Post-Surgery Concerns: Swelling After Hemorrhoid Surgery

Postoperative swelling after hemorrhoid surgery?

Hello Dr.
Ke,
It has been 18 days since my mixed hemorrhoid surgery (stage IV), and I am no longer experiencing pain and have been able to pass stool smoothly.
However, I have noticed a protrusion on the left side of my anus (which is not painful when pressed and has no bleeding).
In the morning, it shrinks into a small lump, but as I go about my day (walking, doing household chores, etc.), it gradually protrudes more, especially after bowel movements or sitz baths (I wonder if posture affects this?).
After resting in bed, it becomes smaller.
When the protrusion is prominent, I feel a slight foreign body sensation while walking and a mild pressure sensation when sitting.
During my two follow-up visits, the doctor mentioned that postoperative swelling is normal and advised me to be patient while waiting for the swelling to subside.
However, I am quite concerned.

I would like to ask:
1.
Why does the lump fluctuate in size? Is this normal?
2.
Will the lump disappear?
3.
Should I continue with sitz baths?
4.
Are there any ointments or oral medications that can help reduce the swelling?
Thank you, Dr.
Ke!

M, 60~69 year old female. Ask Date: 2019/05/17

Dr. Ke Fangxu reply Surgery

1.
The presence of residual skin tags after surgery is a normal phenomenon.

2.
It may or may not resolve; observation over a few months is necessary to determine the outcome.

3.
If there is no discharge from the wound, then no additional treatment is needed.
Generally, it takes about a month for the wound to fully heal post-surgery, so sitz baths should continue for another two weeks.

4.
Topical hemorrhoid ointments can be applied; oral anti-inflammatory medications may not be very helpful.

Reply Date: 2019/05/17

More Info

After undergoing surgery for mixed hemorrhoids, it's not uncommon to experience some swelling and discomfort during the recovery period. Your concerns about the fluctuating size of the lump near your anus, especially after activities like bowel movements or sitting in a warm bath, are valid and worth discussing in detail.

1. Why does the lump fluctuate in size? Is this normal?
The swelling you're observing is likely a result of postoperative inflammation and the body's natural healing process. After surgery, the tissues around the surgical site can become inflamed, leading to swelling. Activities such as walking, sitting, or straining during bowel movements can exacerbate this swelling, causing the lump to appear larger. Conversely, when you rest or lie down, the swelling may decrease, leading to the lump appearing smaller. This fluctuation is generally normal and can be attributed to changes in blood flow and pressure in the area.

2. Will the lump disappear?
In most cases, the swelling should gradually decrease over time as your body heals. The lump may not completely disappear, especially if it is a result of scar tissue formation or residual swelling from the surgery. However, with time, the size and prominence of the lump should diminish significantly. It's essential to monitor the lump for any changes, such as increased pain, redness, or discharge, which could indicate complications.

3. Should I continue sitz baths?
Yes, continuing sitz baths can be beneficial. Sitz baths help to soothe the area, promote blood circulation, and can aid in reducing swelling. Warm water can relax the muscles and alleviate discomfort, making it easier to pass stools. Aim for 15-20 minutes of soaking a few times a day, especially after bowel movements, to maintain hygiene and comfort.

4. Are there any ointments or oral medications to help reduce swelling?
While there are topical treatments available, such as hydrocortisone creams or witch hazel pads, it's crucial to consult your physician before applying any medication to the surgical site. These treatments can help reduce inflammation and soothe discomfort. Oral medications, such as non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, can also help manage pain and reduce swelling. However, always follow your doctor's recommendations regarding medication, especially after surgery.

In summary, the swelling and lump you're experiencing post-hemorrhoid surgery are likely part of the normal healing process. It's essential to maintain communication with your healthcare provider, follow their advice regarding sitz baths and medications, and report any concerning changes. Recovery can take time, and patience is key. If you have any further concerns or if the symptoms worsen, do not hesitate to reach out to your doctor for a follow-up consultation.

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