Anal Fissure Tips

The human body is an intricate mechanism that functions amazingly. And when there is any trouble it does not fail to show signs of trouble, and all we need to do is, to notice it and solve our problems. This is applicable to all types of health issues, including a perianal abscess.

What is Perianal abscess?

Perianal abscess is an extremely painful condition of anal abscess that occurs when one cavity in the anus starts getting filled up with pus. Very often it appears as a painful swelling similar to boil just near the anus. Usually, it appears red in color as well as slightly warm to touch. If the location of the anal abscesses is in the deeper tissue, then it might be less visible and it occurs in people suffering from inflammatory bowel disease.

The worst part is that in certain cases, anal abscesses might lead to more painful anal fistulas. Generally, fistulas occur only if the abscesses fail to heal and break open on the skin’s surface. Therefore, it is important that the abscess heals properly or else it may lead to intolerable pain and may even require surgery.

Symptoms of Perianal Abscess

The immediately noticeable and probably the most common anal abscess symptom is constant and throbbing pain around the anal area. Swelling accompanies the pain and its rate increases during bowel movements.

Various common signs of Perianal abscess are:

1. bleeding or rectal discharge
2. constipation 
3. fatigue
4. Swelling or tenderness,
5. Skin irritation all around the anus.

Patients with deeper abscess might also show symptoms such as chills, fever, malaise, etc. Various reports state that certain people also feel a lump or nodule at their anus’s rim. Facing difficulty while urinating might also be experienced by some people affected by perianal abscess.

HOW TO DIAGNOSE PERIANAL ABSCESS?

One must immediately seek medical if they experience any of the above-mentioned signs or symptoms. Clinical evaluation along with digital rectal exam is sufficient for the proper diagnosis. But, in some cases, patients might need other tests to screen for rectal cancer, diverticular disease, inflammatory bowel disease and sexually transmitted infections. Your physician might also suggest a CT scan, an MRI, or an ultrasound.

HOW DO YOU TREAT PERIANAL ABSCESS?

Just after the diagnosis, prompt surgical drainage would be carried out by the doctor before the abscess erupts. A deeper or larger abscess might require hospitalization as well as an anesthesiologist’s assistance. In most cases, patients are prescribed certain medications for pain relief just after the procedure. Antibiotics are mainly given to those people who have comparatively weaker immunity or suffer from diabetes.

Perianal Abscess develops near the anus or back passage. Typically it tends to develop quite quickly and people suffer from pain in the rectum or on the anus. The pain can get accompanied by fever, chills and a feeling as if they are not well at all. There can well be an obvious painful swelling alongside the anus or back passage.

A Fistula is always a follow of a previous abscess. A fistula connects a previously infected anal gland to the skin on the buttocks outside the anus. People can come across a discharge in a persistent manner from an opening or sinus close to the anus. It may well arise at the site of the discharge of a perianal abscess. The natural methods of treatment through Ayurveda can be extremely effective in getting rid of the problems of Perianal Abscess as well as Fistula.

Symptoms of a Perianal Abscess and Fistula

An abscess is normally associated with symptoms of pain and swelling around the anus. Individuals also tend to experience fatigue, fever, chills.

Symptoms related to the fistula include:

• Pus discharge from an opening close to the anus.
• Feeling of pain and discomfort in the anal region.
• Irritation of skin around the anus.
• Passing off some blood with the discharge.

Causes behind Perianal Abscess

There are small glands located inside the anus. When the glands get clogged, they can become infected and that can lead to the development of an Abscess. An abscess usually results out of an acute infection in the anal glands, when bacteria or any foreign substance enters the tissue through the gland. There are certain conditions, like colitis or other inflammation of the intestine can lead to the occurrence of these infections.

Causes Leading to Fistula

The causes which lead to Fistula are:

Conditions that affect the intestines, like Crohn’s disease or ulcerative colitis. Almost 50% of people suffering from Crohn’s disease get an anal fistula.
People who are HIV positive, up to 30% off them go on to develop an anal fistula.

