Post-Surgery Complications of Hemorrhoid Sclerotherapy: What to Expect

Postoperative Issues Related to Hemorrhoid Drying Therapy

Hello, doctor.
I underwent a hemorrhoid sclerotherapy on February 21, where the doctor explained that a sclerosing agent was injected into the anus to cause necrosis and detachment of the hemorrhoidal tissue.
After the procedure, I had stitches at the anal opening, and the day after, I had them removed, which was painful for over a month.
I had numerous follow-up visits for medication application.
Due to difficulty with bowel movements, the doctor advised me to perform anal dilation myself.
However, I found that using the restroom was still very difficult.
The doctor mentioned that the surgery caused anal stenosis, and I underwent an anal dilation procedure under anesthesia, which was also painful for a while.

Later, since there was no improvement, I was referred to another physician.
After the referral, the new doctor performed a digital examination and instructed me to dilate my anus daily for two months.
I followed the advice, and my bowel movements improved significantly, becoming less strenuous.
However, I have noticed a persistent urge to use the restroom, accompanied by a strange, painful sensation when I do go, and I frequently experience the urge to defecate, which is painful.

I would like to ask the doctor what might be causing this.
I am very worried, especially since it has been almost five months post-surgery, and I still have not recovered!

Niming, 20~29 year old female. Ask Date: 2019/07/07

Dr. Ke Fangxu reply Surgery

The dry treatment for hemorrhoids, which was previously referred to as sclerotherapy, is now less commonly performed.
Your situation may be due to the contraction of the injection site leading to anal stenosis, which is why your doctor has advised you to perform anal dilation.
If your difficulty and pain during bowel movements have significantly improved, then there is no cause for concern, and it should continue to improve gradually.
However, if you continue to experience pain and difficulty with bowel movements, you should consult your doctor to assess the degree of anal stenosis and determine if further treatment or surgery is necessary.

Reply Date: 2019/07/07

More Info

Post-surgery complications following hemorrhoid sclerotherapy can be quite challenging, and it’s understandable that you are feeling concerned about your ongoing symptoms. Hemorrhoid sclerotherapy is a minimally invasive procedure aimed at treating hemorrhoids by injecting a sclerosing agent into the affected tissue, causing it to shrink and eventually fall off. While many patients experience relief from their symptoms, some may encounter complications that can affect their recovery.

From your description, it seems you have experienced several complications, including pain, difficulty with bowel movements, and a sensation of anal tightness or narrowing. These issues can arise for a variety of reasons:
1. Anal Stenosis: After sclerotherapy, some patients may develop anal stenosis, which is a narrowing of the anal canal. This can lead to difficulty passing stool, increased pain during bowel movements, and a sensation of incomplete evacuation. The fact that you underwent anal dilation suggests that your healthcare provider recognized this issue and attempted to alleviate it.

2. Pain and Discomfort: Post-operative pain is common, especially in the first few weeks following the procedure. However, if pain persists for months, it may indicate complications such as inflammation or scarring in the anal area.
3. Frequent Urgency: The sensation of needing to have a bowel movement frequently, even when the bowels are empty, can be a result of nerve sensitivity or irritation in the anal region following surgery. This can also be exacerbated by anxiety about bowel movements, especially if they have been painful in the past.

4. Psychological Factors: The experience of pain and complications can lead to anxiety about bowel movements, which can create a cycle of discomfort and urgency. It’s essential to address both the physical and psychological aspects of recovery.

5. Diet and Hydration: Ensuring that you have a high-fiber diet and adequate hydration is crucial in preventing constipation and making bowel movements easier. If you are still experiencing difficulty, consider discussing dietary adjustments with your healthcare provider.

Given that you have been following your doctor's advice for anal dilation and have seen some improvement, it’s a positive sign. However, if you continue to experience pain and discomfort, it may be beneficial to seek further evaluation. Here are some steps you can take:
- Follow-Up Appointments: Regular follow-ups with your healthcare provider are essential. They can monitor your recovery and make necessary adjustments to your treatment plan.

- Physical Therapy: Some patients benefit from pelvic floor physical therapy, which can help with muscle relaxation and improve bowel function.

- Pain Management: Discuss pain management options with your doctor. They may recommend medications or topical treatments to alleviate discomfort.

- Dietary Modifications: Continue to focus on a high-fiber diet and adequate fluid intake. If you are still struggling with bowel movements, your doctor may suggest stool softeners or other interventions.

- Mental Health Support: If anxiety about bowel movements is affecting your quality of life, consider speaking with a mental health professional who can help you develop coping strategies.

In conclusion, while post-surgery complications can be frustrating and concerning, many patients do find relief with appropriate management and follow-up care. It’s essential to maintain open communication with your healthcare provider and advocate for your health as you navigate your recovery. If symptoms persist or worsen, do not hesitate to seek a second opinion or further evaluation. Your comfort and well-being are paramount, and there are often multiple avenues to explore for relief.

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