Post-Surgery Concerns: Managing Hemorrhoid Recovery and Symptoms

Q: Post-Surgery Concerns: Managing Hemorrhoid Recovery and Symptoms

Answer： Neomycin ointment does not need to be applied deep into the anus. <br>Postoperative bleeding may be due to the wound not being fully healed or prolonged bowel movements. <br>As long as the bleeding is not excessive, it is not a major concern. <br>It is somewhat abnormal t

Two and a half months after hemorrhoid surgery?

Hello Dr.
Ko:
1.
Three months ago, after several days of straining during bowel movements, a small lump about the size of a fingernail protruded and was painful.
The outpatient physician diagnosed it as a fourth-degree hemorrhoid and scheduled surgery.
After the surgery, I have been attending regular follow-ups, and the doctor said everything is normal.
However, a month and a half later, I still experience bleeding when wiping after a bowel movement.
I wonder if this is related to the initial education I received, which only instructed me to apply medication (Xinhui ointment) to the anal area without addressing deeper inside? After the surgery, I have been taking daily sitz baths and drinking plenty of water, which causes me to wake up at night to urinate.
2.
Later, the doctor prescribed (Hiyu suppositories) for me, which I used in conjunction with the previous ointment for a month.
Recently, for the past ten days, after bowel movements, I have been gently wiping the anal area with toilet paper.
For the first two days, there was no bleeding, but on the third day, I exerted a little pressure to help it come out, and there was blood on the toilet paper (one area was yellow stool liquid, and another area was red blood).
The stool was partially formed and partially loose, and I did not see any blood in the stool.
For the next two days, there was no blood on the toilet paper, but then there was a little bit again (a small area of bright red blood).
Yesterday, I finished the suppositories and did not use any medication, but today after a bowel movement, there was blood all over when I wiped my anus.
Is it normal to still have bleeding after two and a half months?
3.
Additionally, I often experience irritating itching around the anal area.
What could be the cause of this? It seems to be worse after gently wiping with toilet paper or when lying in bed at night, but I notice it is less bothersome when sitting on a hard chair at work.
4.
Now, after the surgery, there are two small lumps, which seem to be larger than before, and they do not appear as smooth as they used to.
Will these lumps eventually decrease in size?

kk, 50~59 year old female. Ask Date: 2017/03/03

Dr. Ke Fangxu reply Surgery

Answer: Neomycin ointment does not need to be applied deep into the anus.
Postoperative bleeding may be due to the wound not being fully healed or prolonged bowel movements.
As long as the bleeding is not excessive, it is not a major concern.
It is somewhat abnormal to have bleeding during bowel movements after surgery, but factors such as the patient's constipation and the duration of bowel movements can significantly impact this.
Please maintain good bowel habits and observe the situation.
Anal itching may be caused by excessive wiping.
In addition to medication and ointment application, there are three important things to keep in mind: avoid scratching to prevent wound infection, temporarily avoid spicy foods to prevent capsaicin from irritating the skin, and refrain from using soap or body wash to clean the anus to avoid excessive removal of the skin's natural oils.
If these points are followed, improvement can generally be expected in about a week.
You may need to discuss this further with your surgeon, as they have not seen the pre- and post-operative conditions and are unaware of the specific type of surgery performed, so they may not be able to provide a definitive answer.

Reply Date: 2017/03/03

More Info

Post-surgery concerns regarding hemorrhoid recovery can be quite common, especially after a significant procedure like a hemorrhoidectomy. Your experience with ongoing symptoms such as bleeding, discomfort, and changes in the appearance of the anal area is understandably concerning. Let's break down your questions and provide some insights based on medical knowledge.

1. Ongoing Bleeding: It's not uncommon for patients to experience some bleeding after hemorrhoid surgery, especially if they are straining during bowel movements. The fact that you are still experiencing bleeding two and a half months post-surgery may indicate that the surgical site is still healing or that there may be other factors at play, such as the presence of residual hemorrhoidal tissue or anal fissures. The use of topical treatments like ointments is typically aimed at reducing inflammation and promoting healing, but they may not address deeper issues. It’s crucial to communicate this ongoing bleeding to your healthcare provider, as they may want to perform a physical examination or possibly a colonoscopy to rule out any complications.

