Changes in Anal Tightness After Hemorrhoid Surgery

After hemorrhoid surgery, it feels like the anus is not as tight as before?

Hello, Dr.
Hsu: Several years ago, I underwent a rubber band ligation procedure to treat multiple hemorrhoids, which were tied off externally for about seven days.
Within three months post-surgery, I frequently visited the doctor for anal massages and also had an anal dilation procedure (where incisions were made around the anal area with a scalpel).
Later, upon consulting other doctors, I discovered that there was still a large hemorrhoid inside the anal canal (the surgeon only performed a digital examination without using any instruments for deeper inspection).
Before the surgery, I attempted to insert my finger into the anus but felt a resistance as if it were a solid wall, making it difficult to penetrate.
However, after the surgery, I found it easier to insert my finger for anal massage.
I feel that my anus is not as tight as it was before the surgery.
A few months after the surgery, I occasionally touched the anal opening (not after a bowel movement) and noticed a slight fecal odor and some fecal-like material (there were a few instances where there was a larger amount), but there were also times when there was no fecal odor.
A few months post-surgery, when using a handheld showerhead to rinse the anus, I felt a bit of water entering the anal canal.
I was hesitant to use the showerhead, but after some time, I felt less of this sensation when rinsing (before the surgery, I often used the showerhead to clean the anus).
Could you please advise if the anal tightness cannot return to what it was before after hemorrhoid surgery? Is my anus normal?

john, 40~49 year old female. Ask Date: 2019/01/25

Dr. Xu Kaixi reply Surgery

The tightness and looseness of the anus are controlled by the anal sphincter muscles.
To assess the function of the anal sphincter, it is recommended that you visit a surgical outpatient clinic for a digital rectal examination or other assessments.

Reply Date: 2019/01/25

More Info

After undergoing hemorrhoid surgery, it is not uncommon for patients to experience changes in anal tightness and sensation. The surgical procedures, such as rubber band ligation or excision, can alter the anatomy and function of the anal sphincter muscles, which may lead to a feeling of decreased tightness or altered sensation in the anal region.

In your case, it seems that prior to the surgery, you experienced significant tightness in the anal canal, which made it difficult to insert a finger. Post-surgery, you have noted that it feels easier to insert a finger, suggesting that the tightness has indeed decreased. This change can be attributed to several factors:
1. Sphincter Muscle Relaxation: Surgical interventions can sometimes lead to a temporary or permanent relaxation of the anal sphincter muscles. This can result in a feeling of decreased tightness, which may be perceived as a positive change for some patients, especially if they experienced discomfort prior to surgery.

2. Healing and Scarring: The healing process after surgery can also affect the tightness of the anal canal. Scar tissue formation can alter the elasticity and function of the anal sphincters. In some cases, this may lead to a feeling of looseness or a change in sensation.

3. Nerve Sensitivity: Surgery can impact the nerves in the anal region, which may alter sensation. Some patients report changes in how they perceive pressure or touch in the area, which could explain the differences you are experiencing.

Regarding the presence of fecal odor or residue when you touch the anal area, this could be due to a few reasons:
- Incomplete Closure: If the anal sphincter is not closing completely, it may allow for some residual stool to remain in the anal canal, leading to the sensation and odor you describe. This could be a result of the surgical procedure or changes in muscle tone.

- Hygiene Practices: Post-surgery, it is essential to maintain good hygiene to prevent any infections or complications. If you are experiencing difficulty with cleanliness, you might consider discussing this with your healthcare provider for tailored advice.

- Fecal Incontinence: In some cases, changes in anal tightness can lead to mild fecal incontinence, where small amounts of stool may escape unintentionally. If this is a concern, it is crucial to discuss it with your doctor.

As for the sensation of water entering the anal canal when using a bidet, this could be related to the changes in the anal anatomy post-surgery. If you feel uncomfortable with this sensation, it might be best to avoid using the bidet until you have discussed it with your healthcare provider.

In conclusion, while it is possible that your anal tightness may not return to its pre-surgery state, many patients adapt to these changes over time. It is essential to have open communication with your healthcare provider regarding any concerns you have about your symptoms, as they can offer guidance and reassurance. If you experience significant changes in bowel habits, incontinence, or discomfort, seeking a follow-up appointment with a colorectal specialist may be beneficial. They can perform a thorough evaluation and provide recommendations tailored to your specific situation.

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