Post-Surgery Constipation and Concerns About Anal Stricture After Hemorrhoidectomy

Postoperative constipation and concerns about anal stenosis after hemorrhoid surgery?

Hello Doctor: I underwent hemorrhoid electrosurgical excision in early December.
I had constipation before the surgery, but I was continuously taking the stool softeners prescribed by my doctor and diligently doing sitz baths, so after about 4 to 5 days, I started to have more regular bowel movements.
However, about three weeks later, after finishing the stool softeners, I was afraid of becoming dependent on them, so I stopped taking them, which led to difficulties in bowel movements.
During a follow-up appointment, the surgeon said that there was no anal stricture 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, but I began to realize that my stools were very thin, sometimes resembling slightly thicker worms, which made me worry that it might not just be a matter of stricture.
Recently, even while continuing to take docusate sodium, I have started experiencing irregular bowel movements again.
I can only pass a small amount at a time, and if the stool is 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 defecate becomes more frequent.
I would like to ask the doctor if this could indicate anal stricture.
As a member of the LGBTQ+ community, can I use some lubricants to help ease the passage? Since my original surgeon said there was no issue, should I consider seeking a second opinion from another doctor? I apologize for the lengthy message, and I appreciate your help.

Nìmíng shì, 30~39 year old female. Ask Date: 2017/01/14

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, a dilator can be used for gradual expansion, or an analoplasty may be performed to enlarge the anal opening.
Lubricants commonly used include KY Jelly or petroleum jelly.

Reply Date: 2017/01/14

More Info

Post-surgery constipation and concerns about anal stricture after a hemorrhoidectomy are common issues that many patients face. It’s important to understand that after any surgical procedure involving the rectal area, such as a hemorrhoidectomy, changes in bowel habits can occur. This can be due to a variety of factors including pain, changes in diet, and the effects of anesthesia and pain medications.

Firstly, it’s good to hear that you have been proactive in managing your constipation by using stool softeners and engaging in sitz baths. These methods can help alleviate discomfort and promote bowel movements. However, it’s also understandable to be concerned about the potential for anal stricture, especially if you are experiencing narrow stools and difficulty with bowel movements.

Anal stricture refers to a narrowing of the anal canal, which can lead to difficulty in passing stool. While your surgeon has indicated that there is no stricture, it’s important to monitor your symptoms closely. The fact that you are experiencing thin stools and difficulty with bowel movements could be indicative of several issues, including:
1. Constipation: This is often the most common cause of hard, narrow stools. If you have stopped taking stool softeners, your body may be reacting to the lack of assistance in softening the stool. It’s crucial to maintain adequate hydration and fiber intake to help prevent constipation.

2. Dietary Changes: After surgery, patients often alter their diets, which can affect bowel habits. Ensure you are consuming enough fiber-rich foods such as fruits, vegetables, and whole grains.

3. Pain and Discomfort: Post-surgical pain can lead to a fear of bowel movements, causing you to hold back. This can result in harder stools that are more difficult to pass.

4. Psychological Factors: Anxiety about bowel movements, especially after surgery, can also contribute to constipation.

Regarding the use of lubricants, while they can help ease the passage of stool, it’s essential to consult with your healthcare provider before using any products, especially if you have concerns about stricture. Your doctor may recommend specific lubricants that are safe for your situation.

If your symptoms persist or worsen, it may be beneficial to seek a second opinion from another healthcare provider. They can perform a thorough examination, possibly including an anoscopy or other diagnostic tests, to assess for any strictures or other complications.
In the meantime, continue to focus on hydration, dietary fiber, and possibly reintroducing stool softeners if necessary. Regular follow-ups with your healthcare provider are crucial to ensure that your recovery is on track and to address any new concerns that may arise.

In summary, while your concerns about anal stricture are valid, it’s essential to consider the broader context of your recovery. Maintaining open communication with your healthcare team and addressing any changes in your symptoms promptly will help ensure a smoother recovery process.

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