Post-Surgery External Hemorrhoids: When to Consider Another Procedure?

Postoperative external hemorrhoids at the anal opening?

Hello Doctor: I underwent a hemorrhoidectomy on November 5th, and it has been a month since the surgery.
There are still four to five external hemorrhoids at the anal opening.
Generally, I don't feel discomfort unless I apply pressure, but after a bowel movement, the hemorrhoids swell up to the size of a pinky finger and only slightly reduce in size the following day.
Given this situation, do I need to consider another surgery to remove the external hemorrhoids?

gordon, 50~59 year old female. Ask Date: 2016/12/05

Dr. Ke Fangxu reply Surgery

The disadvantage of circumferential excision is that it is not very effective in removing external hemorrhoids.
If the swelling of the hemorrhoids is severe enough to affect daily activities, a repeat excision surgery may be necessary; otherwise, observation may be an option.

Reply Date: 2016/12/05

More Info

After undergoing a circumferential hemorrhoidectomy on November 5, it is understandable to have concerns about the presence of external hemorrhoids one month post-surgery. The situation you describe, where external hemorrhoids swell significantly after bowel movements and take time to subside, is not uncommon. However, whether or not you need another procedure to address these external hemorrhoids depends on several factors.

Firstly, it is essential to understand that external hemorrhoids can be a common occurrence after hemorrhoid surgery. The surgical procedure may lead to swelling and inflammation in the area, which can cause existing external hemorrhoids to become more prominent. If the external hemorrhoids are not causing significant pain, bleeding, or discomfort, it may not be necessary to pursue additional surgical intervention immediately.

However, if you are experiencing significant discomfort, persistent swelling, or if the external hemorrhoids are causing complications such as thrombosis (a blood clot within the hemorrhoid), then a follow-up consultation with your surgeon or a gastroenterologist is warranted. They can assess the situation and determine whether another surgical procedure is necessary or if conservative management is more appropriate.

In terms of conservative management, there are several strategies you can consider to alleviate symptoms and promote healing. These include:
1. Dietary Adjustments: Ensure you are consuming a high-fiber diet to prevent constipation and reduce straining during bowel movements. Foods rich in fiber include fruits, vegetables, whole grains, and legumes. Staying well-hydrated is also crucial.

2. Sitz Baths: Taking warm sitz baths can help soothe the anal area, reduce swelling, and promote healing. Aim for 10-15 minutes several times a day, especially after bowel movements.

3. Topical Treatments: Over-the-counter creams or ointments specifically designed for hemorrhoids can provide relief from discomfort and itching. Look for products containing hydrocortisone or witch hazel.

4. Avoid Straining: When using the bathroom, avoid straining or sitting for prolonged periods. If you feel the urge to go, try to respond promptly rather than waiting, as this can lead to harder stools.

5. Pain Management: If you are experiencing pain, over-the-counter pain relievers like acetaminophen or ibuprofen can help manage discomfort.

If, after trying these conservative measures, you find that the external hemorrhoids continue to cause significant issues, or if they worsen, it may be time to discuss surgical options with your healthcare provider. Surgical options may include excision of the external hemorrhoids or other procedures aimed at reducing symptoms.

In conclusion, while the presence of external hemorrhoids post-surgery can be concerning, it is essential to evaluate the severity of symptoms and the impact on your quality of life. Consulting with your healthcare provider will help determine the best course of action, whether it be conservative management or further surgical intervention. Remember, each case is unique, and your healthcare provider will be able to tailor advice to your specific situation.

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