Medical Oncologist
CION Cancer Clinics
The perineal wound after APR: what healing looks like and how to care for it | CION Cancer Clinics
The perineal wound is the stitched cut between the buttocks where the anus used to be. After an APR it heals from the inside out over several weeks to a few months, far more slowly than the wound on the belly. Some discharge, tenderness and trouble sitting are expected. This page explains what is usual, how to look after it at home, and which changes need a same-day call. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
MM
Medically reviewed by Dr. Muralidhar MuddusettyConsultant Surgical Oncologist · MBBS (AIIMS), MS (Surgery, AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh) · last reviewed September 2026, next review due September 2027
17+specialists on panel
15,000+patients treated
35+centres across Telangana & AP
4.8★ / 800+Google rating
On this page
- What is the perineal wound, and how does it heal?
- What does the perineal wound usually do over time?
- How do you look after it at home?
- Words you will see, in plain language
- Four things families worry about, and what is actually true
- Why might yours be slower, and what can this page not tell you?
- Common questions about the perineal wound
The short answer
What is the perineal wound, and how does it heal?
The perineal wound is the cut between the buttocks where the anus used to be. After an APR it is closed with stitches, and it heals from the inside out over several weeks to a few months, much more slowly than the wound on the belly. Some discharge and tenderness along the way is expected, not a sign that something has gone wrong.
Why there is a wound there at all
An APR removes the rectum and the anus together, because the cancer sat too low for the anus to be kept. Once the anus is gone, the skin around it is stitched together and the space above it is left to fill in on its own. The bowel now empties through a colostomy on the belly, so nothing passes through this wound.
What healing looks like
Underneath the skin there is a space where the rectum was. The body fills it slowly with new tissue, and the skin closes over the top as that happens. Until then the wound may weep clear or pinkish fluid, feel firm or lumpy, and ache when you sit. If the pelvic floor muscles were also removed, the space is deeper and the process takes longer.
This page describes what is usual. It cannot tell you how long your own wound will take, and neither can anyone before it starts to heal.Week by week
What does the perineal wound usually do over time?
-
The first days in hospital
A dressing covers the wound and there is often a drain nearby, removed once it stops collecting. Nurses check the wound each day and show you how to lie on your side and get out of bed without pulling on it.
-
The first weeks at home
Stitches are usually taken out at a clinic visit, or dissolve on their own. Clear or pink discharge on a pad is common. The area is tender, and sitting for long is hard. Short walks help the wound more than bed rest does.
-
The first months
The wound gradually closes and the discharge tails off. If the skin has come apart in one spot, it is packed or dressed and left to fill in from the base, which takes longer but usually finishes on its own.
-
Later
Once closed, the scar may stay firm, numb or sensitive for a long time, and sitting on a hard surface can be uncomfortable for months. A closed wound that still aches is common.
Not sure whether this applies to you?
Ask an oncologistDay to day
How do you look after it at home?
Your discharge sheet is the final word.
Keep it clean, gently
Rinse with clean water in the shower or with a jug once a day and after any leakage. Pat dry with a clean, soft cloth. No rubbing, antiseptic liquids or powders unless the team gives them to you.
Dressings and pads
A simple pad in your underwear catches discharge and can be changed as often as needed. If the wound has been packed, a nurse will show a family member how to change it, or arrange visits.
Tell the team if
- The amount of discharge increases
- The colour turns green or brown
- The smell changes
Sitting and lying
Lie on your side rather than your back. Sit for short spells on a soft, flat cushion and lean slightly to one side. Avoid ring cushions, which stretch the wound edges apart.
Eating for healing
New tissue is built from protein. Include dal, eggs, milk, curd, paneer, fish or chicken at every meal, and keep drinking water. If you have diabetes, keeping the sugar steady matters more now than ever.
!
The one thing that cannot wait
A fever together with a foul-smelling, thick or fast-increasing discharge, or the wound edges opening with bleeding, needs to be seen the same day. Ring the number on your discharge sheet or go to the nearest emergency department and say you have had rectal cancer surgery. Do not wait for the next clinic date, and do not start antibiotics from a pharmacy on your own.
Leave a number, we will call you
One field. No form to fill in, and no charge for the call.
On your discharge sheet
Words you will see, in plain language
- Perineum
- The area between the buttocks, between the genitals and the tailbone. The perineal wound sits here.
- Primary closure
- The wound was stitched shut at the end of the operation, rather than left open to heal from the base.
- Dehiscence
- The wound has come apart, in one spot or along its length. Partial dehiscence is common after an APR and is usually managed with dressings rather than more stitches.
- Sinus
- A narrow track from the skin down into the space where the rectum was, which keeps draining fluid. It needs review if it does not close.
- Granulation tissue
- The soft, red, bumpy new tissue that fills a healing wound from the base up. It bleeds easily when touched. This is healing, not infection.
Commonly believed
Four things families worry about, and what is actually true
"Discharge from the wound means it is infected."
Clear, pink or thin yellow fluid is part of a deep wound filling in and can go on for weeks. Infection looks different: thick, foul-smelling discharge, spreading redness, more pain and often a fever.
"The wound must not get wet until it has fully healed."
The opposite. Rinsing with clean water every day keeps the area clean and is one of the most useful things you can do. What the wound should not have is soaking in a tub, rubbing, or strong antiseptics that harm the new tissue.
"If it opens, it will have to be stitched again."
Usually not. A perineal wound that has partly opened is normally cleaned, packed or dressed and left to fill in from the base. Stitching it again would trap fluid inside. The team goes back to theatre only for a specific reason, and will explain it.
