Post-Surgery Concerns After Hemorrhoidectomy: What to Expect

Post-operative questions regarding hemorrhoidectomy?

Dear Dr.
Ke,
I had surgery on January 3rd, and today is February 5th.
The wound is generally not painful anymore, and there is no pain during bowel movements, just a slight tingling sensation.
There is no severe pain inside the anus, but on the outside, there is a growth resembling a hemorrhoid on one side and a small lump on the other side.
Applying pressure causes sharp pain and slight bleeding.
I have returned for follow-ups four times, and the doctors have all said that I am recovering well.
However, it seems that I might be allergic to the sutures, which is causing a slower healing process.
Most of the stitches have been removed.
The doctor switched my topical ointment from an antibiotic to a healing ointment, and the external growth has gradually decreased in size.
However, the small lump that bleeds seems to have only slightly reduced in size, but the condition remains the same.
It hurts when pressed, and if too much pressure is applied, it bleeds.
The doctor has also prescribed antibiotics for me, possibly due to a slight infection.

Could you please advise me, Dr.
Ke? Is my current situation considered normal? Am I being too impatient? Or does the wound require a longer time to heal? I am very concerned about the possibility of developing an anal fistula or something similar.

Youyou, 30~39 year old female. Ask Date: 2018/02/05

Dr. Ke Fangxu reply Surgery

Generally, the wound should heal within a month after surgery, so this situation is indeed somewhat unusual.
The incidence of anal fistula occurring after hemorrhoid surgery is quite low, but it is still a possibility.
It could also be that the surgical wound is larger and requires a longer healing time.
I recommend starting antibiotic treatment and enhancing sitz baths for a while.
After a month, reassess the bleeding situation and avoid pressing on the wound for now.
If this area does not heal over time, you should consult your physician to check for any potential complications such as an anal fistula.

Reply Date: 2018/02/05

More Info

After undergoing a hemorrhoidectomy, it's common for patients to have concerns about their recovery, especially when experiencing symptoms such as pain, swelling, and bleeding. Based on your description, it seems that you are experiencing some typical post-operative issues, but there are also some signs that warrant attention.

Firstly, it's encouraging to hear that your pain has decreased significantly and that you are able to have bowel movements without severe discomfort. This is a positive indicator of healing. However, the presence of swelling resembling hemorrhoids and a small painful lump that bleeds upon pressure is concerning. These symptoms could indicate a few possibilities, including residual hemorrhoidal tissue, a thrombosed hemorrhoid, or even a potential infection.

The fact that your doctor has noted that your recovery is progressing well is reassuring, but it’s important to continue monitoring your symptoms. The slow healing process you mentioned could be attributed to a few factors, including the body's natural healing response, the type of sutures used, and any potential allergic reactions to the sutures, as you noted. Allergic reactions can indeed slow down the healing process, leading to prolonged discomfort and swelling.

The use of topical ointments and antibiotics is a standard approach to manage any signs of infection and to promote healing. If the swelling is reducing with the application of the ointment, that is a good sign. However, if the bleeding persists or worsens, or if the pain becomes more intense, it is crucial to follow up with your healthcare provider.
Regarding your concern about the development of an anal fistula (or anal fistula), it is a valid concern, especially if there is persistent drainage or bleeding. Fistulas can occur as a complication of surgery, particularly if there was an infection or if the surgical site did not heal properly. Symptoms of a fistula may include persistent drainage, pain, and recurrent infections. If you notice any of these symptoms, it would be prudent to consult your surgeon for further evaluation.

In terms of your anxiety about the healing process, it is quite common for patients to feel anxious during recovery, especially when they are experiencing unexpected symptoms. Healing can take time, and each person's recovery timeline can vary significantly based on individual health factors, the extent of the surgery, and adherence to post-operative care instructions.
To summarize, while some of your symptoms may be normal post-surgery, the presence of a painful lump that bleeds and does not improve should be closely monitored. Continue to communicate openly with your healthcare provider about your symptoms, and do not hesitate to seek further evaluation if you feel that your recovery is not progressing as expected. It’s better to be cautious and ensure that any potential complications are addressed promptly.

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