Post-Surgery Anal Itching and Bleeding: Managing Symptoms Abroad

It has been three months since the hemorrhoid surgery, and I am experiencing post-defecation bleeding and anal itching (currently abroad and unable to seek medical attention)?

Three months ago, I specifically flew back to Taiwan for a mixed nevus electrosurgery treatment.
At that time, the doctor had already warned me that there was a high possibility I would need anal dilation after the surgery.
After returning to my home country a month post-surgery, I began to diligently work on anal dilation.
I understand that it is not easy to see a doctor abroad, so I put in a lot of effort.
Initially, I couldn't even insert the first segment of my pinky finger.
Now, three months later, I feel some improvement in dilation, but it may still not be sufficient.
I continue to maintain the habit of occasional sitz baths because I feel that some granulation tissue may have developed at the anal area, but it is not bothersome.
However, I often experience hard stools in the morning (I have a habit of daily morning bowel movements), and I find that my anal opening feels too small, requiring significant effort to pass the stool, which sometimes results in minor bleeding, though not excessive.
If I cannot pass the stool, I give up and try again later.

Recently, I have been experiencing particularly severe itching after bowel movements.
I would like to know how I can manage this issue without seeing a doctor.
I usually drink at least 1500cc of water daily, consume two types of fruit each day, and include vegetables in every meal, so my bowel movements remain regular, but the ease of passing stools has significantly decreased.
What can I do to address the anal itching problem?

Ella, 30~39 year old female. Ask Date: 2017/06/08

Dr. Ke Fangxu reply Surgery

I personally have limited knowledge about the treatment of mixed hemorrhoids using electrocautery, and I am unclear about which specific instrument is used.
I also do not understand why anal dilation is performed postoperatively, as this is not typically seen in standard surgical treatments.
Anal itching may be caused by excessive wiping.
In addition to medication and topical treatments, there are three important considerations: avoid scratching to prevent wound infection, temporarily refrain from consuming spicy foods to prevent capsaicin from irritating the skin, and avoid using soap or body wash to clean the anal area to prevent excessive removal of the skin's natural oils.
If these points are followed, improvement can generally be seen in about a week.

Reply Date: 2017/06/08

More Info

Post-surgery anal itching and bleeding can be quite uncomfortable and concerning, especially after undergoing a procedure like mixed hemorrhoid electrosurgery. It’s important to address these symptoms carefully, particularly since you are currently abroad and may have limited access to medical care.

Firstly, the itching you are experiencing could be attributed to several factors. After surgery, the area around the anus can be sensitive and may take time to heal. The presence of granulation tissue, which you mentioned, can also contribute to irritation and itching. This tissue is a normal part of the healing process but can sometimes become sensitive. Additionally, if you are experiencing bleeding, even if it is minimal, it could indicate that the anal canal is still healing or that there may be some irritation or trauma occurring during bowel movements.

Here are some strategies you can implement to manage your symptoms:
1. Dietary Adjustments: While you mentioned that you are consuming plenty of fruits and vegetables, it’s crucial to ensure that your diet is high in fiber to prevent hard stools. Hard stools can exacerbate the need to strain during bowel movements, leading to further irritation and bleeding. Consider incorporating more soluble fiber sources, such as oats, beans, and psyllium husk, which can help soften stools.

2. Hydration: You are already drinking a good amount of water (1500cc daily), but increasing this further can help keep your stools soft. Aim for at least 2 liters of water a day, especially if you are consuming high-fiber foods.

3. Sitz Baths: Continuing with your sitz baths can be beneficial. Soaking in warm water for about 15-20 minutes several times a day can help soothe the area, reduce itching, and promote healing. You can also add Epsom salts to the bath, which may help reduce inflammation.

4. Topical Treatments: Over-the-counter topical treatments, such as hydrocortisone cream or witch hazel pads, can provide relief from itching and inflammation. However, be cautious with the use of any topical treatments and ensure they are suitable for post-surgical care.

5. Gentle Hygiene Practices: After bowel movements, ensure that you clean the area gently. Using unscented wipes or a gentle, non-irritating soap can help. Avoid harsh soaps or scrubbing, as this can further irritate the area.

6. Avoid Straining: If you find that you are straining during bowel movements, consider using a stool softener or a mild laxative to ease the process. Straining can lead to further irritation and bleeding.

7. Monitor Symptoms: Keep track of your symptoms. If the bleeding increases, or if the itching becomes unbearable, it may be necessary to seek medical attention, even if it means finding a local healthcare provider.

8. Gradual Expansion: Since you are working on anal dilation, ensure that you are doing this gently and gradually. Overdoing it can lead to trauma and irritation. If you feel pain, it’s best to stop and allow your body to adjust.

In conclusion, while managing your symptoms at home, it’s essential to listen to your body and make adjustments as needed. If your symptoms do not improve or worsen, seeking medical advice, even if it requires finding a local doctor, would be prudent. Your health and comfort are paramount, and addressing these issues sooner rather than later can prevent further complications.

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