Post-Surgery Concerns: Blood and Clots After Hemorrhoidectomy

Postoperative hematochezia and blood clots after hemorrhoidectomy?

Hello, doctor.
I underwent a Ligasure excision for stage IV internal and external hemorrhoids on September 11.
My first bowel movement was on the second day post-surgery; it was painful but there was no bleeding.
During my second bowel movement, there was slight bleeding, and the amount of bleeding increased after the third bowel movement.
I had a follow-up appointment on September 18, where the doctor only examined the external hemorrhoid wound and stated that everything looked normal, so he prescribed hemostatic medication.
After taking the medication at home, the bleeding situation improved.
However, today, September 21, during my bowel movement, the bleeding was much more than before (the toilet was filled with blood), and I also noticed jelly-like blood clots.
I can still feel swelling in the internal hemorrhoid during the bowel movement.
I usually take sitz baths and apply Neomycin ointment to care for the wound (only on the external hemorrhoid).
Is it normal to have blood clots ten days post-surgery, and could the hemostatic medication affect my menstrual cycle? Thank you.

Ms. Li, 30~39 year old female. Ask Date: 2018/09/21

Dr. Ke Fangxu reply Surgery

After hemorrhoid surgery, it is common to experience slight bleeding during bowel movements; however, a small number of patients may experience significant bleeding.
If this occurs, it is important to return to the clinic as soon as possible.
If the bleeding does not stop, it may be necessary to undergo a surgical procedure for anal hemostasis.
Please promptly return to your original surgeon to avoid severe anemia caused by excessive bleeding.

Reply Date: 2018/09/21

More Info

After undergoing a hemorrhoidectomy, it is not uncommon for patients to experience some bleeding during bowel movements, especially in the days following the surgery. However, the amount and nature of the bleeding can vary significantly from person to person. In your case, the progression of bleeding from slight to more substantial amounts, especially with the presence of jelly-like clots, raises some concerns that warrant further evaluation.

Firstly, it is essential to understand that after a hemorrhoidectomy, the surgical site is healing, and any strain during bowel movements can lead to bleeding. The presence of blood clots, particularly if they are jelly-like, may indicate that there is still significant inflammation or that the surgical site has not healed adequately. While some bleeding can be expected, especially in the first week or two post-surgery, an increase in bleeding after the initial days, particularly to the extent of filling the toilet with blood, is not typical and should be addressed promptly.

The fact that you experienced bleeding during your second and third bowel movements suggests that your body is reacting to the surgical trauma. It is crucial to ensure that you are not straining during bowel movements, as this can exacerbate bleeding. A diet high in fiber, adequate hydration, and possibly the use of stool softeners can help facilitate easier bowel movements and reduce the risk of straining.

Regarding the use of hemostatic medications prescribed by your doctor, these are typically intended to help control bleeding. However, it is important to discuss any potential side effects or interactions with your healthcare provider, especially concerning your menstrual cycle. Some medications can influence bleeding patterns, and it is essential to clarify with your physician whether the hemostatic agent you are taking could affect your menstrual cycle or if it is safe to continue during this time.

Given the increase in bleeding and the presence of clots, I recommend that you contact your healthcare provider as soon as possible. They may want to perform a physical examination to assess the surgical site and ensure that there are no complications such as a hematoma (a localized collection of blood outside of blood vessels) or an infection. In some cases, additional interventions may be necessary to address excessive bleeding or to ensure proper healing.

In summary, while some bleeding after a hemorrhoidectomy is normal, the increase in bleeding you are experiencing, especially with the presence of clots, is concerning and should be evaluated by a medical professional. It is crucial to maintain open communication with your healthcare provider regarding your symptoms and any changes you observe. They can provide the best guidance tailored to your specific situation and ensure that you are on the path to recovery without complications.

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