At a glance
The first week after a fistulotomy is widely described as the hardest part of recovery. The procedure leaves an open wound that will heal over several weeks, but those initial days — managing pain, navigating the first bowel movement, learning wound care, and adjusting to a body that needs rest — are what people remember most vividly.
This guide focuses specifically on what to expect during days one through seven. If you are looking for the broader recovery picture, our general fistulotomy recovery guide covers the full timeline. This page is about getting through the first week.
Before you leave the hospital
Most fistulotomies are day cases — you go home the same day. Before you leave, a few things typically happen:
- Pain relief kicks in. You will usually still have the benefit of local anaesthetic from the procedure. This can give a false sense of how manageable things will be.
- Wound packing. Some surgeons pack the wound with gauze or alginate dressing. Others leave it open. Both approaches are normal — your surgeon will explain what they did and why.
- Discharge instructions. You should receive written guidance on wound care, pain medication, when to bathe, and what to watch for. If you do not receive this, ask before you leave.
- Prescriptions. Make sure your pain relief and any prescribed stool softeners are filled before you get home. You will not want to make a pharmacy trip later.
People consistently say: have everything ready at home before you go in. Dressings, pain medication, soft foods, water within reach, a comfortable place to rest. The less you need to do when you get home, the better.
Day one: the anaesthetic wears off
The first day home is often a shock. The local anaesthetic that kept things comfortable at the hospital wears off — sometimes within hours, sometimes by the evening — and the reality of having an open wound in a very sensitive area arrives.
What people commonly describe:
- Pain that ranges from moderate to significant, often coming in waves
- A burning or throbbing sensation around the wound site
- Difficulty finding a comfortable position — sitting, standing, and lying down can all be uncomfortable
- Fatigue, partly from the general anaesthetic and partly from the stress response
- Anxiety about what is happening “down there” — the urge to look, combined with the fear of looking
What tends to help on day one:
- Taking pain relief on a schedule, not waiting until the pain becomes severe
- Lying on your side with a pillow between your knees
- Applying a cold pack wrapped in cloth near (not directly on) the wound area, if your surgeon has approved this
- Drinking plenty of water — hydration matters more than eating a full meal today
- Accepting that today is about rest, not productivity
Days two and three: the first bowel movement
For many people, the anxiety around the first bowel movement is the single most stressful part of the first week. This is entirely understandable. You have an open wound in the anal area and the idea of passing stool through it can feel genuinely frightening.
What people typically experience:
- The first bowel movement usually happens within one to three days
- Stool softeners (commonly lactulose or Movicol) help significantly — the goal is a soft, formed stool that passes without straining
- Many people describe the anticipation as worse than the reality
- There is often some pain during and immediately after, followed by a period of discomfort that gradually settles
- Some bleeding is normal — seeing blood on toilet paper or in the bowl is expected
- A warm sitz bath immediately after a bowel movement is one of the most consistently recommended strategies
What helps:
- Starting stool softeners as prescribed — ideally from the day of surgery
- Eating gentle, fibre-containing foods when you feel ready (not forcing it)
- Drinking water throughout the day
- Having a sitz bath prepared and ready to use immediately afterwards
- Breathing slowly and not bracing or clenching — this is easier said than done, but tension makes it harder
- Reminding yourself that this gets easier each time
Days three to five: wound care routine
By around day three, most people are establishing a daily wound care routine. The wound is open and will remain open for weeks — this is intentional and normal. Keeping it clean is the priority.
A typical wound care pattern people describe:
- Sitz baths two to three times a day, and after every bowel movement. Warm (not hot) water, sometimes with a pinch of salt. These soothe the area and help keep the wound clean.
- Dressing changes as needed — light gauze or a pad to protect clothing. The wound will produce discharge, particularly in the early days. This is part of the healing process.
- Gentle cleaning — most people use warm water rather than soap directly on the wound. Pat dry rather than wiping.
- No heavy lifting, straining, or vigorous activity. The wound needs rest.
What people describe at this stage:
- Pain is still present but often beginning to settle into a more predictable pattern
- Discharge is normal — it may be blood-tinged, yellowish, or clear. The key concern is if it becomes foul-smelling or looks like pus
- Sitting for long periods is uncomfortable. Many people use a donut-shaped cushion or lie on their side
- Sleep may be disrupted by discomfort or the need to change position
- Bowel movements are becoming slightly easier, though still anxiety-inducing
Days five to seven: settling in
By the end of the first week, most people describe a shift. The acute crisis feeling of the first few days has passed. Pain is still present but more manageable. The wound care routine feels more familiar. There is often a cautious sense that things are moving in the right direction.
What people commonly notice:
- Pain gradually becoming less intense, with the worst moments still tied to bowel movements
- More confidence in the wound care routine
- Beginning to feel more like themselves — some people manage short walks by day five or six
- The wound may look larger or more open than expected. This is normal. It heals from the inside out, and the visible wound is not a good indicator of how healing is progressing beneath the surface.
- Some people notice the wound “opening up” slightly after a bowel movement. This is common and typically closes back down as healing continues.
What to watch for:
- Pain that is getting worse rather than gradually improving
- Increasing redness, swelling, or warmth around the wound
- Discharge that becomes foul-smelling, thick, or green/yellow
- Fever — even a low-grade temperature warrants a call to your surgical team
- Bleeding that is heavy or not slowing down
Practical tips people wish they had known
These come up repeatedly in first-week accounts:
- Have supplies ready before surgery. Dressings, stool softeners, gentle wipes, comfortable underwear, a sitz bath basin, and easy meals.
- Sleep on a towel. Overnight discharge can stain bedding.
- Take the full course of pain relief. People who try to tough it out often regret it. Pain management is not a competition.
- Accept help. If someone offers to cook, shop, or handle things around the house — say yes.
- Do not Google images of healing fistulotomy wounds. This is mentioned surprisingly often. What you see online is not representative, and it fuels anxiety. Trust your surgical team’s assessment, not internet images.
- Expect emotional ups and downs. The combination of pain, anaesthesia recovery, limited mobility, and worry about healing creates a real emotional load. This is normal.
- It does get better. Almost universally, people describe week two as significantly easier than week one. The first week is the hardest part.
When to contact your doctor
Seek medical attention if you experience any of the following during the first week:
- Increasing pain, swelling, or redness around the wound — particularly after day three when things should be gradually improving
- Fever or chills
- Pus or foul-smelling discharge from the wound
- Heavy bleeding that soaks through dressings and does not slow down
- Inability to urinate — this can happen after anal surgery and may require attention
- New or worsening symptoms that concern you
If you are unsure whether something is normal, it is always better to call your surgical team and ask. They expect these calls in the first week and would rather hear from you than have you worry at home.