Post-Surgery Concerns: Managing Hemorrhoid Recovery Challenges

Postoperative issues related to hemorrhoid surgery?

Hello Dr.
Ke, on April 10th, I consulted about the issue of frequent urges related to stage IV internal and external hemorrhoids.
After discussing with my physician, I opted for an early surgery, which was done a month and a half ago.
During this period, I have not experienced any major bleeding or infection.
Three weeks post-surgery, there has been no more bleeding or discharge.
I stopped taking stool softeners a week after the surgery, and my bowel movements have been relatively smooth since then.
However, I still have some questions I would like to ask you.
First, there is a lump where the external hemorrhoid was severe (without bleeding or discharge).
During my follow-up, the doctor mentioned it would gradually shrink and become a skin tag.
It is currently about the size of a fingernail.
Will it continue to shrink? Is this skin tag a remnant of the external hemorrhoid? Could it potentially become an external hemorrhoid again? Does it need to be addressed? There is a small granulation tissue next to the lump, and the doctor also mentioned it would slowly disappear, but its size has not changed so far.
Although there is currently no discharge or bleeding, is there a possibility of infection occurring in the future?
Second, it has been a month and a half since the surgery, and I still cannot eliminate the feeling of swelling.
Usually, it feels okay in the morning, but after noon, I gradually feel more swollen, with a tight sensation around the anus, followed by an urge to defecate (not related to gastrointestinal motility).
After having a bowel movement or passing gas, the discomfort eases slightly, but it doesn't take long before the swelling sensation returns.
Using suppositories only provides relief for about three hours, which is very uncomfortable and makes it difficult for me to go out, causing significant distress.
Dr.
Ke, what could be the cause of this condition? Will the urge to defecate ever disappear? I am very anxious and unsure of what to do.
I apologize for the lengthy message and appreciate your understanding!

Miss Hou, 60~69 year old female. Ask Date: 2019/06/08

Dr. Ke Fangxu reply Surgery

1.
If the surgery has been performed for two months, the extent of further reduction will be limited, and the likelihood of infection should also be low.
If treatment is desired, excisional surgery can be performed under local anesthesia.

2.
If a colonoscopy has not been conducted, it is recommended to undergo this examination first.
If the possibility of a tumor can be ruled out, then taking intestinal medications may help improve the issue.
If medication is not preferred, increasing dietary fiber intake and drinking more water can also lead to improvement.

Reply Date: 2019/06/08

More Info

Post-surgery recovery from hemorrhoid surgery, particularly for mixed hemorrhoids, can be a challenging process, and it is understandable that you have several concerns after your procedure. Let's address your questions one by one, while also providing some context about the recovery process and what you might expect moving forward.

1. Regarding the lump at the site of the external hemorrhoid: It is common for patients to experience some residual swelling or a lump after hemorrhoid surgery. This lump is often referred to as a "skin tag" or "piles remnant," which can occur as a result of the surgical procedure. Your doctor mentioned that it would gradually shrink and become less prominent, which is typical. However, the rate at which this occurs can vary from person to person. While it is possible for this skin tag to remain or even become symptomatic in the future, it is unlikely to revert back into a full-blown external hemorrhoid. If it continues to cause discomfort or does not shrink over time, you should discuss potential treatment options with your physician.

2. Concerning the small granulation tissue: Granulation tissue is a normal part of the healing process, and while it may take some time to resolve, it should gradually diminish. If it remains unchanged and does not cause any symptoms such as bleeding or infection, it is generally not a cause for concern. However, if you notice any changes, such as increased size, pain, or discharge, it would be prudent to consult your doctor.

3. Persistent swelling and discomfort: The sensation of swelling and the feeling of tightness around the anal area can be quite distressing. This may be due to several factors, including inflammation from the surgery, residual swelling, or even muscle tension in the anal sphincter. It is also possible that you are experiencing heightened sensitivity in the area as it heals. The fact that you feel relief after bowel movements or passing gas suggests that the sensation may be related to pressure or tension in the anal region.
It is important to maintain a high-fiber diet and stay well-hydrated to ensure smooth bowel movements, which can help reduce strain and discomfort. If you are still experiencing significant swelling after a month and a half, it would be advisable to follow up with your surgeon or a gastroenterologist for further evaluation. They may recommend treatments such as topical medications, sitz baths, or even physical therapy to help alleviate tension in the pelvic floor muscles.

4. Regarding the urgency of bowel movements: The feeling of frequent urgency can be distressing, especially post-surgery. This could be related to the healing process, where the nerves and muscles in the area are still adjusting after the trauma of surgery. Over time, as healing progresses, you may find that this urgency diminishes. However, if it persists, it is worth discussing with your healthcare provider, as they may want to evaluate for any underlying issues such as anal sphincter dysfunction or other gastrointestinal concerns.

5. Infection risk: While the absence of bleeding or discharge is a good sign, any surgical site can be at risk for infection, especially if there is any residual tissue or swelling. Maintaining good hygiene and monitoring for any signs of infection (such as increased redness, warmth, or discharge) is essential. If you have concerns about infection, do not hesitate to reach out to your healthcare provider.

In summary, while your recovery seems to be progressing well, it is essential to maintain open communication with your healthcare provider regarding your symptoms. They can provide tailored advice and interventions to help manage your recovery effectively. Remember that healing takes time, and it is normal to experience fluctuations in symptoms during this period. If your symptoms do not improve or worsen, seeking further evaluation is always a good idea.

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