Post-Surgery Bowel Issues: and Managing Symptoms

Postoperative bowel issues after hemorrhoid surgery?

Hello Dr.
Ke! Thank you very much for your prompt response regarding the previous granuloma issue! This time, my question is: My wife is nearly a month post-surgery but still frequently experiences the urge to have a bowel movement.
Generally, she is able to pass stool, but for the past two days, she has suddenly been having difficulty.
She often feels the urge but sometimes cannot pass stool, and when she tries to push, there is a little blood.
She has experienced this bleeding five times over the last two days, which is a phenomenon she has not encountered before, and we are very concerned about any negative impact on her recovery post-surgery! My wife is very disciplined and keeps a daily record of her diet, ensuring she has a consistent intake of water, vegetables, and fruits.
We are unsure why her bowel movements have suddenly become irregular.
Could you please provide some clarification and suggestions? Thank you!

Mr. Shi, 60~69 year old female. Ask Date: 2019/05/27

Dr. Ke Fangxu reply Surgery

It is common to experience abnormal sensations during bowel movements after hemorrhoid surgery, and mild bleeding is also considered normal.
If a colonoscopy was performed prior to the surgery, there is no need for concern.
Otherwise, it is advisable to schedule a colonoscopy after the wound has healed for better assessment.

Reply Date: 2019/05/27

More Info

Post-surgery bowel issues can be quite common, especially after significant procedures like colon surgery. It’s understandable that you are concerned about your wife's recent symptoms, particularly the difficulty in bowel movements and the presence of blood. Let's break down the potential causes and management strategies for these symptoms.

Understanding Post-Surgery Bowel Issues
1. Changes in Bowel Function: After surgery, especially involving the colon, the bowel may take time to adjust. The surgical procedure can alter the normal anatomy and function of the intestines, leading to changes in bowel habits. It is not unusual for patients to experience irregular bowel movements, including increased urgency or difficulty passing stool.

2. Diet and Hydration: Even with a well-planned diet, factors such as hydration levels can significantly impact bowel function. Insufficient fluid intake can lead to harder stools, making them more difficult to pass. Ensure that your wife is drinking enough water throughout the day, as hydration is crucial for maintaining soft stools.

3. Medication Effects: If your wife is taking pain medications or other medications post-surgery, these can also affect bowel motility. Opioids, for example, are known to cause constipation. If she is on any medications, it might be worth discussing with her healthcare provider whether these could be contributing to her symptoms.

4. Scar Tissue Formation: Surgical procedures can lead to the formation of scar tissue (adhesions) in the abdomen, which may affect bowel function. This can sometimes cause blockages or changes in how the intestines move.

5. Hemorrhoids or Anal Fissures: The presence of blood during bowel movements can indicate hemorrhoids or anal fissures, which can develop due to straining or changes in bowel habits. These conditions can cause pain and bleeding, especially if the stool is hard or if there is excessive straining.

Management Strategies
1. Dietary Adjustments: Continue to focus on a high-fiber diet, including fruits, vegetables, and whole grains. Fiber helps to bulk up the stool and can promote regular bowel movements. However, if your wife is experiencing bloating or gas, it may be beneficial to gradually increase fiber intake to allow her digestive system to adjust.

2. Hydration: Encourage her to drink plenty of fluids, aiming for at least 8-10 glasses of water a day. This can help soften the stool and make it easier to pass.

3. Gentle Laxatives: If dietary changes are not sufficient, consider discussing the use of gentle laxatives with her healthcare provider. Options like polyethylene glycol (MiraLAX) can help relieve constipation without causing cramping.

4. Avoid Straining: Encourage her to avoid straining during bowel movements, as this can exacerbate any existing issues like hemorrhoids or fissures. If she feels the urge to go but cannot, it may be better to wait a bit and try again later rather than forcing it.

5. Follow-Up with Healthcare Provider: Given the presence of blood and the sudden change in bowel habits, it is crucial to follow up with her healthcare provider. They may want to perform an examination or additional tests to rule out any complications from the surgery or other underlying issues.

6. Pelvic Floor Therapy: If the issues persist, consider consulting a specialist in pelvic floor therapy. They can provide exercises and techniques to help improve bowel function and reduce any discomfort associated with bowel movements.

Conclusion
Post-surgical bowel issues can be complex and multifactorial. While it is common to experience changes in bowel habits after surgery, the presence of blood and significant discomfort warrants prompt attention from a healthcare professional. By addressing dietary habits, hydration, and potential medication effects, along with regular follow-ups, you can help your wife manage her symptoms effectively and support her recovery process. Always prioritize communication with her healthcare team to ensure that any concerning symptoms are evaluated and managed appropriately.

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