Hello!
I'm currently 36 days post-op (wow seems like time really flew by!) and doing OK. I really haven't seen any significant progress since about 2 weeks ago at my followup appointment.
The area is still swollen where the sutures are. That's right - I still have one or two visible stitches that haven't dissolved/fallen out. I'm shocked by that, but if I even try to lightly pull on the most accessible one it hurts, so I think it must be a deep stitch and may just take longer to fall out. This could be because my fistula was in the posterior in the 5 o'clock position. This area tends to be harder to heal, I hear. As of the last few days I've had a little bit of blood, but I think it's where the last of the incision is still healing.
My biggest worry is that I have fluid building up under the skin where the sutures remain. I assume it's just new tissue fluid and it gets trapped because the area is stitched closed rather than truly laid open. I notice it swells more after a BM and drains the fluid mixed with some stool. That was happening back during post op appointment and the CRS said not to worry, it was normal, and he's the one that first told me he noticed the swelling and not to worry about that either.
Well, I have worried and because the swelling gets larger I will gently press on the outside edge of the swelling, sort of aiming to "push" anything out toward where I assume the incision is (in my rectum), and even the lightest pressure causes instant drainage and reduced swelling. In Saturday this past week I woke up to noticeably less swelling so that is encouraging, but the cycle is still occurring.
For now I'm not concerned enough to call the doctor. The fluid is not the infected kind, I have no other symptoms of infection and the stitches are still firmly in place so I think this is still just the healing process at work.
At 5 days - you're past the worst of it! Every day now will be a noticeable improvement. Keep it clean, dry, change any gauze you're using to catch drainage regularly and make sure to Sitz bath 2-3 times a day. Get plenty of rest, lots of water and fiber, and keep yourself regular with stool softeners. You'll be close to healing before you know it.
Best of luck!