Post-Surgery Rectal Bleeding: Causes and Solutions

Rectal bleeding

Hello Dr.
Ke, I had traditional hemorrhoid surgery last year, and it has been a year since then.
I have been experiencing intermittent rectal bleeding.
I have a bowel movement once a day, and often there is some blood on the stool, especially at the end.
This occurs even with soft stools.
Sometimes I feel a sharp pain, and sometimes I don’t.
Before the surgery, I had a colonoscopy that showed no issues.
The bleeding after the surgery has been troubling me.
When I do some light exercises and stretch, I feel pain, and my anus bleeds.
There is also bleeding after ejaculation.
Sometimes when I cough or sneeze, I feel something coming out.
When I wipe with toilet paper, I notice a yellowish mucus, which I feel is pus.
Occasionally, it even sticks to my underwear.
What is happening to me, and what should I do? In the past month, I have visited the proctology clinic twice and told the doctor that I sometimes have pus.
After examining me, the doctor said he didn’t see any pus (how can I explain to the doctor that it is pus?).
I have been using ointment and suppositories for a month.
The pain has decreased somewhat, but the pus and bleeding continue to occur repeatedly.
What should I do? Please help me with this.
Thank you.

Jin Yu, 40~49 year old female. Ask Date: 2016/06/16

Dr. Ke Fangxu reply Surgery

This situation is mostly caused by hemorrhoids or anal fistulas.
However, if a colorectal specialist has examined you and found no issues, it would be best to schedule a colonoscopy given your age.
Early detection and treatment are important if there are any problems.
If everything is normal, you can be reassured that what you observed as pus is not actually pus, but rather an increase in rectal secretions.

Reply Date: 2016/06/16

More Info

Understanding post-surgery rectal bleeding can be quite complex, especially after a hemorrhoidectomy, which is a common surgical procedure for treating hemorrhoids. It’s important to recognize that while some bleeding can be expected after such a surgery, persistent or recurrent bleeding, especially one accompanied by pain or discharge, warrants further investigation.

Causes of Post-Surgery Rectal Bleeding
1. Incomplete Healing: After a hemorrhoidectomy, the surgical site may take time to heal completely. If the tissue has not healed properly, it can lead to intermittent bleeding, especially during bowel movements.

2. Anal Fissures: These are small tears in the lining of the anus that can occur due to passing hard stools. They can cause sharp pain and bleeding, particularly after bowel movements.

3. Infection: Post-surgical infections can lead to pus formation, which may be mistaken for blood. If you are experiencing a yellowish discharge, it could be a sign of infection, even if the doctor did not observe pus during the examination.

4. Residual Hemorrhoids: Sometimes, if the hemorrhoids are not completely removed or if new ones develop, they can cause bleeding.

5. Fistulas: An abnormal connection between the rectum and the skin can develop after surgery, leading to discharge and bleeding.

6. Inflammation: The surgical site may remain inflamed for an extended period, leading to discomfort and bleeding.

Recommended Actions
1. Follow-Up with a Specialist: Since you have already seen a doctor twice and are still experiencing symptoms, it may be beneficial to seek a second opinion from a colorectal specialist. They may perform additional diagnostic tests, such as a flexible sigmoidoscopy, to get a better view of the rectal area.

2. Document Symptoms: Keep a detailed record of your symptoms, including when the bleeding occurs, the consistency of your stools, and any associated pain or discomfort. This information can be invaluable for your healthcare provider.

3. Dietary Adjustments: Ensure that you are consuming a high-fiber diet to prevent constipation and straining during bowel movements. This can help reduce the risk of fissures and promote healing.

4. Hydration: Drink plenty of fluids to help keep your stools soft.

5. Topical Treatments: Continue using any prescribed ointments or suppositories, as they can help soothe the area and promote healing. If you feel they are not effective, discuss this with your doctor.

6. Avoid Straining: During bowel movements, try to relax and avoid straining, as this can exacerbate bleeding and pain.

7. Pain Management: If you experience pain, over-the-counter pain relievers may help, but consult with your doctor before taking any new medications.

8. Physical Activity: While light exercise can be beneficial, avoid any strenuous activities that may aggravate your symptoms. Listen to your body and rest when needed.

Conclusion
Persistent rectal bleeding after hemorrhoid surgery can be concerning and should not be ignored. It is crucial to communicate openly with your healthcare provider about your symptoms, including any discharge that resembles pus. A thorough evaluation may be necessary to rule out complications such as infections or the development of new hemorrhoids. By taking proactive steps and maintaining open lines of communication with your healthcare team, you can work towards finding a solution to your ongoing symptoms.

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