Granulation tissue in fistula wound

Published 13 March 2026 ·Last reviewed 13 March 2026 by the editorial team ·How we create our content

A composite account, drawn from many real anonymised experiences. It is not any one person's story.

What this experience covers

This is a composite account of what people experience when they notice granulation tissue in their fistula wound — the questions it raises, the anxiety it creates, and what it actually means for healing. It draws from many anonymised stories.

The pattern

What granulation tissue looks like

People describe noticing tissue in the wound that looks different from what they expected:

Red or pinkish tissue that appears bumpy or granular
Tissue that looks moist and slightly raised
Sometimes described as “proud flesh” when it grows above the wound surface
It can bleed easily when touched or during cleaning

Is it good or bad?

The short answer: granulation tissue is generally a positive sign. It indicates that the body is building new tissue to fill the wound. It is a normal and expected part of healing by secondary intention (how open fistula wounds heal).

However, excessive granulation tissue — tissue that grows above the wound surface (hypergranulation or “proud flesh”) — can delay healing by preventing the skin from closing over the top. This is not dangerous, but it may need attention from your surgical team.

What people find confusing

The main source of anxiety: granulation tissue can look alarming if you do not know what it is. It is red, moist, and bleeds easily — all of which trigger worry. People frequently describe searching online, seeing images, and becoming more anxious rather than less.

The reassurance from many accounts: granulation tissue in a fistula wound is expected and normal. If you are concerned about its appearance, a quick check with your surgical team can confirm whether healing is progressing as expected.

If something about your recovery does not feel right, or you just want reassurance about what is normal, our chat can help you think it through.

When to contact your doctor

Seek medical attention if you experience:

Increasing pain, swelling, or redness near the anus
Fever or chills
Pus or foul-smelling discharge
New or worsening symptoms after surgery

When to seek care Heavy bleeding or feeling faint: emergency. Fever or trouble passing urine: call today. Emergency: 911

Not sure how urgent it is? Get help today.

Emergency
Heavy bleeding, black tarry stools, feeling faint, severe pain or trouble breathing.

Call 911 or go to the ER.
Today
Fever, pain getting worse, a hot swollen lump, or trouble passing urine.

Call your doctor or go to urgent care.
Soon
Bleeding or bowel changes nobody has checked, or anything lasting 3 weeks.

Book a doctor’s appointment.

Feeling overwhelmed? Call or text 988, any time.

See all the signs

For this topic, get medical advice if you notice:

Severe or worsening pain
Heavy bleeding
Fever
Black stools
Fainting or dizziness
Pus or unusual discharge
Inability to pass stool or gas
Unexplained weight loss

Recording how you feel is not the same as being checked. These are the signs that need a doctor’s attention.

Call 911 or go to the emergency room now if you have:

bleeding that will not stop, a lot of blood (the toilet water turns red, or you pass large clots), or any bleeding with feeling faint or dizzy
fainting, a racing heart or trouble breathing
confusion or slurred speech, extreme shivering, no urine in a day, or blotchy skin
sudden severe belly pain, or a swollen, hard belly with vomiting or not passing stool or gas
you cannot pass urine at all, or your bladder feels full and painful and you can’t empty it
redness, swelling or severe pain spreading quickly around your anus, genitals or groin, especially with a fever or feeling very ill
a fever with a painful swelling near your anus if you have diabetes or a weakened immune system (for example, from chemotherapy or transplant medicines)
black, tarry stools

Call your doctor or go to urgent care today (or the ER if you can’t be seen today) if you have:

a temperature of 100.4°F (38°C) or higher, chills, vomiting, or feeling generally unwell
pain that is getting worse over days, or severe pain that stops you sitting or sleeping
a hot, swollen or very tender lump near your anus or at the top of the crease between your buttocks, or foul-smelling discharge
trouble urinating
bleeding that is getting heavier or more frequent, or blood mixed into your stool
feeling much more tired than usual, looking pale, or getting out of breath more easily than you used to
not passing stool for several days, or new belly pain

Make an appointment with your doctor if:

you have never had these symptoms checked by a doctor or nurse — whatever your age
you have had rectal bleeding for more than 3 weeks
your bowel movements have been looser, thinner or more frequent than usual for 3 weeks or more, or you have lost weight without trying
symptoms have not settled after a week or so, or keep coming back
you notice a new lump near your anus, between your buttocks or in your belly, or an itch or discharge that does not clear
you have new leakage or trouble controlling your bowels
you are 45 or over, or have a family history of bowel cancer or inflammatory bowel disease, and any of these symptoms are new for you

If you are unsure, it is always reasonable to ask. If things feel overwhelming, call or text 988 (Suicide & Crisis Lifeline) or chat at 988lifeline.org, any time. If you don’t feel safe, call 911.

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