A stitch after a normal delivery has not healed after five months. Is it a fistula?

Hi,

Welcome to icliniq.com.

Do not worry. This is not infected, it is just a skin gap. Nearly everyone will have this much of wound gaping. This is more if the stitch was put very tight, it will cut through. This does not need any resuturing. But you will have to avoid sex till fully healed, or else the gaping may get infected or gap further.

1. Do sitz bath daily. Use a tub with lukewarm water with few drops of Betadine or any mild antiseptic lotion, use it for 15 to 30 minutes per day for 7 to 10 days. This will clean away all the discharge from the vagina soiling the wound, and also reduce the edema around the wound.

2. I suggest taking tablet Chymoral forte(Chymotrypsin and Trypsin) or Seratid-D (Diclofenac and Serratiopeptidase), three times a day for five days. This will reduce the edema in the skin, so the margins of the wound will come close to each other. Only then can it heal.

3. If it is painful to touch the wound, it means infection, then you will need antibiotics, like tablet Augmentin 625 (Amoxicillin and Clavulanic acid), twice a day for five days.

4. Avoid using nylon or synthetic undergarment, as they hold water for long. At bedtime, avoid undergarment. After a bath, try to dry the area by just mopping with a clean, dry towel, do not rub. Each time you use the bathroom, wash from behind, water from the anal area better avoided from coming front. Keep using the T-Bact (Mupirocin) ointment for 1 to 2 weeks. Try to keep the area as dry as possible. I know it is not possible.

Hope I have clarified your query, do write back. All the best.

Hi,

Welcome back to icliniq.com. Nice to hear from you.

Usually while in the healing phase of the episiotomy wound on your perineum, the area will have some edema and you also will be holding the area tight unknowingly. This period is also associated with constipation and poor bowel movements, as your water balance is low or poor. So this is what we can do:

1. Keep having sitz bath. During periods it can be done unless you have the discomfort of being in blood stain water. There will not be any problem to the wound.

2. Have lots of water, juices, milk, liquid diet, a high-fiber diet like banana, green leaves, etc. Keep dry grapes (big medicinal ones) 3 to 5 in water overnight. In the morning, squeeze it and drink the water and eat the grapes. This will improve bowel movement. Incontinence will get corrected once the wound heals.

3. If you feel you have to strain to pass stools or have difficulty in passing stools, I suggest syrup Cremaffin plus (Sodium picosulfate, Magnesium hydroxide, and Liquid paraffin), two tablespoons at bedtime. In a couple of days, your stools will be softer, and bowel movement will be better. Do not use it regularly. Once constipation is solved, your gas problem will get corrected.

4. Pain on the left side means your bowel is not getting emptied properly, opening into the anus is from there. The doctor has sutured the wound so now the anus would have got pulled towards the wound. Thus you will feel the gas coming out of the vagina.

5. Pain in calf muscles is due to salt imbalance, have lime juice with salt and sugar, 2 to 3 times or more a day. This will correct the weakness in muscles, cramps, back pain or aches.

Hope I have been of help to you, do write back. All the best.

Hi,

Welcome back to icliniq.com.

You definitely have a very keen observation. I should appreciate that.

A fistula is the first diagnosis any doctor will have in mind. I too got that impression on hearing your complaints. But we always have to think of simpler and more common problems. If I had told you that, you would have had few more sleepless hours. Without the healing of the perineal wound, we cannot confirm the diagnosis. So, I thought you better wait.

Let us think for a moment that you have a fistula. I just hope you do not. This is, first of all, accusing the doctor who stitched the episiotomy. Treatment would be to wait for the surface wound to heal, as doing an internal examination is very painful now. During this time, you will need sitz bath, local antibiotics, and stool softeners. You are already on it now. Many of these openings are so small that they may close on its own. If they still cause difficulties, then after good bowel preparation, under anesthesia, we will have to open the wound and freshen the wound and suture the defect, taking care to leave no gap.

As you asked, it is not just fistula I suspect from the history. I think you had a tear of the anal sphincter. Was the baby very big or was it a sudden delivery or were instruments used to deliver the baby? Was there no experienced doctor available for delivery? This could be the reason for the incontinence. You are not able to hold back gas or stool. But many of these will disappear on its own. Even after few months, the problems are unbearable or disturbing your day to day activities, then you will need to go for surgical correction.

Hope I have cleared your queries and not confused you further. Do write back. All the best.