Post-Hemorrhoid Surgery: Bowel Movement Difficulties

Post-operative constipation after hemorrhoid surgery?

Hello Doctor, I had hemorrhoid surgery on November 1st for mixed hemorrhoids.
After the surgery, the doctor did not prescribe any ointment for me, only painkillers, stool softeners, and laxatives.
It has been 20 days since the surgery, and I would like to ask:
1.
When I gently insert my index finger into my anus, I find it very tight and painful.
Is this normal? When I insert my finger slightly, I can feel a stitch; does this mean the wound has not healed yet?
2.
Sometimes I experience cramping in my abdomen and when I sit on the toilet, I push very hard, to the point where my abdominal muscles are straining, but I still cannot have a bowel movement.
I am very worried that my anus may be narrowed, but sometimes I can easily pass some long, soft stools.
I have tried enemas, but they did not result in much stool being expelled.

3.
Is the likelihood of anal stenosis very high? I am very concerned that I may have to rely on laxatives and stool softeners for the rest of my life.
I apologize for asking so many questions.

Niming, 20~29 year old female. Ask Date: 2017/11/21

Dr. Ke Fangxu reply Surgery

1.
It is normal for the anus to feel tighter after hemorrhoid surgery; it will gradually return to normal as the wound fully heals.
The surgical sutures typically take about a month to dissolve.
Although it is not recommended to insert fingers into the anus, it is normal to feel the suture ends.

2 & 3.
To determine if there is anal stenosis, a personal examination is necessary.
However, if you can insert a finger into the anus and feel the suture ends, it is likely that there is no anal stenosis.
It is also normal to experience temporary abnormal sensations during bowel movements after surgery.
Maintaining a normal diet and bowel habits is important.
If difficulties with bowel movements and pain persist, it is advisable to consult a physician for further evaluation.

Reply Date: 2017/11/21

More Info

Post-hemorrhoid surgery, especially for mixed hemorrhoids, can lead to various challenges during recovery, particularly concerning bowel movements. It's understandable to have concerns about pain, tightness, and the overall healing process. Let’s address your questions one by one and provide some additional context regarding recovery after such surgeries.

1. Pain and Tightness: Experiencing significant tightness and pain when attempting to insert a finger into the rectum is not uncommon after hemorrhoid surgery. The surgical site is still healing, and the surrounding tissues may be inflamed or sensitive. If you can feel stitches, it’s likely that they are part of the surgical closure, which can take time to dissolve or be absorbed by the body. It’s essential to avoid any unnecessary manipulation of the area, as this can exacerbate pain and potentially disrupt the healing process.

2. Bowel Movement Difficulties: It’s quite common for patients to experience difficulties with bowel movements after hemorrhoid surgery. The combination of pain, fear of pain during bowel movements, and the effects of anesthesia can lead to constipation. Straining can worsen the situation, leading to a cycle of discomfort. If you find yourself straining excessively, it’s crucial to address this with your healthcare provider. They may suggest dietary changes, increased fluid intake, or adjustments to your current medications to help facilitate easier bowel movements.
The fact that you can occasionally pass soft stools suggests that your bowel is functioning, but the inconsistency can be frustrating. If you are experiencing severe abdominal pain and are unable to have a bowel movement despite efforts, it may be worth discussing the possibility of a bowel obstruction or other complications with your doctor.

3. Risk of Anal Stenosis: The risk of developing anal stenosis (narrowing of the anal canal) after hemorrhoid surgery exists, but it is not exceedingly high. Factors that can contribute to this include the extent of the surgery, the healing process, and any complications that may arise. While it’s natural to worry about long-term reliance on laxatives and stool softeners, many patients find that their bowel habits normalize over time as healing progresses. Regular follow-ups with your healthcare provider can help monitor your recovery and address any concerns about anal stenosis.

Additional Considerations:
- Diet and Hydration: A high-fiber diet is crucial during recovery. Incorporating fruits, vegetables, whole grains, and plenty of fluids can help soften stools and promote regular bowel movements. If you are not already doing so, consider consulting a nutritionist for tailored dietary advice.

- Pain Management: If pain is a significant barrier to having bowel movements, discuss pain management options with your doctor. Sometimes, adjusting pain medications can help reduce discomfort during bowel movements.

- Follow-Up Care: Regular follow-ups with your surgeon or healthcare provider are essential. They can assess your healing progress and address any complications early on. If you notice persistent pain, changes in bowel habits, or any other concerning symptoms, do not hesitate to reach out to them.

In summary, while the recovery process after hemorrhoid surgery can be challenging, it is essential to maintain open communication with your healthcare provider. They can provide guidance tailored to your specific situation, ensuring that you receive the support you need during this recovery phase.

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