"Sitting will tear the wound open, so she should stay in bed."
Bed rest slows healing, weakens the legs and raises the risk of a clot. Short walks several times a day are better for the wound than lying still. Sitting is limited because it hurts, not because it will tear the stitches.
Being straight with you
Why might yours be slower, and what can this page not tell you?
Most people who have an APR had radiotherapy to the pelvis first, and radiotherapy leaves the tissue with a poorer blood supply for good. That alone makes this wound slower than any other wound you have had. It is the single most common reason a perineal wound takes months.
Other things that slow it
Diabetes, smoking, being underweight or short of protein, steroid tablets, and a wider operation that took the pelvic floor muscles. None of these mean the wound will not heal. They mean it needs more time and closer watching.
What this page cannot tell you
It cannot tell you how long your wound will take, whether it will open, or whether you will need a flap. It cannot tell you anything about the cancer, because the wound and the cancer are separate questions. A slow wound is not the cancer coming back.
If you are unsure whether a change is ordinary, send a photograph to your team rather than waiting for the next appointment.Questions we are asked
Common questions about the perineal wound
How long does the perineal wound take to heal after APR?
Usually several weeks to a few months, and longer if the area had radiotherapy, if the pelvic floor muscles were removed, or if the wound has partly opened. It is slower than the belly wound for everyone. Nobody can give you an exact date before it starts to heal.
Is it normal for fluid to keep coming out?
Yes, for a deep wound like this one. Clear, pink or thin yellow fluid on a pad is the space underneath filling in. What is not normal is thick, green or foul-smelling discharge, a sudden increase, or discharge with a fever. Those need a same-day call.
Can I bathe or shower?
Showering is encouraged, usually from the first days at home, and rinsing the area with clean water is part of keeping it clean. Sitting in a bucket bath or tub is best avoided until the team says the wound has closed, because soaking softens the new tissue.
Why does it hurt to sit, and how long will that last?
Because your weight rests exactly on the wound. Sitting is uncomfortable for weeks in most people and for months in some, especially on hard chairs, two-wheelers and long car journeys. A soft, flat cushion helps. Ring cushions do not, because they pull the edges apart.
Who changes the dressing at home?
For a simple closed wound, a pad in the underwear is enough and you can manage it yourself. If the wound has been packed, a nurse will teach a family member before discharge, or a home nursing visit can be arranged. Ask before you leave hospital rather than working it out at home.
Will the wound affect the stoma or the colostomy bag?
No. The colostomy is on the belly and the perineal wound is between the buttocks, and nothing passes between them. Stool comes out through the stoma only. If you see stool or gas coming from the perineal wound, that is unusual and needs to be reported the same day.
My father is diabetic. Does that change anything?
It makes steady sugar control more important than usual, because high sugar slows every stage of healing and raises the risk of infection. Keep his usual medicines as prescribed and check sugars as the team advises. Tell the treating doctor if readings are running high rather than changing a dose yourself.
When should I ask for the wound to be looked at?
Any time you are unsure. A photograph sent to the team is often enough to settle it. Ask for a review if the discharge changes colour or smell, the wound opens, a lump or bulge appears, or it has stopped improving for a few weeks. Fever with any of these is a same-day call.
Meet the Specialists
17+ senior cancer specialists. One panel for your case.
Trained at AIIMS, Tata Memorial, and leading international centres. Combined 150+ years of experience. Every complex case is reviewed by 3+ of them — together.
Medical Oncologist
Dr. C. Raghavendra Reddy
MBBS(Gold Medal), DNB(General Medicine), DM(Medical Oncology)(Gold Medal)
Medical Oncologist
Dr. Bharati Devi Gorantla
MBBS, MD(General Medicine), DM(Medical Oncology)(Adyar,Chennai), ECMO, MRCP SCE(UK)
Medical Oncologist
Dr. Owais Mohammed
MBBS, MD (General Medicine), DrNB (Medical Oncology), ECMO, MRCP SCE (Medical Oncology) (UK)
Medical Oncologist
Medical Oncologist
Surgical Oncologist
Dr. Muralidhar Muddusetty
MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
Surgical Oncologist
Surgical Oncologist
Surgical Oncologist
Dr. Vinay Mamidala
MBBS, MS(General Surgery), M.Ch(Surgical Oncology), FMAS, FARIS(Ongoing)
Surgical Oncologist
Radiation Oncologist
Radiation Oncologist
Radiation Oncologist
Hematologist
Surgical Oncologist
Dr. Vajja Sandeep Kumar
MBBS, MS (General Surgery), DrNB (Surgical Oncology), FALS Oncology
Surgical Oncologist
Want a specific doctor for your case? Mention them when booking.
Book Free ConsultationBook an appointment with our specialist
Share your name and number — we'll call you back within 30 minutes to schedule your consultation.
Sources
- Cancer Research UK — Surgery for bowel cancer
- NHS — Bowel cancer: treatment
- American Cancer Society — Surgery for rectal cancer
- Macmillan Cancer Support — Surgery for cancer
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Why the Perineal Wound Heals SlowlyThe reasons behind the slow course, and what helpsFlap Closure of the Perineal WoundWhen muscle and skin are moved in to close the gapSitting, Cushions and Comfort After APRPractical ways to sit, travel and rest while it healsPerineal Hernia After APRWhat a bulge in the perineum months later can meanWound, Stitches and ScarsGeneral wound care after any cancer operation
Talk to us
Worried about a wound that is not settling?
Send us a photograph and your discharge summary, or call the helpline. A surgical oncologist will tell you whether it needs to be seen and how soon. One helpline serves every CION centre.