting very low, I also experience tearing pain above the anus.

I returned for follow-up visits in July and August with the same surgeon, who diagnosed me with inflammation at the surgical site.
I was prescribed softeners and hemorrhoid suppositories, but there has been no improvement in the aforementioned symptoms.
What could these symptoms indicate? Why have they worsened after surgery, and should I consider consulting a different physician?

Nìmíng, 20~29 year old female. Ask Date: 2012/09/22

Dr. Ke Fangxu reply Surgery

Based on your description, it seems that the anal fistula has recurred.
Typically, anal fistula surgery involves suturing the wound with absorbable sutures, which will dissolve or fall off on their own after about a week.
The wound generally heals within a month; however, there is a recurrence rate of 5% to 30% depending on the complexity of the initial fistula.
I recommend consulting your physician to determine if another surgery is necessary.
Seeking a second opinion from another doctor can also provide a more objective perspective.

Reply Date: 2012/09/22

More Info

Understanding anal fistulas involves recognizing their symptoms, surgical options, and post-operative care. An anal fistula is an abnormal connection between the anal canal and the skin near the anus, often resulting from an infection in the anal glands. The symptoms can vary, but they typically include persistent drainage of pus or blood, pain during bowel movements, and discomfort around the anal area.

In your case, it seems you initially experienced yellow-green discharge without odor, normal bowel movements, and occasional blood. After surgery in March, you reported a temporary relief with no pain or discharge, which is a positive sign post-operation. However, the recurrence of yellow-green discharge, pain during bowel movements, and increased bleeding suggests that the fistula may not have been completely resolved or that there may be complications such as infection or inflammation at the surgical site.

The presence of stitches after surgery is common, as they help to close the surgical site. However, if the fistula is complex or if there are multiple tracts, it may require additional procedures or a different surgical approach. The fact that you are experiencing increased symptoms, including severe pain and bleeding, indicates that something may not be right.
It is crucial to follow up with your surgeon, but if you feel that your concerns are not being adequately addressed, seeking a second opinion from another specialist, such as a colorectal surgeon, may be beneficial. They can provide a fresh perspective on your condition and suggest alternative treatment options.

Post-operative care is vital in managing symptoms and preventing complications. Here are some general recommendations:
1. Hygiene: Maintain good anal hygiene. After bowel movements, gently clean the area with mild soap and water. Avoid using harsh soaps or wipes that may irritate the skin.

2. Diet: A high-fiber diet can help soften stools and reduce straining during bowel movements. Consider incorporating fruits, vegetables, and whole grains into your meals. Staying hydrated is also essential.

3. Pain Management: Over-the-counter pain relievers can help manage discomfort. However, consult your doctor before taking any medication.

4. Follow-Up Appointments: Regular follow-ups with your surgeon are crucial to monitor healing and address any complications early. If symptoms persist or worsen, do not hesitate to seek further evaluation.

5. Avoid Straining: Straining during bowel movements can exacerbate symptoms. If you experience constipation, consider using stool softeners or laxatives as recommended by your healthcare provider.

6. Watch for Signs of Infection: If you notice increased redness, swelling, or discharge, or if you develop a fever, contact your healthcare provider immediately.

In conclusion, while surgery can often resolve issues related to anal fistulas, complications can arise. Your symptoms suggest that further evaluation is necessary. Do not hesitate to seek a second opinion if you feel your current treatment plan is not effective. Your health and comfort are paramount, and there are various treatment options available to manage your condition effectively.

Similar Q&A

Post-Surgery Complications After Anal Fistula Treatment: Understanding Symptoms

Hello Dr. Ke, In July 2021, I underwent surgery to drain an anal abscess, which left a significant wound (approximately 3-4 cm long) that was almost deep enough to reach the pelvis, located in the lower left area of the anus. After healing, I had another surgery in August due to...

Dr. Ke Fangxu reply Surgery
Anal abscesses typically require a longer recovery time, as the space created by the internal abscess needs time for the tissue to gradually regenerate and fill in. As long as there is no pain or accumulation of pus, there is no need for further incision. Based on your descriptio...

Understanding Anal Fistulas: Symptoms, Treatment, and Recovery

Hello, I discovered frequent discharge on my underwear around October last year. The discharge was greenish-yellow and odorless. There was no pain or unusual symptoms during bowel movements. I delayed seeking treatment until February of this year when I visited Chi Mei Medical Ce...

Dr. Xu Kaixi reply Surgery
Dear Dr. Hsu Kai-Hsi of the Department of Surgery at Tainan Hospital, Ministry of Health and Welfare: We kindly request that you come to the outpatient clinic for an examination to clarify and address the issues you have described. Wishing you good health and safety from the Dep...

Understanding Anal Fistulas: Symptoms, Risks, and Treatment Options

Hello, doctor. At the end of January and the beginning of February, I had an anal abscess that was not drained because it seemed to be located deeper. I was treated with antibiotics and pain relievers. However, after experiencing continuous diarrhea on the night of March 27, I ha...

Dr. Ke Fangxu reply Surgery
Anal abscesses should primarily be treated with surgery. Sometimes, if the symptoms are mild or the location is unclear, oral antibiotics may be administered initially. However, if symptoms worsen, incision and drainage surgery is necessary; otherwise, severe cases can lead to se...

Understanding Anal Wound Infections: Symptoms and Surgical Concerns

I underwent hemorrhoidectomy on July 25th, and it has been six weeks since the surgery. The wound still hurts, and there is a small amount of yellow discharge. Initially, the wound felt like it was healing, but last Friday (September 2nd), I suddenly experienced diarrhea, after w...

Dr. Ke Fangxu reply Surgery
Hello: In response to your question, the likelihood of developing an anal fistula after hemorrhoidectomy is quite low, although it is not impossible. Based on your description, it does seem possible that you may have a wound infection. It is generally recommended to use oral anti...