Tips to Follow

People can get themselves treated from Perianal Abscess and Fistula through Ayurveda. Ayurveda ensures to treat problems in a natural manner. The following tips need to be followed:

• One who suffers from Fistula or Perianal Abscess can make use of ayurvedic herbs like ginger, elephant yam, turmeric, guggul, hirataki and Indian gooseberry.
• People must ensure that they drink a lot of water on a regular basis.
• Patients should eat a balanced diet, which is rich in dietary fibres.
• They must avoid spicy and junk foods.
• Sitting in warm water can be very useful for cleaning and getting relief from pain
• Diet should contain lots of green vegetables, fruits and salads.
• Cereals and barley can help people to have form and thus avoid the occurrence of these problems

Anal fistula, a challenge for modern surgery, but can be cured with grade ksharsutra in Ayurveda (Indian system of medicine).  Anal fistula is a disease for which different methods of treatment have been advocated time to time, even today when we are talking about robotic surgery, this disease has no satisfactory method of treatment in modern surgery. The latest method of video assisted anal fistula treatment (VAAFT) is not satisfactory due to high incidences of recurrence after the surgery. But at Sushruta Anorectal Institute New Delhi; with the help of Graded KsharsutraTM all these patients of complex Anal fistula are being successfully treated.

In Ayurveda about 2000 yrs ago Acharya Sushruta has indicated ksharsutra treatment to treat fistula-in-ano. Late professor P J Deshpandey at the faculty of Ayurveda Institute of Medical Sciences B H U; had done extensive research in this field and established a treatment module to cure this disease. In 1990 Indian council of medical research has clinically evaluated this Ayurvedic treatment module at four premiere institutes in our country including AIIMS Delhi & PGIChandigarh. Subsequently, it was concluded by I.C.M.R. that in the patients of fistula in ano, ksharsutra treatment is more effective& convenient as compared to modern surgery.

Ksharsutra is a thread coated with certain Ayurvedic medicines known for their antiseptic, debridement & healing properties. After u v sterilization this medicated thread (ksharsutra) is used under complete aseptic precautions in the patients. The patient is routinely investigated with special reference to any other associated disorder like hypertension, diabetes mellitus, tuberculosis etc. The next step lies in the proper identification& evaluation of the fistulous tract. It is mandatory to define the fistula tract wrt its depth, direction & branching pattern. This may be achieved by careful probing under expert hands using malleable probes& if required help may be taken from other investigations like x-ray fistulogram or MRI fistulogram.

Once the tract has been clearly defined the Ksharsutra is placed in it with the help of certain instruments, under local anesthesia. This entire procedure is usually completed in ten to fifteen mins. As there is no cutting of tissues hence no bleeding, no pain & patients can go home after half an hr rest in the daycare room. The medicine-coated on the thread is gradually released in the tract. The cumulative effect of the coated drugs exerts a powerful debridement effect on the fistula tract & induces healing by the fresh & healthy granulation tissues. Thus Ksharsutra is the mechanism of drug delivery precisely at the tissues involved. 

Every seventh or tenth day the old sutra is replaced with a new Ksharsutra till there is a final cut through. It has been observed that the tract heals @ 0.5-1 cm per week. The post-operative complications like recurrence of the disease, fecal incontinence, bleeding is not seen with Ksharsutra treatment. Further, this therapy is performed as an OPD procedure. No general anesthesia & no hospitalization is required. Patient maintains his normal routine activities as usual during the treatment period.  

 At Sushruta Anorectal Institute; Rohini - New Delhi, we have been working on this disease including piles fissures & pilonidal sinus for the last 30 yrs. Here we have developed the concept of Graded KsharsutraTM which has given us a more effective & convenient way to treat anal fistula. At Sushruta Anorectai Institute we have treated on record thousands of patients of anal fistula from different states including overseas patients. We have records to prove that the patients of high anal complex fistula, those have been operated two or three times but failed to heal were successfully treated at this institute.

Anal fissures are the small tears formed in the anal lining. They are also known as anal ulcers. An anal fissure causes a lot of pain and bleeding during your bowel movements. Usually a fissure heals automatically in a few days time. It can be treated with simple home remedies as well.

CAUSES:

1.  You can suffer from an anal fissure if you pass hard and large stools. 

2.  Also strained childbirth or suffering from violent spells of diarrhea might get you an anal fissure. 

3.  Chronic constipation may also be cause of a fissure. 

4.  Other rare causes may be anal cancer, HIV, tuberculosis or herpes. 

Individuals of all age groups can suffer from anal fissures. It is not a very serious problem, and heals on its own in a few weeks. Although it can heal itself, there are certain treatments which can help relieve the pain you get from an anal fissure.

