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How long does fistula take to heal after fistulotomy?

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Posted on Thu, 12 May 2016
Question: How long does it take to heal after fistulotomy ? The Fistula was simple in 2 and 3'o clock position. its 2 weeks post surgery. i have discharge, moderate to severe pain. Doctor had given medicine wash twice after surgery
doctor
Answered by Dr. T Chandrakant (2 hours later)
Brief Answer:
Depends upon many factors as discussed.

Detailed Answer:
Hi.
Thanks for your query, albeit short and specific.
To recapitulate: Female/26 - simple fistula at 2 and 3 o'clock - operated 2 weeks back - have discharge - moderate to severe pain - on medicines and asked to wash twice - wants to know the healing period ...

The healing depends upon many factor, to enumerate few important once:
Depth of fistulotomy/fistulectomy - deeper or wider wounds would take more time to heal.
Your hemoglobin, serum proteins- good numbers help normal healing. Low numbers do lengthen the period.
Infection of the wound, infection delays healing.
Rest given to the area.
Local care, cleaning and dressing.
Deficiency of vitamins and minerals.
Hence with all these factors being taken into consideration, it usually takes 2 weeks to 6 weeks for good healing.

I hope this answers your query, please see all the parameters and you will know the duration the wound will take to heal completely.
Please feel free to ask for further relevant queries if you feel that there is a gap of communication.


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. T Chandrakant (14 hours later)
Thankyou Doctor for the kind response. I have few queries.
1. Its been 2 weeks since surgery. The size of the fistula opening has come down from 2 inch to abt 1/2 inch now but the tract is still swollen. i have moderate (Bearable) to severe pain(sometimes) in both my fistula opening and anal region. i also have yellowish discharge and found few drops of blood. Is this normal ? is this a part of the healing process?
2. Right from the second day of surgery the wound is kept open. I dint have any dressing over it expect for sanitary napkins. Doctor asked me to stop pills. She advised me to take sitz bath and stool softner syrup. She hasnt given me ointments to apply. My question is, is dressing essential, as i have started working now? is any ointment required to enhance healing process?

Thankyou in advance.
doctor
Answered by Dr. T Chandrakant (3 hours later)
Brief Answer:
As detailed.

Detailed Answer:
Thanks for your feedback and additional queries.
1. 2 weeks - 2 inches to 1/2 inch is a good progress - tract is probably swollen due to movement, inevitable infection as the stool with full bacterial load passes above it. The pain again can be explained by the things just mentioned and in addition the muscles of sphincter go into reflex spasm continuing pain. The bare area has numerous nerve endings open also contributes for the pain.
You can certainly take anti-inflammatory medicines with painkiller property like Ibuprofen or Diclofenac whichever suits you.
As mentioned the fecal contamination will cause secondary infection in all the patients of fistula surgery, hence yellow discharge is common. Few drops of blood is a good sign of healing.
2. Now how to go about the wound care is the preference of individual surgeon. Your Surgeon will follow whichever she experience as the best.
Please do not use any ointments.
I can tell you what I do for my patients:
Clean the wound with equal parts of normal saline (which we use for intravenous infusion) and hydrogen peroxide (thus diluted to half strength) - this cleans all the debris, pus and cleans the area thoroughly. Then apply liquid betadine (povidone iodine) at least twice daily. Change the dressing (sanitary pads if sterile) as it soaks the discharge and helps keeping the area clean, provided it is changed when wet or at least twice daily irrespective of wet or not.
Sitz bath with cleaning the area with soaked cotton to after passing motion to clean off the fecal matter.

I hope this simplifies further and helps you.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. T Chandrakant (38 minutes later)
Thankyou doctor.
What to expect in the coming days about pain and discharge? Does the wound close before the entire tract is healed? Apart from cleaning outside, is there any way to prevent infection.
If Secondary infection by fecal matter is common, is it a concern?
doctor
Answered by Dr. T Chandrakant (4 minutes later)
Brief Answer:
Most welcome.

Detailed Answer:
The pain and discharge will settle with time.
Keeping a dressing like as I advised allows the wound to heal from within/bottom.
Occasional course of an antibiotic and probiotic helps to have some control over the infection, as also the proper wound care.
No, secondary infection is not a concern as the wound is open, there is no trapping.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. T Chandrakant (26 hours later)
Thankyou doctor. As you mentioned, the pain has come down. i am feeling comfortable sitting now. I can see noticeable changes in the size of the opening but my only concern is the tract is still swollen. How does the tract heal henceforth? Does the tract heal first and only then the opening will close?
doctor
Answered by Dr. T Chandrakant (42 minutes later)
Brief Answer:
Most welcome.

Detailed Answer:
Thank for your appreciation.
The tract will and should heal from the floor. Do not allow the skin to close before the tract, hence the additional need of some dressing as we discussed already.
The tract heals first and thence the opening.
The swelling will go away.
Please continue as we discussed and you will be fine.
Take care.
All the best.
Above answer was peer-reviewed by : Dr. Yogesh D
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Dr. T Chandrakant

General Surgeon

Practicing since :1984

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How long does fistula take to heal after fistulotomy?

Brief Answer: Depends upon many factors as discussed. Detailed Answer: Hi. Thanks for your query, albeit short and specific. To recapitulate: Female/26 - simple fistula at 2 and 3 o'clock - operated 2 weeks back - have discharge - moderate to severe pain - on medicines and asked to wash twice - wants to know the healing period ... The healing depends upon many factor, to enumerate few important once: Depth of fistulotomy/fistulectomy - deeper or wider wounds would take more time to heal. Your hemoglobin, serum proteins- good numbers help normal healing. Low numbers do lengthen the period. Infection of the wound, infection delays healing. Rest given to the area. Local care, cleaning and dressing. Deficiency of vitamins and minerals. Hence with all these factors being taken into consideration, it usually takes 2 weeks to 6 weeks for good healing. I hope this answers your query, please see all the parameters and you will know the duration the wound will take to heal completely. Please feel free to ask for further relevant queries if you feel that there is a gap of communication.