Post-Surgery Symptoms: Hemorrhoids and Recovery Insights

Hemorrhoid surgery

Hello, I had surgery for a fistula and hemorrhoids on June 30.
The doctor said they removed both external and internal hemorrhoids, but there is still a small remnant of the internal hemorrhoid that may need to be treated with rubber band ligation later, around the end of July.
I noticed a slight swelling on the left side of the anal area, but the doctor didn't mention anything during my follow-up visit, and I didn't ask specifically.
Now I feel like there is a bit of a protrusion, but there is no skin breakdown, and the right side does not have any protrusion.
The protruding area is in a different location from where the external hemorrhoid was removed (directly above the anal opening), feels soft to the touch, and is not painful.
Additionally, at the beginning of August, I felt that the wound had mostly healed, and there was no discharge.
However, in the past week, I have noticed that if I exert a little while having a bowel movement, there are sometimes blood stains on the toilet paper, but sometimes there are none.
If I do not exert myself, there are generally no blood traces.

I would like to ask:
1.
Is the bleeding situation normal? Should I go back to see the doctor for an examination?
2.
The protruding part does not feel like excess tissue to me, as there is no similar issue on the right side.
Is this a recurrence of the external hemorrhoid, or could it be a sign of developing external hemorrhoids? Is it possible for this to appear so quickly again? Thank you.

a, 30~39 year old female. Ask Date: 2018/08/20

Dr. Ke Fangxu reply Surgery

1.
It is normal to experience slight bleeding after hemorrhoid surgery.
If there is still straining during bowel movements post-surgery, the bleeding may persist.
It is advisable to avoid constipation and enhance sitz baths; if there is no improvement, please consult a physician for further evaluation.
2.
To determine what the protruding part is, a physician's examination is necessary.
If there are remnants of excess skin after surgery combined with straining during bowel movements, it is indeed possible for external hemorrhoids to form more rapidly.

Reply Date: 2018/08/20

More Info

After undergoing surgery for anal fistula and hemorrhoids on June 30, it’s understandable to have concerns about your recovery and any new symptoms that may arise. Let's break down your questions regarding the post-surgery symptoms, particularly the bleeding and the protrusion you’ve noticed.

1. Bleeding After Surgery: Experiencing some bleeding after hemorrhoid surgery can be relatively common, especially if you are straining during bowel movements. The presence of blood on toilet paper, particularly when you exert pressure, may indicate that the surgical site is still healing or that there is some irritation in the area. However, if the bleeding is persistent, increasing in volume, or accompanied by pain, it is essential to consult your surgeon or healthcare provider. They may want to examine the surgical site to ensure that there are no complications, such as a reopening of the wound or the development of new hemorrhoids.

2. Protrusion Near the Surgical Site: The soft, protruding area you described above the anal opening could be concerning. It might not necessarily be a recurrence of hemorrhoids, but it could be a number of things, including:
- Residual Hemorrhoidal Tissue: Sometimes, if a portion of the internal hemorrhoid is left behind, it can become engorged and protrude.

- Skin Tags: After hemorrhoid surgery, it’s not uncommon for skin tags to form, which are benign and may not cause any discomfort.

- New Hemorrhoids: While it may seem quick for new hemorrhoids to develop, it is possible, especially if there are factors such as straining during bowel movements or constipation.

Given that the protrusion is soft and not painful, it may not be an immediate cause for alarm, but it is still advisable to have it evaluated by your healthcare provider. They can perform a physical examination to determine the nature of the protrusion and whether any further treatment is necessary.

Recommendations for Recovery:
- Dietary Adjustments: To prevent straining during bowel movements, ensure you are consuming a high-fiber diet. Foods rich in fiber, such as fruits, vegetables, and whole grains, can help soften stools. Staying well-hydrated is also crucial.

- Gentle Bowel Movements: Avoid straining when using the bathroom. If you find yourself needing to push hard, consider using a stool softener or a fiber supplement.

- Follow-Up Appointments: Regular follow-ups with your surgeon are important to monitor your recovery. If you notice any changes, such as increased bleeding, pain, or changes in the protrusion, do not hesitate to reach out to your doctor.

- Avoiding Irritation: Be cautious with hygiene practices. Use gentle cleansing methods and avoid harsh soaps or wipes that could irritate the area.

In summary, while some bleeding and minor protrusions can be part of the healing process after hemorrhoid surgery, it’s essential to monitor these symptoms closely. Regular communication with your healthcare provider will ensure that any potential complications are addressed promptly, and your recovery remains on track. If you have any doubts or concerns, it’s always best to err on the side of caution and seek medical advice.

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