Post-Hemorrhoid Surgery: Granulomas and Recovery Concerns

Granuloma after hemorrhoid surgery

Hello Dr.
Ke,
I would like to ask you a couple of questions.
It has been about two months since my hemorrhoid surgery, during which the doctor mentioned that a harmonic scalpel was used.
I have had three follow-up appointments since the surgery, and each time there has been an issue with granulation tissue.
The doctor addressed this with electrocautery.
About two weeks ago, during my last follow-up, I was told that the granulation tissue had scabbed over and should not reappear.
However, I have been feeling some discomfort in my anal area over the past couple of days, and it seems that granulation tissue may be returning.

I would like to ask the following questions:
1.
Is it common to have persistent granulation tissue after surgery, and can it be completely resolved?
2.
Is it normal to experience slight bleeding when wiping with toilet paper?
Thank you for taking the time to address these questions.

Xiao Lin, 30~39 year old female. Ask Date: 2016/09/02

Dr. Ke Fangxu reply Surgery

1.
The occurrence of granulomas after hemorrhoid surgery is often due to uneven suturing of the wound.
If there is no discomfort, it can be ignored, and topical ointments may be used.
However, if granulomas persist, it may be necessary to consider the possibility of an anal fistula formation.

2.
The surgical wound from hemorrhoid surgery typically takes about one month to heal completely.
It is less common for bleeding to continue for up to two months.
However, if there is ongoing electrocautery treatment due to granulomas, it may delay the healing process of the wound.

Reply Date: 2016/09/02

More Info

Post-hemorrhoid surgery recovery can be a complex process, and it's not uncommon for patients to experience issues such as granulomas and discomfort during their healing journey. Let's address your concerns regarding the recurrence of granulomas and the presence of slight bleeding after wiping.

1. Granulomas After Surgery: Granulomas are a type of inflammatory tissue that can form as part of the healing process after surgery. They are typically a response to irritation, infection, or foreign bodies, and in the case of hemorrhoid surgery, they can occur due to the surgical technique used, the healing environment, or even the patient's individual healing response. The use of ultrasound knives (harmonic scalpels) can sometimes lead to tissue changes that may predispose to granuloma formation.
It is not uncommon for patients to experience recurrent granulomas after hemorrhoid surgery, especially in the initial weeks to months post-operation. While they can be bothersome, they are generally manageable. Your doctor’s approach of using electrocautery to treat these granulomas is a common practice. The fact that your doctor mentioned the last granuloma has scabbed over is a positive sign, indicating that the body is healing. However, if you are experiencing discomfort and suspect the return of a granuloma, it is essential to follow up with your healthcare provider. They can assess the area and determine if further treatment is necessary.

In terms of whether granulomas can be completely cured, it largely depends on the underlying cause and the individual’s healing response. In many cases, with appropriate management, they can resolve completely. However, some patients may experience recurrent issues, and ongoing monitoring may be necessary.

2. Slight Bleeding After Wiping: Experiencing slight bleeding after wiping can be concerning, but it is not uncommon in the postoperative period following hemorrhoid surgery. The surgical site is still healing, and the tissues can be sensitive. If you are using toilet paper, the friction can sometimes irritate the area, leading to minor bleeding.
However, it is crucial to differentiate between minor spotting and more significant bleeding. If the bleeding is light and resolves quickly, it may not be a cause for alarm. Still, if you notice persistent bleeding, increased pain, or any signs of infection (such as fever, increased swelling, or discharge), you should contact your healthcare provider immediately. They may recommend gentle cleaning methods, such as using moist wipes or a sitz bath, to minimize irritation and promote healing.

In conclusion, while the presence of granulomas and slight bleeding can be concerning, they are not uncommon after hemorrhoid surgery. Continuous communication with your healthcare provider is essential for managing these issues effectively. They can provide personalized advice based on your specific situation and help ensure that your recovery progresses smoothly. Remember to prioritize gentle care of the surgical area and report any significant changes or concerns to your doctor. Your comfort and health are paramount during this recovery phase.

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