Post-Hemorrhoid Surgery: and Managing Hematoma Pain

Hematoma after hemorrhoid surgery?

Hello Doctor: Two days ago, on April 6th, I underwent hemorrhoid surgery, where one internal hemorrhoid was ligated and one mixed hemorrhoid was excised using Ligasure.
The following morning, the nurse observed that the anal area appeared normal.
After discharge, I was only given pain relief, anti-inflammatory, and gastrointestinal medications (Futon, Broen-C, Magnesium oxide).
However, after returning home, I started to notice a lump at the anal area, which is painful and throbs in sync with my heartbeat (pain level 6).
Additionally, when I involuntarily contract my anus after urination, it puts pressure on the lump, causing significant pain.
Sitting in a warm bath provides some relief, but the periodic pain returns once I get up.

1.
Could this be a hematoma?
2.
Is it advisable to apply hemorrhoid ointment or to press on it for relief?
3.
Should I try to avoid contracting the anus since the lump is located there?
4.
Should I return for an earlier follow-up to obtain stronger medication?
I apologize for the many questions, and thank you!

Mr. Li, 20~29 year old female. Ask Date: 2018/04/08

Dr. Ke Fangxu reply Surgery

The benefits of using Ligasure include reduced blood loss; however, postoperative pain is similar to that of traditional surgery, typically diminishing after about a week.
1.
The pain may be due to simple wound swelling; if a hematoma is present, a dark blue-black lump may be observed.
2.
Opinions among physicians regarding the application of ointment post-surgery vary; some believe that early application may affect the drainage of secretions, while others see no issue with it.
You may want to consult your attending physician for their opinion.
3.
There is no need for enhanced warm sitz baths; regular ones are sufficient.
4.
The pain medication you are currently using is strong enough, and there should be no need to increase the dosage.

Reply Date: 2018/04/08

More Info

After undergoing hemorrhoid surgery, it is not uncommon for patients to experience discomfort and complications such as hematoma formation. In your case, the symptoms you describe, including the presence of a lump at the anal area that is painful and pulsates with your heartbeat, could indeed suggest the presence of a hematoma. Hematomas can occur when blood collects outside of blood vessels, often due to surgical trauma, and can lead to swelling and pain.

1. Is this possibly a hematoma?
Yes, the lump you are experiencing could be a hematoma. After surgery, especially in delicate areas like the anal region, it is possible for blood vessels to leak blood into surrounding tissues, leading to swelling and pain. The fact that the pain intensifies with certain movements, such as urination or muscle contractions, supports this possibility.
2. Can I apply hemorrhoid cream or press on it for relief?
While topical treatments like hemorrhoid creams may provide some symptomatic relief, they should be used cautiously. Applying pressure directly on the hematoma may exacerbate the pain or cause further bleeding. It is advisable to consult your surgeon or healthcare provider before applying any topical medications to ensure they are appropriate for your situation.

3. Should I avoid anal contractions?
Yes, it is generally advisable to minimize unnecessary contractions of the anal sphincter, especially if they cause pain. Straining or excessive contraction can increase pressure in the area and potentially worsen the hematoma or cause additional discomfort. Gentle movements and avoiding heavy lifting or straining during bowel movements can help reduce pressure on the surgical site.

4. Should I return for a stronger medication?
If your pain is significant (rated at 6 out of 10) and is not adequately managed with the medications you were prescribed, it would be wise to return to your healthcare provider for further evaluation. They may consider prescribing stronger pain relief or anti-inflammatory medications. Additionally, they can assess the lump to determine if it is indeed a hematoma and whether any further intervention is necessary.

In the postoperative period, it is crucial to monitor for signs of complications, such as increased swelling, redness, fever, or worsening pain, as these could indicate an infection or other issues requiring medical attention. Regular follow-up with your healthcare provider is essential to ensure proper healing and to address any concerns you may have.

In summary, while hematoma formation can be a common complication after hemorrhoid surgery, it is important to manage your symptoms carefully and seek medical advice if your pain persists or worsens. Your healthcare provider can offer tailored advice and treatment options based on your specific situation, ensuring a smoother recovery process.

Similar Q&A

Managing Pain After Hemorrhoid Surgery: Causes and Treatments

It has been four months since the surgery for the thrombosed external hemorrhoid. Initially, there was no pain, but recently, over the past two months, the pain has returned. The pain does not occur while standing, but it does when lying down to sleep. One doctor suggested that t...

Dr. Ke Fangxu reply Surgery
Is it possible that it is an anal fissure? Generally, four months after surgery, the wound should not reopen. You can first improve your bowel habits and apply hemorrhoid ointment to avoid constipation or diarrhea. If there is no improvement, please consult a doctor for a detaile...

Post-Surgery Recovery Issues: Managing Pain and Bleeding After Hemorrhoid Surgery

Hello Dr. Ke, I underwent traditional hemorrhoid surgery in June 2015, during which both internal and external hemorrhoids were excised. However, my recovery has not been satisfactory. I have a regular bowel movement once a day, but I notice some blood on the stool, particularl...

Dr. Ke Fangxu reply Surgery
Mild bleeding within one month after hemorrhoid surgery is considered normal. During this period, it is recommended to avoid constipation and to take warm sitz baths frequently. However, if there is heavy bleeding or if the bleeding lasts longer than one month, it is important to...

Post-Hemorrhoid Surgery: Common Concerns and Pain Management

Hello, doctor. It has been four days since my external hemorrhoidectomy, and I am still experiencing unbearable pain. The area around the wound is swollen around half of the anus. I have been lying in bed and relying on painkillers to manage my daily activities. However, I read t...

Dr. Ke Fangxu reply Surgery
Personally, I have not undergone outpatient hemorrhoidectomy because postoperative swelling and pain are inevitable. Mild bleeding and discharge are also considered normal. During this time, it is not recommended to apply ointments to avoid compromising wound cleanliness. Frequen...

Chronic Pain and Inflammation After Hemorrhoid Surgery: Seeking Relief

Since undergoing a hemorrhoid ligation surgery at the clinic in early April, I returned for a second surgery (excision of internal and external hemorrhoids) in mid-April (16 days later) to remove the remaining hemorrhoids. However, after climbing stairs, I experienced swelling be...

Dr. Ke Fangxu reply Surgery
I am unsure how surgery can be performed in a clinic without complete anesthesia, and I do not know whether you underwent a procedure for only external hemorrhoid removal or a complete excision of both internal and external hemorrhoids. However, theoretically, it should not take ...