SYMPTOMS:

An anal fissure has quite a lot of symptoms for you to understand what you are suffering from:

1.  There will be a very visible tear around the anal region. You will be able to spot the tear on the skin very easily.

2.  A small lump of skin may form next to the tear.

3.  When you will be undergoing your bowel movements, you will feel a very sharp pain in the anal region.

4.  You will find spots of blood on the stool passed.

5.  You will also feel a burning or an itching sensation in the anal region.

TREATMENT:
Although most fissures do not require treatment, there are a few remedies that will help cure them faster:

1.  Stool softeners: You get certain medicines at the chemist, which are known for their stool softening functions. These stool softeners help to soften the hard stools and initiates smooth bowel movements.

2.  Eat fibrous foods: Eat foods rich in fiber like fruits, whole grain cereals, raw vegetables, etc.

3.  Take warm baths: Take a bath in warm water as it relaxes your anal muscles, helps to relieve irritation in the region, and increases blood flow in the anorectal region.

4.  Use ointment: Apply nitroglycerin ointments and topical pain relievers to promote blood flow to the anal region and to relieve discomfort from the region respectively.

Anal fistulas or fistula-in-ano generally cause discomfort due pus or watery discharges and sometimes pain. This is a condition where a nodular swellingappears in area surrounding the anal opening. Intermittent pus discharged is noticed from this nodular swelling. Instead of a nodular swelling; there might be simply an opening in this region. An anal abscess is one of the most common causes for this condition. Here are ten things you should know about these anal fistulas:

1. It is curable through Ayurveda only: Till date many treatment options are tried to cure Anal Fistula which include Anal Fistula Surgery/ Glu technique/ cutting seton/ Colostomy/ Fistula plug/ VAAFT and many more. But all of these treatment methods have pretty high recurrence rate of about 20-25 %. However with Ksharsutra treatment for Anal Fistula; chances of recurrence are negligible. Other complications generally seen in surgery like bleeding, incontinence (inability to hold stool); are not seen with Ksharsutra Treatment. Clinical trials conducted by Indian Council for Medical Research (ICMR); at AIIMS New Delhi and PGI Chandigarh in 1992 have proved that Ksharsutra treatment is more convenient and more effective than Surgery in the patients of Anal Fistula. 
2. There are symptoms you can look out for: Some of the symptoms that indicate anal fistulas include appearance of a nodular swelling in area surrounding Anal opening. Intermittent pus discharge is also observed from this swelling. Usually pain subsides and opening closes after the discharges; and patient feels relief. But after certain interval of time again pus accumulates; swelling re-appears with some amount of pain which is again relieved after the discharge. This cycle is repeated at varying interval in the patient of anal fistula.
3. Medication can only provide temporary relief: Anti biotics and painkiller might give temporary relief from the symptoms. But after some time there will be again pus formation and associated swelling & pain in area surrounding anal opening. 
4. Anal fistulas can recur after surgical treatment: As discussed above all the treatment options tried by modern medicine (including most recent treatment VAAFT) have high incidence of recurrence (about 20-25%) Whereas there are negligible chances of recurrence after Ksharsutra Treatment for Anal Fistula. . 
5. Anal fistulas treated by Graded Ksharsutra do not recur: Ayurvedic treatment for anal fistulas is known as Kshar sutra therapy. This involves the use of medicated thread being ligated in Fistula Tract. The medicines present in this thread act as a strong debriding agent and induces healing of Fistula tract. In few weekly sittings of Ksharsutra change; Fistula gets healed completely and it do not recur. Pt. maintains his normal routine life during treatment period. 
6. Sitz bath can be beneficial: This involves sitting in a tub filled with warm water so that the affected site is submerged. An antiseptic and astringent agent like Triphala decoction may be added to the water if needed. A sitz bath soothes the skin and provides relief from pain. This also helps keep the area clean and thus reduces chances of infection. 
7. Oily and spicy foods should be avoided: When dealing with anal fistulas, you should try and take a diet that keeps your stool soft and regular. Hence use of oily and spicy foods should be reduced. Eat plenty of fiber and drink lots of water. Alcohol should also be avoided. 

