Post-Surgery Pain Management for Severe Hemorrhoids and Anal Conditions

Surgery for fourth-degree internal and external hemorrhoids, rectal prolapse, and anal ulcers?

Hello Doctor, I underwent surgery on January 16, but five days later, the wound is still extremely painful.
I need to take two painkillers every 3 to 4 hours; otherwise, the pain causes me to break into a cold sweat.
Is this normal?
Especially after having a bowel movement, the pain is unbearable, to the point where I feel like I need to go to the emergency room, and the painkillers don't seem to help.

On the third day post-surgery, I had a bowel movement and noticed about half a bowl of blood in the toilet, with no visible stool, and the amount felt very minimal.
The next day, I had another bowel movement, and the toilet was again full of blood, but I could barely see the stool, which was even less in quantity, about the length and thickness of two fingers.

I have been doing sitz baths, but they have had no soothing effect, and the wound continues to hurt.
I would like to ask the doctor when I can expect the pain to subside.
Currently, I am in pain whether sitting, lying down, or standing; it feels unbearable, and I can hardly walk.
Should I return for an earlier check-up on the wound? This was a self-paid surgery, not a traditional one, and post-operative care only included painkillers, stomach medication, and ointment for the wound.

elaine, 20~29 year old female. Ask Date: 2019/01/20

Dr. Ke Fangxu reply Surgery

1.
Generally, after this type of surgery, there will be more pain within the first week, but the pain should gradually decrease after that.
If you experience severe pain after bowel movements, you can take a warm sitz bath to alleviate the discomfort.

2.
Mild bleeding after bowel movements is unavoidable; however, the bleeding you described seems to be more severe.
It would be best to contact your surgeon for further evaluation.

3.
Since I am unaware of the specific type of out-of-pocket surgery you underwent, I cannot make a judgment.
If it was a hemorrhoidectomy, it is possible that excessive pain could be due to the incision being made too low, resulting in persistent pain.
Regardless, your pain symptoms do not seem normal, so I recommend that you return for a follow-up appointment as soon as possible.

Reply Date: 2019/01/20

More Info

Post-surgery pain management, especially after procedures for severe hemorrhoids and anal conditions, can be quite challenging. Based on your description, it seems you are experiencing significant pain and discomfort following your surgery on January 16. Let’s break down your concerns and provide some insights.

1. Pain Levels Post-Surgery: It is not uncommon to experience considerable pain after surgery for hemorrhoids or anal conditions. The pain can be exacerbated by bowel movements, as the area is sensitive and healing. However, if you find that the pain is so severe that it requires multiple doses of pain medication (like two pills every few hours) and is accompanied by cold sweats, this may indicate that your pain management plan needs to be reassessed. It’s essential to communicate this level of discomfort to your healthcare provider, as they may need to adjust your pain medications or explore other options.

2. Bleeding After Bowel Movements: The presence of significant bleeding after bowel movements, especially if it resembles "half a bowl of blood," is concerning. While some bleeding can be expected after surgery, especially if you are straining during bowel movements, excessive bleeding can indicate complications such as a hematoma, infection, or issues with the surgical site. It is crucial to report this to your doctor immediately, as they may need to evaluate the surgical site and ensure that there are no underlying issues.

3. Bowel Movements and Pain: The pain you are experiencing during bowel movements is likely due to the surgical site being inflamed and sensitive. It is important to ensure that you are not straining during bowel movements, as this can worsen pain and lead to further complications. If your stools are hard or you are experiencing constipation, consider increasing your fluid intake, dietary fiber, or using stool softeners as recommended by your doctor.

4. Sitz Baths and Pain Relief: While sitz baths can provide some relief, they may not be sufficient alone, especially if the pain is severe. You might want to try using warm water for longer periods or consider adding Epsom salts, which can help soothe the area. However, if you find that sitz baths are not helping, it is essential to discuss this with your healthcare provider.

5. When to Seek Further Medical Attention: Given your symptoms—persistent severe pain, significant bleeding, and difficulty with daily activities—it would be prudent to return to your healthcare provider for a follow-up appointment sooner rather than later. They may want to perform a physical examination, possibly including imaging studies, to assess the surgical site and ensure that healing is progressing as expected.

In summary, while some pain and discomfort are expected after surgery for severe hemorrhoids and anal conditions, the level of pain you are experiencing, especially with associated bleeding, warrants further evaluation. Effective pain management is crucial for recovery, and your healthcare provider can help tailor a plan that addresses your specific needs. Don’t hesitate to reach out to them for assistance, as they are best equipped to provide the necessary care and support during your recovery process.

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