My father had incision and drainage, अ, around seven days back for an abscess around the anal region. And now it's not healing properly, I guess, because he has complained of continuous, अ, leakage of... Watery. Substance from the draining site. Is already taking vitamin C, vitamin B complex. What other medication can help this to heal?
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My father had incision and drainage, अ, around seven days back for an abscess around the anal region. And now it's not healing properly, I guess, because he has complained of continuous, अ, leakage of... Watery. Substance from the draining site. Is already taking vitamin C, vitamin B complex. What other medication can help this to heal? He's also applying quercetin acid cream. And the pain is still per- still persistent. The pain only relieves when he takes medications like paracetamol.
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"perianal abscess" AND "fistula" AND management
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I now have comprehensive information from authoritative surgical textbooks. Here is a thorough, honest answer:
Important: This is Likely Not a Healing Problem - It's a Fistula
Please read this carefully before focusing on supplements or creams.
What is almost certainly happening
Continuous watery/seropurulent discharge from a perianal abscess drainage site at 7 days, combined with persistent pain, is a classic presentation of fistula-in-ano. This is not a failure of vitamins or wound care - it is a structural problem requiring surgical management.
From Harrison's Principles of Internal Medicine (2025): "Patients experiencing continuous drainage at 1 month following the treatment of a perianal abscess likely have an anal fistula." - in clinical practice, continuous drainage starting this early (within days of I&D) is even more concerning.
From Sabiston Textbook of Surgery: "Approximately 50% of patients with a history of perianal abscess will ultimately develop fistulae." The discharge you describe - chronic wound with ongoing drainage - is exactly how fistula-in-ano presents.
What a fistula-in-ano is
After an abscess is drained, the original infected anal gland may create a persistent channel (fistula tract) connecting the inside of the anal canal to the skin opening. This tract does NOT close with time, supplements, or topical creams. It requires surgical treatment.
What your father needs RIGHT NOW
He needs to go back to his surgeon immediately. Here is why:
-
The drainage is coming from a persistent fistula tract, not from normal wound healing. No amount of Vitamin C, B-complex, or topical cream will close a fistula.
-
A physical examination is needed to check if:
- The abscess has recurred or incompletely drained
- A fistula tract has formed
- There is spreading infection (cellulitis, necrotizing fasciitis - rare but serious)
- Crohn's disease needs to be ruled out (especially if there are any GI symptoms)
-
Surgical options the surgeon will likely discuss:
- Seton placement - a thread placed through the tract to keep it draining safely while inflammation settles (first-line)
- Fistulotomy - surgical laying-open of the tract (for low/superficial tracts)
- MRI pelvis with fistula protocol - if the tract anatomy is unclear
- Examination under anesthesia (EUA) - the gold standard for evaluation
Regarding medications
| Medication | Role | Verdict |
|---|---|---|
| Paracetamol | Pain relief | Appropriate - continue |
| Vitamin C | Wound healing support | Fine but won't fix a fistula |
| Vitamin B complex | General nutrition | Fine but won't fix a fistula |
| "Quercetin acid cream" | Topical anti-inflammatory | No evidence this helps perianal fistulas; not a standard treatment |
| Antibiotics (e.g. metronidazole + ciprofloxacin) | Can reduce inflammation around a fistula | Only useful if a fistula is confirmed AND particularly if Crohn's disease is involved - must be prescribed by a doctor after examination |
| NSAIDs (e.g. ibuprofen) | Better anti-inflammatory pain relief than paracetamol alone | Can be added for pain if no contraindications, under doctor guidance |
From Maingot's Abdominal Operations: "Attempts at treating purulent collections with antibiotics alone are invariably unsuccessful." Antibiotics are NOT the answer without proper drainage/surgical management.
Practical steps to take TODAY
- Call the operating surgeon - describe the continuous discharge and persistent pain. This warrants an urgent review appointment, not a "wait and watch."
- Warm sitz baths (sitting in warm water for 10-15 minutes, 2-3 times daily) - these genuinely help with pain and hygiene around the wound. This is a standard recommendation from Sabiston Textbook of Surgery.
- Fibre and fluids - soft stools reduce strain and pain during bowel movements. A bulk-forming supplement (like ispaghula/psyllium husk) can help.
- Keep the area clean and dry between sitz baths - use soft gauze pads to absorb discharge.
- Paracetamol can be continued as needed for pain.
Red flags - go to emergency if any of these develop
- Fever > 38.5°C
- Rapidly spreading redness/swelling around the anal region
- Severe worsening pain
- Signs of systemic illness (chills, feeling very unwell)
These could indicate necrotizing fasciitis or spreading sepsis, which is a surgical emergency.
Bottom line: The watery discharge and persistent pain 7 days after I&D are not signs of poor nutrition or inadequate topical treatment. They are signs of a fistula tract that needs surgical evaluation. No supplement or cream will resolve this. Please get him back to his colorectal/general surgeon as soon as possible.
Sources: Harrison's Principles of Internal Medicine 22E (2025), Sabiston Textbook of Surgery, Maingot's Abdominal Operations; European Society of Coloproctology guidelines on anal fistula (2024, PMID 38050857)
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