Is it normal for a fistulotomy wound to smell?

Some degree of odour from a healing fistulotomy wound is common and usually normal. The wound is in an area near the bowel, it is healing by secondary intention (open), and there is drainage. A mild wound odour that is not accompanied by fever, increasing pain, or worsening discharge is typically part of normal healing.

When does the smell indicate a problem?

A significantly foul, worsening, or newly different smell — particularly if accompanied by fever, increased pain, swelling, redness, or a change in the colour of the discharge — may indicate infection. Contact your surgical team if you notice this combination of changes.

How can I manage the odour?

Regular sitz baths keep the wound clean and reduce odour. Changing gauze pads frequently helps. Keeping the area dry between changes reduces bacterial growth. Some people find that showering the area with warm water two to three times a day makes a significant difference.

How long does the smell last?

Mild wound odour typically reduces as the wound heals and drainage decreases. For most people, the noticeable smell has largely resolved by three to six weeks, though this depends on the size and depth of the wound.

Fistulotomy smell: is it normal?

At a glance

Wound odour after fistulotomy is one of the most common concerns people have during recovery — and one of the least discussed. The wound is left open to heal from the inside out, it is in close proximity to the bowel, and it produces drainage. Some smell is expected. But knowing the difference between normal healing odour and a sign of infection is important.

Why fistulotomy wounds have an odour

Several factors contribute:

Location — the wound is near the anal area, where bacteria are naturally present
Open wound healing — the wound is not stitched closed, so it is exposed to the environment
Drainage — wound fluid (serous or serosanguinous) has a natural mild odour
Gauze and packing — wound packing that sits in a warm, moist environment can develop an odour between changes
Proximity to bowel movements — even with careful cleaning, small amounts of stool can contact the wound area

Normal versus concerning odour

Normal

A mild, slightly musty or wound-like smell
Odour that is most noticeable when changing gauze or packing
Smell that reduces after cleaning or a sitz bath
Consistent — not suddenly changing or worsening
Not accompanied by fever, increasing pain, or dramatic changes in discharge

Potentially concerning

A distinctly foul or putrid smell — different from the baseline wound odour
Odour that is getting worse over days
Accompanied by green or yellow discharge that is increasing
Accompanied by fever, chills, or feeling generally unwell
Accompanied by increasing pain or redness around the wound
A sudden change in smell character

Managing wound odour

Keep the wound clean

Sitz baths after every bowel movement — warm water, no additives needed
Additional sitz baths or gentle showers one to two times daily
Pat dry thoroughly — moisture promotes bacterial growth

Change dressings regularly

Gauze or wound packing should be changed at least once or twice daily, and after any bowel movement
Damp gauze left in place for extended periods will develop more odour
Use clean, fresh gauze each time

Wound care basics

No soap, antiseptic, or fragranced products in or near the wound
Warm water only for cleaning
Let the wound air dry when possible — after a sitz bath, before applying fresh gauze
Wear loose, breathable underwear

Practical tips for managing odour in daily life

Keep spare gauze and underwear with you when out
Change gauze before social situations
Dark underwear reduces anxiety about visible drainage
A small, discreet bag with supplies makes workplace or travel management easier

When to contact your surgical team

Contact your surgical team or GP if:

The smell is distinctly foul and getting worse
You develop a fever (temperature above 38 degrees C)
Pain is increasing rather than gradually decreasing
Discharge becomes thick, green, or significantly increased in amount
Redness is spreading around the wound
You are concerned — wound assessment is a routine part of post-operative care, and your team expects these calls