2. Itching and Discomfort: The itching you are experiencing around the anal area can be attributed to several factors. It may be due to irritation from wiping, especially if you are using rough toilet paper or if there is residual moisture. Additionally, the healing process can lead to increased sensitivity in the area. If you are using topical medications, they can sometimes cause irritation as well. Maintaining good hygiene, using soft toilet paper, and considering the use of moisture-wicking products can help alleviate some of this discomfort. If the itching persists, it may be beneficial to discuss this with your doctor, as they might recommend a different treatment approach.

3. Changes in Appearance: The presence of two small lumps post-surgery could be a result of scar tissue formation or residual hemorrhoidal tissue. It’s not unusual for the area to look different after surgery, and in some cases, the tissue may take time to settle down. However, if these lumps are painful, growing, or causing significant discomfort, it’s essential to have them evaluated by your surgeon. They can determine whether these are normal post-operative changes or if further intervention is necessary.

4. Management and Follow-Up: Given your ongoing symptoms, it is critical to maintain regular follow-up appointments with your healthcare provider. They can monitor your healing process and make necessary adjustments to your treatment plan. In the meantime, consider dietary changes to ensure soft stools, such as increasing fiber intake and staying well-hydrated. This can help reduce straining during bowel movements, which is crucial for healing.

In summary, while some post-operative symptoms can be expected, persistent bleeding, discomfort, and changes in the anal area warrant further investigation. Open communication with your healthcare provider is key to ensuring a smooth recovery and addressing any complications that may arise. They can provide tailored advice and treatment options based on your specific situation.

Similar Q&A

Post-Surgery Concerns: Managing Bowel Issues After Hemorrhoid Surgery

Hello Dr. Ke: I am a long-term patient with hemorrhoids and also have issues with fistulas. I delayed treatment for a long time and finally underwent surgery in February of last year. I have been very worried about my recovery, but during several follow-up visits, my attending ph...

Dr. Ke Fangxu reply Surgery
After general anal surgery, we typically prescribe stool softeners for patients. If diarrhea occurs, the first step is to stop taking the stool softeners, as they can affect wound healing. Additionally, hemorrhoid ointment should be used to treat skin inflammation around the anal...

Post-Surgery Recovery: Managing Bowel Issues After Hemorrhoid Surgery

Hello Doctor, my father (79 years old) underwent minimally invasive surgery for hemorrhoids (PPH hemorrhoidectomy) on March 1st of this year. Due to his enlarged prostate issue, he had a urinary catheter for about a month post-surgery. For the first two months, he experienced fec...

Dr. Zhang Shuhao reply Surgery
Generally, hemorrhoidectomy wounds heal within a few weeks, and there should be no issues with incontinence. Benign prostatic hyperplasia may lead to short-term urinary difficulties post-surgery, but it does not affect bowel movements in the long term. Based on the description, t...

Post-Surgery Recovery Issues: Managing Pain and Bleeding After Hemorrhoid Surgery

Hello Dr. Ke, I underwent traditional hemorrhoid surgery in June 2015, during which both internal and external hemorrhoids were excised. However, my recovery has not been satisfactory. I have a regular bowel movement once a day, but I notice some blood on the stool, particularl...

Dr. Ke Fangxu reply Surgery
Mild bleeding within one month after hemorrhoid surgery is considered normal. During this period, it is recommended to avoid constipation and to take warm sitz baths frequently. However, if there is heavy bleeding or if the bleeding lasts longer than one month, it is important to...

Post-Surgery Concerns: Managing Symptoms After Hemorrhoid Surgery

Hello, I underwent surgery for hemorrhoids (stage III mixed hemorrhoids) at Chang Gung Memorial Hospital on September 20. After finishing the medication from Chang Gung on September 30, I noticed that my bowel movements have been loose and unformed since the surgery. Today, Octob...

Dr. Ke Fangxu reply Surgery
After hemorrhoid surgery, doctors typically prescribe stool softeners to prevent constipation. If bowel movements are too loose, it is recommended to discontinue the stool softeners. Symptoms of anal stenosis include difficulty in bowel movements accompanied by pain. Your situati...