Comparative Study: 

Ksharsutra vs Surgery in Anal Fistula Patients- 

1. Ksharsutra is done under Local Anesthesia. Hence complications of General Anesthesia are avoided. Surgical procedures are done under GA with all impending complications of General Anesthesia. 
2. Ksharsutra being a parasurgical procedure hence no bleeding/ cutting of tissue is involved. Surgery involves cutting/ bleeding. 
3. No hospitalization or bed rest is required in Ksharsutra Treatment. In Surgery hospitalization is must. 
4. In Ksharsutra; patient can continue his normal daily routine Surgery may require bed rest. 
5. Complications like incontinence (inability to hold stool) and recurrence are seen after surgery
6. Ksharsutra is a safe procedure and these complications are not seen. 
7. Ksharsutra Treatment is more economical as compared to VAAFT surgery. VAAFT Surgery is comparatively too expensive.

Piles or fistula are two very severe problems which men can face at any point in their life. These two medical conditions affect one of the main parts of a men's system, i.e. the anus. But many a time people confuse one of these disorder with the other one.

What Are Piles?
Piles are the inflamed or swollen set of tissues which are present in the sensitive anal area. These can range from different sizes and can also be present in various areas i.e. internal or external. Internal piles are usually present between 2-4 cms above the anus opening whereas the external piles are present on the outside.

There are different symptoms for Piles

• The person can experience severe to moderate pain in the rectum area.
• Immense pain can also occur when the person is sitting or moving in a difficult position.
• Experiencing discomfort, itchiness, or swelling of the anus is very common in Piles.
• The person may see blood in his stool or problems related to digestion.

The causes of Piles can be of different reasons

1. Chronic constipation
2. Chronic diarrhoea
3. Lifting heavy weights
4. Pregnancy

Treatment and Diagnosis

Homoeopathy can be effectively used to treat piles. Most of the time, piles are caused due to unhealthy lifestyle and food habits. So homoeopathy can be easily treated with the help of homoeopathic methods which can be used to change one's food habits and keep them healthy.

What is Fistula?

The anus is like an exit point in the body for wastes and semen. Inside this anus, many small glands are present. If due to some reason, these glands or a single gland is blocked, then an abscess is formed which infects the anus and causes severe pain or abnormalities. This condition is known as Anus fistula.

There is no exact cause of fistula. Usually, these are caused due to some severe accident or injury which affects the anus. It can also be caused due to some other disease which affects the anus like STDs, Crohn’s Disease, tuberculosis etc.

Here are some important symptoms

1. Blockage of anal abscesses
2. Pain and inflammation around the anus
3. Immense pain with bowel movements
4. Bleeding from the anus
5. Bloody or foul-smelling drainage coming out from the anus

Treatment and Diagnosis 

Homoeopathy can be a very important and efficient way by which fistula can be relieved. Homoeopathy has a very high chance of solving fistula because homoeopathic medicines and methods can cure the abscess completely. Due to the complete removal of the abscess, the normal tissues appear once again with time.

An anal fistula, is also called as fistula- in -ano, it is a small channel that develops between the end of the large intestine called the anal canal and the skin near the anus. This is a painful condition, especially when the patient is passing stools. It can also cause bleeding and discharge during defecation.

Genesis of fistula-in-ano

Almost all anal fistulae occur due to an anorectal abscess that begins as an infection in one of the anal glands. This infection spreads down to the skin around the anus causing fistula-in -ano. The anorectal abscess usually leads to pain and swelling around the anus, along with fever. Treatment for anorectal abscess involves incising the skin over the abscess to drain the pus. This is done usually under local anesthesia. A fistula-in-ano happens when there is failure of the anorectal abscess wound to heal completely. Almost 50% of patients with an abscess go on to develop a chronic fistula-in-ano.

Anal Fistula - What Causes It? 

An anal fistula refers to a small infected tunnel connecting the anus to the outer skin. Your body eliminates solid waste products or feces through the anus. When any of the glands inside the anus becomes infected or blocked, an abscess may form, which in turn results in formation of anal fistula. In about 50% of the cases, abscesses develop into fistulae. What are the causes for anal fistula? Anal fistulae occur primarily due to the formation of an abscess or infection in the anus. If the abscess does not heal completely after the pus has been drained away, a fistulacan develop. 

