Post-Fistula Surgery: Concerns About Prolapsed Hemorrhoids

Prolapse of hemorrhoids after fistula surgery?

Hello Doctor, I previously had a problem with a protruding hemorrhoid that I could push back after bowel movements.
A week ago, I underwent fistula surgery, but the hemorrhoid has been continuously protruding, and due to the pain from the wound, I am hesitant to push it back in.
I would like to ask if, over time, it could become irreducible.
I am also worried that having it exposed for an extended period might require hemorrhoid surgery.
Thank you for taking the time to answer my questions.

Ms. Hsu, 30~39 year old female. Ask Date: 2019/01/20

Dr. Ke Fangxu reply Surgery

If hemorrhoids are large enough to protrude outside the anus, conservative treatment is generally less effective.
However, during fistula surgery, hemorrhoids are often removed to prevent the situation where both the surgical site and the hemorrhoids are painful.
Currently, the best approach is to take warm sitz baths and apply topical ointments.
If manual reduction is very painful, it should not be forced.
If, after the fistula surgery has healed, there is still prolapse, then consideration can be given to performing a hemorrhoidectomy at that time.

Reply Date: 2019/01/20

More Info

After undergoing fistula surgery, it is not uncommon for patients to experience concerns related to hemorrhoids, especially if they have a history of protruding hemorrhoids. In your case, the presence of a "meatball" or protruding tissue after bowel movements, which you could previously push back in, raises some important considerations.

Firstly, it is essential to understand that the surgery for a fistula can lead to changes in the surrounding tissues, including the anal sphincter and rectal area. This can sometimes exacerbate existing hemorrhoidal issues or lead to new ones. The pain you are experiencing may discourage you from attempting to push the protruding tissue back in, which can lead to further complications if left untreated.

1. Prolapsed Hemorrhoids: If the hemorrhoids are indeed prolapsed, they may not return to their normal position without intervention, especially if they remain outside for an extended period. Prolapsed hemorrhoids can become thrombosed (develop a blood clot), which can be quite painful and may require surgical intervention. If you notice that the tissue is becoming increasingly painful, discolored, or shows signs of infection (such as swelling, redness, or discharge), it is crucial to seek medical attention promptly.

2. Time Frame for Reduction: The longer the hemorrhoids remain prolapsed, the more difficult it may become to reduce them manually. If they are not reducible, this may indicate a more severe condition that could necessitate surgical intervention. It is advisable to consult your surgeon or a gastroenterologist to assess the situation. They may perform a physical examination to determine the best course of action.

3. Pain Management: Managing pain is crucial in your recovery. If the pain is preventing you from pushing the hemorrhoids back in, your doctor may recommend pain relief options, such as over-the-counter pain medications or topical treatments. Additionally, warm sitz baths can help alleviate discomfort and promote healing.

4. Diet and Bowel Habits: Ensuring that you have a high-fiber diet and staying well-hydrated can help prevent constipation, which can exacerbate hemorrhoidal issues. Softening your stool can reduce the strain during bowel movements, potentially alleviating some of the pressure on the hemorrhoids.

5. Follow-Up Care: It is essential to maintain regular follow-up appointments with your healthcare provider after fistula surgery. They can monitor your recovery and address any complications that arise, including issues related to hemorrhoids. If your current surgeon is not addressing your concerns adequately, consider seeking a second opinion.

6. Surgical Options: If the hemorrhoids do not resolve with conservative measures, surgical options may be necessary. This could include hemorrhoidectomy or other minimally invasive procedures, depending on the severity of the hemorrhoids and your overall health.

In summary, while it is concerning that your hemorrhoids are protruding after fistula surgery, it is essential to consult with your healthcare provider to evaluate the situation properly. They can provide tailored advice and treatment options based on your specific condition. Early intervention can prevent further complications and improve your quality of life.

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