Post-Surgery Complications: Heavy Bleeding and Clots After Hemorrhoid Surgery

Postoperative hemorrhage and blood clots after hemorrhoid surgery?

Hello Dr.
Ke: I underwent a complete excision of internal and external hemorrhoids on August 8 and used a self-paid tissue coagulation device.
After being discharged on August 11, my bowel movements were normal with only slight bleeding.
However, on the morning of August 16, I suddenly experienced a large amount of bleeding and blood clots during a bowel movement, accompanied by uncontrollable urges to defecate.
The output was entirely blood and clots (it was indeed a significant amount), which led to me fainting and being sent to the emergency room, where I was hospitalized for two days (during which I received hemostatic injections).
During my two days in the hospital, there was no bleeding during bowel movements.
I was discharged on August 18, but on the evening of August 19, I noticed slight bleeding again.
On the morning of August 20, I had another bowel movement that resulted in blood and clots, although the amount was not as significant as on August 16.
I would like to ask you, Dr.
Ke, if this could be due to the sutures coming undone or if the bleeding is caused by the internal wounds? I consulted my surgeon, who mentioned that the bleeding was refluxing back into the intestines.
I am really puzzled and scared that there might be an issue with the surgical site.
It has been 12 days post-surgery; is it normal to continue passing blood and clots like this? I apologize for the lengthy message, and I appreciate your help.

Lai Xiaojie, 30~39 year old female. Ask Date: 2017/08/20

Dr. Ke Fangxu reply Surgery

After hemorrhoid surgery, it is possible to experience significant bleeding complications about a week later.
This is often due to the absorption or detachment of sutures.
By changing the type of sutures and the suturing technique, the occurrence of this issue can be effectively reduced.
The use of tissue sealing devices theoretically allows for the avoidance of sutures; however, individual physician preferences may vary, and some may still use sutures for reinforcement.
If bleeding occurs, it typically requires a return to the operating room for targeted suturing at the bleeding site, which tends to yield better treatment outcomes.
If there is no further bleeding afterward, medication can be used for treatment.
However, if bleeding persists, it is essential to have the surgical physician evaluate and manage the situation.

Reply Date: 2017/08/20

More Info

Post-surgery complications, particularly after hemorrhoid surgery, can indeed be concerning, especially when heavy bleeding and clots are involved. Your experience of significant bleeding after the procedure raises several important considerations regarding the healing process and potential complications.

Firstly, it's essential to understand that some bleeding can be expected after hemorrhoid surgery, particularly in the initial days following the operation. However, the amount and nature of the bleeding you described—especially the sudden onset of large clots and significant blood loss—are not typical and warrant careful evaluation.
The bleeding you experienced on August 16 could be attributed to several factors. One possibility is that the sutures used to close the surgical site may have become dislodged or have not adequately secured the tissue, leading to bleeding. This is particularly plausible if the bleeding was accompanied by a feeling of urgency and the passage of clots, which can indicate that blood is pooling in the rectal area before being expelled.
Another potential cause could be related to the healing process itself. Sometimes, as the tissue heals, it can become fragile, and any straining during bowel movements can exacerbate bleeding. The fact that you experienced a significant amount of blood and clots could suggest that the surgical site was under stress, possibly due to constipation or straining, which is common after surgery due to pain or fear of discomfort during bowel movements.

Your surgeon's explanation that the bleeding was a result of "wound bleeding refluxing into the intestines" could imply that the blood was coming from a source that was not immediately apparent, such as a deeper vessel that may have been inadvertently affected during the surgery. This could lead to a situation where blood accumulates and is later expelled during bowel movements, appearing as clots.

Given that you experienced a recurrence of bleeding on August 19 and 20, it is crucial to maintain close communication with your healthcare provider. Continuous bleeding, even if less severe than the initial episode, should not be overlooked. It is advisable to seek a follow-up examination to assess the surgical site, check for any signs of infection, and ensure that the healing process is proceeding as expected.
In terms of management, your healthcare provider may recommend several strategies to minimize the risk of further bleeding. These can include dietary modifications to ensure soft stools, the use of stool softeners, and possibly medications to manage pain without causing constipation. Additionally, if bleeding persists or worsens, further interventions may be necessary, such as cauterization of the bleeding site or even surgical revision.

In conclusion, while some bleeding can be expected after hemorrhoid surgery, the severity and recurrence of your symptoms suggest that further evaluation is warranted. It is essential to monitor your symptoms closely and maintain open communication with your healthcare provider to ensure appropriate management and prevent complications. Your health and recovery are paramount, and addressing these concerns promptly can help facilitate a smoother healing process.

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