Post-Surgery Rectal Bleeding: Should I Worry About New Hemorrhoids?

I have had surgery for resection, but recently I have been experiencing blood in my stool again?

Hello, Dr.
Ke: I had a traditional excision surgery for a mixed nevus in October of last year, but in the past couple of days, I've been experiencing a lot of blood in my stool, and it hurts when I have a bowel movement, requiring some effort to pass.
In severe cases, there is even dripping blood, but there is no blood on the toilet paper after wiping.
I had a follow-up appointment last month, and the doctor said there was no narrowing of my anus, but could this recent issue indicate the possibility of new internal hemorrhoids developing? Given my current condition, do I need to undergo another hemorrhoidectomy?

Niming, 20~29 year old female. Ask Date: 2017/01/28

Dr. Ke Fangxu reply Surgery

After hemorrhoid surgery, if good bowel habits are not maintained, hemorrhoidal bleeding can quickly recur.
The surgery does not completely remove the hemorrhoidal tissue; some must be left intact to maintain closure for gas and liquid.
Therefore, if constipation or prolonged bowel movements occur postoperatively, it is inevitable that hemorrhoidal bleeding may happen again.
It is recommended to avoid constipation during this period and to shorten the time spent on the toilet.
Warm sitz baths may also help alleviate symptoms.
Over-the-counter hemorrhoidal suppositories can be used, but laxatives should not be taken indiscriminately.
At this age, increasing dietary fiber and hydration should be sufficient.
If bleeding persists, it is best to consult a physician for evaluation.

Reply Date: 2017/01/28

More Info

Post-surgery rectal bleeding can indeed be concerning, especially after undergoing a procedure for hemorrhoids. Based on your description, it sounds like you are experiencing significant bleeding during bowel movements, accompanied by pain and straining. While it is possible that new hemorrhoids could be developing, there are several factors to consider before jumping to conclusions.

Firstly, it is important to understand that after a hemorrhoidectomy, the tissue in the anal region can be sensitive and may take time to heal completely. Straining during bowel movements, especially if you are experiencing constipation, can exacerbate the situation and lead to bleeding. The fact that you are experiencing pain and blood during bowel movements suggests that there may be irritation or inflammation in the anal area, which could be due to several reasons, including:
1. New Hemorrhoids: It is possible that new internal hemorrhoids could have developed, especially if you have been straining during bowel movements. Internal hemorrhoids can cause bleeding, particularly when passing stool.

2. Anal Fissures: These are small tears in the lining of the anus that can occur due to hard stools or straining. They can cause sharp pain and bleeding during bowel movements.

3. Residual Symptoms from Previous Surgery: Sometimes, after surgery, the area can remain sensitive for a while, and any irritation can lead to bleeding.

4. Infection or Inflammation: If there is any infection or inflammation in the area, it could also lead to bleeding.

Given that you have already had a follow-up appointment where the doctor indicated that there was no narrowing of the anal canal, it is essential to consider the possibility of new hemorrhoids or other complications. The absence of blood on the toilet paper after wiping suggests that the bleeding is likely coming from within the rectum rather than from an external source, which aligns with the possibility of internal hemorrhoids or fissures.

In terms of management, here are some steps you can take:
- Dietary Adjustments: Ensure you are consuming a high-fiber diet to soften your stools and reduce straining during bowel movements. Consider incorporating fruits, vegetables, whole grains, and plenty of fluids.

- Stool Softeners: Over-the-counter stool softeners can help ease bowel movements and reduce the need for straining.

- Warm Sitz Baths: Taking warm baths can help soothe the anal area and promote healing.

- Topical Treatments: Over-the-counter creams or ointments designed for hemorrhoids can provide relief from pain and discomfort.

- Monitoring Symptoms: Keep an eye on your symptoms. If the bleeding persists, worsens, or if you experience significant pain, it is crucial to seek medical attention.

As for whether you need another surgery, that decision should be made in consultation with your healthcare provider. They may recommend further evaluation, such as a digital rectal exam or anoscopy, to assess the situation more thoroughly. If new hemorrhoids are confirmed, treatment options may include non-surgical methods such as rubber band ligation or sclerotherapy, or surgical intervention if necessary.

In conclusion, while new hemorrhoids are a possibility, it is essential to evaluate all potential causes of your symptoms. Maintaining open communication with your healthcare provider and following their recommendations will be key in managing your condition effectively. If you have any doubts or concerns, do not hesitate to reach out to your doctor for further evaluation and guidance.

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