Other factors responsible for the occurrence of anal fistulae are- 

1. Crohn’s disease- a chronic condition where the digestive system becomes inflamed. 
2. Diverticulitis- an inflammation of the small pouches that develop along the intestinal walls. 
3. Hidradenitis suppurativa- a chronic painful skin condition which causes scarring and abscesses on the skin. Apart from these, people with HIV or infected with Tuberculosis disease also develop anal fistulae. If you’ve had a surgery around the anus, then post-surgery complications may lead to infection or abscess on the skin. 

Symptoms

Pain- Constant pain which gets worse when sitting down
Irritation around the anus, like swelling, redness and tenderness
Discharge of blood or pus
Constipation or pain while evacuation
Fever

Diagnosis

A clinical evaluation, including a digital rectal examination under anesthesia, is carried out to diagnose anal fistula. However, few patients may be advised screening for rectal cancer, sexually transmitted diseases and diverticular disease.

Treatment

Surgery is the only treatment of fistula. For fistulas associated with inflammatory bowel disease treatment of the conditions is required for the healing of fistulas. The type of surgery depends on the position of the anal fistula. Most patients are treated by simply laying open the fistula tract to flush out pus, called Fistulotomy. This type is used in 85-95% of cases and the fistula tract heals after one to two months. 

1. Seton techniques: A seton is a piece of thread (silk, plastic) which is left in the fistula tract to treat anal fissures. This is used if a patient is at high risk of developing incontinence after fistulotomy.
2. Advancement flap procedures: When the fistula is considered complex, carrying a high risk of incontinence, then this advanced technique is used.
Other techniques like Fibrin glue and Bioprosthetic plug are also used to surgically treat anal fistulas. In the Fibrin glue technique, glue is injected into the fistula to seal the tract, after which the opening is stitch closed. Bioprosthetic plug is a cone-shaped plug made from human tissue, which is used to block the internal opening of the fistula. After these stitches are used to keep the plug in place. 

Whatever the surgical technique, one can experience minor changes incontinence. Patients usually don t require antibiotics after surgery but have to take pain medication. They may also have to use gauze to soak up drainage from anus. After surgery, patients should seek help if they have increased pain or swelling, heavy bleeding, difficulty in urination, high temperature, nausea or constipation.

An Anal fistula (also known as fistula-in-ano) is a small tunnel that can develop between anal canal and the skin near the anus often resulting from an untreated or inadequately treated perianal abscess. No medicinal treatment shows complete cure of anal fistula except few conditions like tubercular fistula. Early surgery, short & straight fistula tract and anal fistula treatment with ksharasutra give promising results with high rate of success.

Fast facts on Anal fistula

• Essentially surgical intervention required.

• Recurrence is common.

• Should be planned for surgery as early as possible, late cases are mostly complicated.

• Anal fistula treatment with ksharasutra shows high rate of success.

What Causes Anal fistula?

• Abscess in buttock and/or around the anus.

• Long standing anal fissure.

• Traumatic injury to the perianal region.

• Tuberculosis.

• Crohn’s disease.

• AIDS.

• Not maintaining local hygiene.

What are the symptoms of Anal fistula?

• Discharging wound at perianal region or buttock which is repeatedly swelling, discharging some amount of pus and/or blood and resolving. The swelling is often associated with pain and fever.

• There may be single or multiple wounds.

• Passing of flatus through the tunnel like wound.

What are the must know facts about Anal fistula?

• Anal fistula is notoriously famous for its recurrence even after repeated surgery.

• An anal sphincter-sparing or minimal invasive surgery should always be the choice of patient as well as surgeon.

• Different surgical modalities are available for treatment of Anal fistula like fistulectomy, fistulotomy, video assisted anal fistula treatment, fistula treatment with laser, fistula plug, two-stage seton fistulotomy and multistage anal fistula treatment with ksharasutra, etc.

• Anal fistula treatment with ksharasutra (Ayurvedic) has shown the promising result with the lowest rate of reported recurrence and complications like incontinence of stool.

• Medicinal treatment is not considered as curative management except in few conditions like tuberculous fistula. 

The modern lifestyle, along with providing comfort, has also made us susceptible to a host of diseases and ailments. The regular and indiscriminate intake of junk foods, high-salt content foods, and sugar-laden fizzy drinks deprives the body of necessary fiber and essential nutrients. These habits can cause the condition known as the fistula. What more, stress and sedentary lifestyles also figure among the primary causes of the disease.

