Post-Surgery Concerns: Recovery After Hemorrhoid and Fissure Surgery

Postoperative issues..?

Hello, Doctor! I had surgery on July 5th for a mixed hemorrhoid and anal fissure.
I experienced severe diarrhea in April, which caused a rupture in the mucosal lining on the right side.
I tried various ointments and sitz baths, but nothing worked, so I opted for surgery.
Since I had an external hemorrhoid excision, there are sutures on the outside, which are said to be absorbable.
The mucosal wound has become a chronic wound with scarring, so I often experience pain.
The doctor performed debridement and relaxation of the mucosal area, then sutured the wound with thick absorbable sutures.
I take sitz baths multiple times a day to reduce pain and swelling.
After nearly a week, although the external sutures are thick, it seems that the right side has come loose! The internal sutures should still be intact.
There are sutures on both sides of the anal opening, and currently, the right side towards the anal opening has come loose.
The doctor mentioned that thicker sutures were used to prevent them from breaking shortly after bowel movements.
The internal sutures on the right side cause pain when walking due to friction, but I’m unsure why the external sutures on the right side came loose.
The nurse said that the absorbable sutures start to dissolve in 7-10 days, and mine came loose in less than a week...
Could it be due to the frequent sitz baths? The external suture site on the right side shows noticeable swelling, feels hard when pressed, and is painful, while the other areas have reduced swelling.
I’m unsure what’s happening here...
The area where the sutures came loose also has a noticeable indentation! Is this normal? How long does it take for all the sutures to be fully absorbed? Does complete absorption indicate that the wound has healed? I’m particularly concerned about the internal sutures; aside from sitz baths and applying ointment, there’s not much I can do.
Any contraction of the anal sphincter causes pain due to the sutures, and I can’t walk too quickly, so I can only relax.
Lastly, once the mucosal sutures are fully absorbed, will there be new scar tissue that causes pain again? Thank you, Doctor!

ken, 40~49 year old female. Ask Date: 2016/07/11

Dr. Ke Fangxu reply Surgery

1.
The sutures from hemorrhoid surgery typically dissolve after one week; however, early detachment is also common and does not affect wound healing.
2.
The surgical site usually takes about two weeks to reduce swelling, and complete healing may take a month.
It is normal to experience mild swelling and pain at this stage, and there is no need to worry about the indentation where the sutures have fallen out; the wound will heal properly.
3.
As long as there is no severe pain or significant bleeding after the surgery, there is no cause for concern.
Worrying about the physiological mechanisms related to tissue repair and absorbable sutures is unnecessary.
Please continue with sitz baths, maintain a healthy diet and bowel habits, and try to relax; in another week, these postoperative symptoms should improve significantly.

Reply Date: 2016/07/11

More Info

After undergoing surgery for hemorrhoids and anal fissures, it is common to have concerns about recovery and the healing process. Your experience, particularly with the pain and the condition of your stitches, is not unusual, and I will address your questions and concerns based on medical knowledge.

Firstly, it is important to understand that the recovery process after such surgeries can vary significantly from person to person. The use of absorbable sutures is standard practice, especially in delicate areas like the anal region. These sutures are designed to dissolve over time, typically within a few weeks to months, depending on the type of material used. The fact that you noticed the external sutures appearing to fall out within a week is not necessarily alarming, especially if they are absorbable. However, it is crucial to monitor the area for signs of infection or improper healing.

The swelling and hardness you describe around the right side of the anal area could be due to several factors, including inflammation from the surgery, the healing process, or even a localized reaction to the sutures. It is not uncommon for the surgical site to feel tender and swollen, particularly in the first few weeks post-operation. The pain you experience when walking or during bowel movements is also typical, as the area is still healing and may be sensitive.

Regarding your concern about the internal sutures, it is essential to follow your doctor's advice on care, including sitz baths, which can help soothe the area and promote healing. While excessive soaking may not directly cause the sutures to dissolve prematurely, it can contribute to increased sensitivity and discomfort if the area becomes overly moist or irritated.
As for the timeline for suture absorption, it generally takes about 7 to 14 days for external sutures to start dissolving, while internal sutures may take longer, sometimes up to several weeks. The complete healing of the wound does not solely depend on the absorption of the sutures; it also involves the formation of new tissue and scar formation. It is normal for scar tissue to develop, and while it may be sensitive initially, many patients find that the discomfort diminishes over time as the area heals.

If you are experiencing significant pain, persistent swelling, or any signs of infection (such as increased redness, warmth, or discharge), it is crucial to contact your healthcare provider. They may want to assess the area to ensure that there are no complications, such as an abscess or improper healing.

In summary, while your concerns are valid, many aspects of your recovery are typical for this type of surgery. Continue to follow your post-operative care instructions, including pain management and hygiene practices. If you have any doubts or if your symptoms worsen, do not hesitate to reach out to your healthcare provider for further evaluation and guidance. Your recovery is a process, and with proper care, you should see improvement over time.

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