Managing Non-Healing Wounds After Minimally Invasive Hemorrhoid Treatment

Non-healing wounds after minimally invasive hemorrhoidectomy?

Hello, Dr.
Ko.
Three months ago, I underwent a dry minimally invasive treatment for hemorrhoids at a specialized clinic in Kaohsiung.
This involved injecting a drying agent into the base of the hemorrhoid to allow it to fall off naturally.
I have been following the doctor's instructions diligently, applying medication with my fingers twice a day, taking warm sitz baths twice daily, rinsing with water after bowel movements, and avoiding high-sugar foods and pasta, as well as preventing gas and loose stools.
Currently, 95% of the wound has healed, but there is a small wound approximately 0.8 square centimeters near the anal opening that has not yet healed.
The wound appears pink and has a slight pinkish discharge (but it is not bleeding).
I have no issues with mobility, bowel movements are smooth with almost no bleeding, and there is no pain, swelling, or discomfort.
What should I do about this small, difficult-to-heal wound?

Mr. Wang, 30~39 year old female. Ask Date: 2017/10/13

Dr. Ke Fangxu reply Surgery

Based on your description, it seems that this is a traditional sclerotherapy treatment, just referred to by a different name.
Typically, the wound heals within two to four weeks after the injection.
This type of treatment is less commonly performed by physicians now due to the difficulty in controlling the depth and extent of the injection, which may lead to complications.
If you are experiencing delayed wound healing without pain or bleeding, it is advisable to continue with warm sitz baths and allow time for the wound to heal.
However, if it has not improved after three months, it is somewhat slow, and I recommend that you consult your treating physician for further evaluation.

Reply Date: 2017/10/13

More Info

Managing non-healing wounds after minimally invasive hemorrhoid treatment can be a challenging process, especially when the majority of the wound has healed but a small area remains problematic. In your case, it sounds like you have been diligent in following post-operative care instructions, which is crucial for optimal healing.
Firstly, it’s important to understand that non-healing wounds can occur for various reasons, including inadequate blood supply, infection, moisture imbalance, or underlying health conditions such as diabetes or vascular issues. In your situation, since the wound is small (0.8 square centimeters) and you report no significant pain, swelling, or other discomfort, it may be a matter of local factors affecting healing.

Here are some steps you can take to manage the non-healing wound:
1. Continue Proper Care: Maintain your current wound care regimen, which includes applying medication as prescribed and keeping the area clean. Regular sitz baths can help keep the area clean and promote healing.

2. Moisture Balance: Ensure that the wound remains moist but not overly wet. A moist wound environment can promote healing, but excessive moisture can lead to maceration and delayed healing. Consider using a hydrogel or a moisture-retentive dressing if recommended by your healthcare provider.

3. Nutritional Support: Ensure you are consuming a balanced diet rich in vitamins and minerals that support wound healing, such as vitamin C, zinc, and protein. Staying hydrated is also essential.

4. Avoid Irritants: Be cautious with any products you apply to the area. Avoid harsh soaps or chemicals that may irritate the wound. Stick to gentle, hypoallergenic products.

5. Monitor for Signs of Infection: While you mentioned no significant bleeding or pain, keep an eye out for any signs of infection, such as increased redness, warmth, swelling, or discharge that changes in color or odor. If you notice any of these signs, contact your healthcare provider immediately.

6. Follow-Up with Your Doctor: Since the wound is not healing as expected, it’s advisable to follow up with your healthcare provider. They may want to assess the wound more closely and could consider options such as debridement (removing dead tissue), applying a different type of dressing, or even exploring other treatments like advanced wound care therapies.

7. Consider Underlying Conditions: If you have any underlying health conditions that could affect healing, such as diabetes or vascular disease, managing those conditions is crucial. Discuss with your doctor if any adjustments to your treatment plan are necessary.

8. Patience and Time: Lastly, remember that wound healing can take time, and some wounds may take longer than others to heal completely. Continue to care for the wound as instructed, and give it the time it needs.

In summary, while it can be frustrating to deal with a non-healing wound, following these steps and maintaining open communication with your healthcare provider will help you manage the situation effectively. If the wound does not show signs of improvement in the coming weeks, further evaluation and intervention may be necessary to promote healing.

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