Problem
Fistula can generate extreme pain and bleeding during or after passing stool, blood spots in the stool, and an uncomfortable feeling of something hanging from the anus. The disease can trigger a discharge of pus from the anus or the anal region, along with itching and a burning sensation. Constipation is an associated symptom.

Therapy
Traditional medicines, such as Ayurveda, recommend the Kshara Sutra treatment which is designed to offer both preventive care and relief from fistula. Kshara Sutra is a minimally invasive surgical procedure which helps patients and Ayurvedic practitioners to manage anorectal diseases. It is a safe and cost-effective means to treat fistula, hemorrhoids, and other similar diseases. Indian sages such as Sushruta and Charaka have attested to the efficacy of such Ayurvedic interventions. In modern times, the efficacy of the procedure has been re-evaluated by the Department of Shalya Tantra in the Benaras Hindu University. The technique is widely practised in India and some other countries.

Procedure
Patients undergoing Kshara Sutra are anesthetized with either local or general anesthesia. Then a malleable probe is passed through the external opening of the fistula to the internal aperture in the anal canal. The probe is taken out gently through the anal opening along with the Kshara Sutra. Later, both ends of the sutra are tied together. The process is repeated once every week and gradually helps in healing the infected tract.

Benefits
The treatment helps to cut, drain, and heal the fistulous track which causes the discomfort. It also destroys and helps in the removal of unhealthy tissues, thereby facilitating fast healing of the fistula tract. The Kshara Sutra therapy also controls infection through its microbicidal action. It separates the debris and completely cleans the wound.

Also, this simple and safe para-surgical process is ambulatory, and patient need not stay overnight in the hospital. They may freely pursue their day to day activities immediately after the process is administered. The treatment does not trigger any complications, such as incontinence or stenosis, or strictures. This makes it suitable for patients of all ages.

The procedure being natural, and promises prevention and cure, is recommended to patients that suffer from fistula. However, patients must be advised to seek consultations from trained medical practitioners.

An anal fistula, is also called as fistula- in -ano, it is a small channel that develops between the end of the large intestine called the anal canal and the skin near the anus. This is a painful condition, especially when the patient is passing stools. It can also cause bleeding and discharge during defecation.

Genesis of fistula-in-ano
Almost all anal fistulae occur due to an anorectal abscess that begins as an infection in one of the anal glands. This infection spreads down to the skin around the anus causing fistula-in -ano. The anorectal abscess usually leads to pain and swelling around the anus, along with fever. Treatment for anorectal abscess involves incising the skin over the abscess to drain the pus. This is done usually under local anesthesia. A fistula-in-ano happens when there is failure of the anorectal abscess wound to heal completely. Almost 50% of patients with an abscess go on to develop a chronic fistula-in-ano.

Symptoms

1. Pain- Constant pain which gets worse when sitting down
2. Irritation around the anus, like swelling, redness and tenderness
3. Discharge of blood or pus
4. Constipation or pain while evacuation
5. Fever

Diagnosis
A clinical evaluation, including a digital rectal examination under anesthesia, is carried out to diagnose anal fistula. However, few patients may be advised screening for rectal cancer, sexually transmitted diseases and diverticular disease.

Treatment
The only cure for an anal fistula is surgery. The type of surgery will depend on the position of the anal fistula. Most patients are treated by simply laying open the fistula tract to flush out pus, called Fistulotomy. This type is used in 85-95% of cases and the fistula tract heals after one to two months.

1. Seton techniques: A seton is a piece of thread (silk, plastic) which is left in the fistula tract to treat anal fissures. This is used if a patient is at high risk of developing incontinence after fistulotomy.
2. Advancement flap procedures: When the fistula is considered complex, carrying a high risk of incontinence, then this advanced technique is used.

Other techniques like Fibrin glue and Bioprosthetic plug are also used to surgically treat anal fistulas. In the Fibrin glue technique, glue is injected into the fistula to seal the tract, after which the opening is stitch closed. Bioprosthetic plug is a cone-shaped plug made from human tissue, which is used to block the internal opening of the fistula. After this stitches are used to keep the plug in place. 

Whatever the surgical technique, one can experience minor changes in continence. Patients usually don’t require antibiotics after surgery but have to take pain medication. They may also have to use gauze to soak up drainage from anus. After surgery, patients should seek help if they have increased pain or swelling, heavy bleeding, difficulty in urination, high temperature, nausea or constipation.