Post-Hemorrhoid Surgery: Managing Constipation and Anal Narrowing Concerns

Concerns about constipation and anal stenosis after hemorrhoid surgery?

Hello Doctor: I underwent hemorrhoid electrosurgical excision in early December.
I had constipation prior to the surgery, but I was consistently taking the stool softeners prescribed by my doctor and diligently doing sitz baths.
After about 4 to 5 days, I started to have bowel movements more easily! However, about three weeks later, I finished the stool softeners and, fearing dependency, I stopped taking them.
At this point, I began to experience difficulty with bowel movements! During a follow-up visit, the surgeon said it was not due to anal stenosis and advised me to drink more water.
He also prescribed a bottle of docusate sodium along with stool softeners, assuring me that things would gradually improve! After that, I did notice some improvement.
However, I started to realize that my stools were very thin, sometimes resembling slightly thicker worms, which made me worry that it might indeed be a problem related to stenosis! In the last few days (I am still taking docusate sodium), I have started to have difficulty again! I can only pass a small amount at a time! If the stool is even slightly thicker (about the thickness of a thumb, approximately 1.5 to 2 cm), I have to exert a lot of effort to pass it! I can only manage to expel a little before I feel too fatigued to continue.
Each day, my stools become harder, my abdomen feels more distended, and the urge to go becomes more frequent! I would like to ask the doctor...
could this be anal stenosis? Since I am gay, can I use some lubricants to help ease the passage? I apologize for writing so much! Thank you for your help.

Nìmíng shì, 30~39 year old female. Ask Date: 2017/01/13

Dr. Ke Fangxu reply Surgery

Anal stenosis refers to the narrowing of the anal canal caused by excessive scarring and contraction of skin tissue following hemorrhoid surgery.
Common symptoms include difficulty in bowel movements accompanied by severe pain.
Diagnosis of anal stenosis typically requires a physician's digital examination, and in severe cases, even a finger may not be able to be inserted.
If stenosis occurs, dilators can be used to gradually widen the anal canal, or an analoplasty may be performed to enlarge the anal opening.
Lubricants commonly used include KY Jelly or petroleum jelly.

Reply Date: 2017/01/13

More Info

After undergoing hemorrhoid surgery, managing constipation and concerns about anal narrowing can be quite challenging. It’s important to understand that post-operative changes in bowel habits are common, and several factors can contribute to these issues.

Firstly, constipation is a frequent problem after any abdominal or pelvic surgery, including hemorrhoidectomy. The pain and discomfort associated with bowel movements can lead to a fear of straining, which can exacerbate constipation. It’s good to hear that you were initially using stool softeners and taking measures like sitz baths, which are beneficial for promoting healing and easing discomfort.

The fact that you experienced a temporary improvement after resuming stool softeners suggests that your body may still require assistance in maintaining regular bowel movements. It’s crucial to stay hydrated and consume a high-fiber diet to help soften stools naturally. If you’re concerned about becoming reliant on stool softeners, consider gradually reducing their use while simultaneously increasing your fiber intake and water consumption.

Regarding your concerns about anal narrowing, it’s essential to differentiate between actual narrowing (stricture) and the sensation of difficulty in passing stools. The observation that your stools are thin, resembling a worm, can be alarming and may lead you to believe that narrowing is occurring. However, this can also be a result of the stool consistency and the pressure dynamics during defecation. If your doctor has assessed that there is no narrowing, it’s worth trusting their evaluation, but it’s also valid to seek a second opinion if your symptoms persist.

You mentioned that you have been experiencing increased difficulty with bowel movements, especially with larger stools. This could indicate that your bowel habits need further adjustment. Using lubricants can be helpful, but it’s essential to use products that are safe for anal use and to avoid anything that could irritate the area post-surgery. Additionally, if you are considering using lubricants to facilitate bowel movements, consult your healthcare provider for recommendations on safe options.

If you continue to experience significant discomfort or changes in your bowel habits, it may be beneficial to consult a gastroenterologist or a colorectal specialist. They can perform a thorough evaluation, including a physical examination and possibly imaging studies, to rule out any structural issues and provide tailored advice for your situation.

In summary, managing constipation after hemorrhoid surgery involves a combination of dietary changes, hydration, and possibly the continued use of stool softeners. Monitoring your symptoms closely and maintaining open communication with your healthcare provider is crucial. If you have ongoing concerns about anal narrowing or bowel function, don’t hesitate to seek further evaluation. Your comfort and health are paramount, and addressing these issues proactively can lead to better outcomes.

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