Post-Surgery Concerns: Managing Hemorrhoid Surgery Recovery Challenges

Postoperative Issues Related to Hemorrhoid Surgery

Hello Dr.
Ke, I underwent a complete excision of internal and external hemorrhoids (using a tissue coagulator) in early January of this year, and it has been almost three months since the surgery.
I have been taking magnesium oxide stool softeners postoperatively.
In the fifth week after surgery, when I tried to reduce the magnesium oxide from four capsules a day to two, I found that I had to strain excessively to have a bowel movement, to the point where I felt like my head was going to explode.
During a follow-up visit with the surgeon who performed the operation, the doctor indicated that a digital examination could be performed (which was very painful), and stated that it was not a stricture, and continued to prescribe magnesium oxide.
Concerned about my condition, I consulted another colorectal specialist, who noted the presence of scar tissue and signs of stricture, prescribed Lactulose, discontinued magnesium oxide, and performed dilation with a dilator in the eighth week post-surgery, although the treatment lasted only three minutes.
During this time, I also attempted to dilate myself with my finger and tried stopping Lactulose for two days, but I still had to strain excessively to have a bowel movement, so I continued taking it.
After consulting a third physician, they suggested that if I did not want to rely on medication, I should consider surgery to incise the internal anal sphincter to enlarge the anal diameter.
I then returned to the original surgeon, who reiterated that a digital examination could be performed without it being considered a stricture, and advised against further surgery, recommending continued use of Lactulose.

I would like to ask Dr.
Ke:
1.
What are the diagnostic criteria for anal stricture? Different physicians have varying opinions; whom should I trust?
2.
I am very concerned about hard stools causing anal fissures.
I am currently taking Lactulose, half to one packet a day, and my stool width is about the size of my index finger.
The medication's instructions indicate it contains a mild stimulant laxative, and I am worried about the long-term safety of its use.
Can Lactulose be used long-term?
3.
When I stop taking Lactulose, I have to strain a lot, my stools become thinner, and the frequency increases, making life very inconvenient.
If Lactulose cannot be used long-term, are there other safer stool softeners that can be used long-term? My diet is already high in fiber with plenty of fruits and vegetables, and I drink 2500cc of water, so I feel there is limited room for dietary improvement.
4.
Will long-term use of stool softeners worsen the degree of stricture?
5.
How should I choose between lifelong use of stool softeners and undergoing surgery again? What potential complications are associated with the method suggested by the third physician? Will incising the sphincter lead to scarring that could cause further stricture?
Thank you for taking the time to read my many questions, and I appreciate your response.

Youxin de ren, 40~49 year old female. Ask Date: 2017/04/02

Dr. Ke Fangxu reply Surgery

1.
A normal anus should be able to accommodate four fingers under anesthesia, and if not anesthetized, it should be able to accommodate one finger without pain.
If normal bowel movements can be achieved, surgery may not be necessary.
However, if there are difficulties with bowel movements and anal dilation is ineffective, surgery may indeed be the only option for improvement.

2.
The long-term safety of Laxative (Lemac) is not a concern.
However, if taking Laxative allows for normal bowel movements, increasing dietary fiber intake from plant sources should provide similar effects.
3.
The concept of high fiber from fruits and vegetables can be subjective.
Although one packet of Laxative contains only 7 grams, the fiber content is equivalent to that found in 1.5 kilograms of fruits and vegetables due to water content.
It is recommended to reassess whether your intake of fiber in dry weight is sufficient.
4.
No.
5.
Surgery certainly has its limitations and risks, so please discuss this thoroughly with your physician, as the degree of improvement after surgery can vary from person to person and cannot be generalized.

Reply Date: 2017/04/02

More Info

Post-surgery recovery from hemorrhoid surgery can be a challenging process, especially when complications such as anal stenosis (narrowing of the anal canal) arise. Your concerns are valid, and it's important to address them comprehensively.

1. Diagnosis of Anal Stenosis: Anal stenosis is typically diagnosed based on symptoms, physical examination, and sometimes imaging studies. The key indicators include difficulty passing stool, pain during bowel movements, and the need to strain excessively. Different physicians may have varying opinions based on their assessments and experiences. It is crucial to consider the consistency of your symptoms and the findings from the examinations. If multiple doctors are providing conflicting opinions, seeking a third or even fourth opinion from a specialist in colorectal surgery may be beneficial. A thorough examination under anesthesia might also provide clearer insights into the condition of the anal canal.

2. Long-term Use of Lactulose: Lactulose is a synthetic sugar used to treat constipation and is generally considered safe for long-term use. However, it can lead to dependency if used excessively. The concern about its mild stimulant effect is valid, but many patients use it long-term without significant issues. It's essential to monitor your body's response and consult your healthcare provider regularly to adjust dosages as needed.

3. Alternatives to Lactulose: If you're concerned about the long-term use of Lactulose, there are several alternatives you can consider. Other osmotic laxatives, such as polyethylene glycol (MiraLAX), may be effective and are often well-tolerated. Additionally, dietary modifications, including increasing fiber intake through supplements like psyllium husk, can help maintain softer stools. Staying hydrated is crucial, and you might also explore natural remedies like prunes or other high-fiber foods that can aid in digestion.

4. Impact of Long-term Laxative Use on Stenosis: Long-term use of laxatives can sometimes exacerbate underlying issues, including anal stenosis. If the stool remains consistently soft, it may not contribute to further narrowing. However, if the laxative is not effective and you are straining, this could potentially worsen the condition. Regular follow-ups with your healthcare provider can help monitor any changes in your condition.

5. Decision-Making Between Laxative Use and Surgery: The decision between continuing laxative use and opting for surgical intervention is complex and should be made collaboratively with your healthcare provider. If surgery is recommended, it typically involves cutting the anal sphincter to widen the anal canal. While this can relieve symptoms, it carries risks, including infection, bleeding, and the potential for recurrence of stenosis due to scarring. Discussing the potential complications and benefits with your surgeon is crucial. They can provide insights based on your specific case and help you weigh the risks versus the benefits.

In conclusion, managing recovery after hemorrhoid surgery requires a multifaceted approach. Regular communication with your healthcare providers, exploring dietary options, and considering the implications of long-term laxative use are all essential steps. If surgical options are on the table, ensure you fully understand the procedure, potential complications, and recovery expectations. Your health and comfort are paramount, and taking proactive steps will help you navigate this challenging recovery period.

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