Post-Surgery Complications of Hemorrhoid Surgery: Insights and Solutions

Postoperative issues related to hemorrhoid surgery?

Dr.
Ke: Hello! I consulted you in June regarding a post-operative external anal mass issue, and I appreciate your detailed response.
It has been nearly four months since my surgery for mixed internal and external hemorrhoids, and I still have one large and three small masses remaining externally.
The surgeon mentioned that these are scars (which do not affect bowel movements).
The largest mass measures approximately 1.5 x 0.5 cm.
The doctor also stated that the rectal mucosa is fine, but I am unsure why every two to three days, or when I have a soft, large stool and a rapid bowel movement, I experience swelling in the anal area (rectum) and the external scar, which triggers a strong urge to defecate.
When the urge is intense, it is extremely painful, giving me a feeling of being worse than dead.
During multiple follow-up visits, the surgeon has consistently said that my blood circulation is relatively poor, and the newly formed delicate skin inside the anus needs time to adapt to the pulling of the stool, while the scar will gradually shrink a bit more.
I have been advised to observe for several months, but the urge to defecate is so painful that I am eager to find a solution.
What are your thoughts and suggestions regarding my condition? Do I need to undergo further examinations? Additionally, I would like to inquire if deep-seated abscesses have symptoms.
There is no redness, swelling, heat, or pain externally, and there are no painful points internally, but I have been experiencing a constant feeling of heaviness in the anal area (this has been ongoing for over two months), and I am worried it might be an abscess.
I underwent a colonoscopy at Taichung Veterans General Hospital in mid-March, which showed no issues, and I typically have bowel movements two to three times a day, mostly consisting of soft, formed stools.
Thank you for your assistance!

Miss Hou, 60~69 year old female. Ask Date: 2019/08/18

Dr. Ke Fangxu reply Surgery

1.
A troublesome complication after hemorrhoid surgery is anal stenosis.
If this occurs, you may need to undergo anal dilation or anal reconstructive surgery.
However, based on your description alone, it is difficult to make a judgment.
I recommend consulting another physician for a second opinion.
2.
Deep-seated abscesses can indeed present with such symptoms, but it is unlikely that they are the cause.
If left untreated, they can rapidly lead to sepsis within a week, so it shouldn't take this long.

Reply Date: 2019/08/18

More Info

Post-surgery complications following hemorrhoid surgery can be quite distressing, and it’s understandable that you are experiencing significant discomfort. Hemorrhoid surgery, particularly for mixed hemorrhoids, can lead to various complications, including scarring, pain, and changes in bowel habits.
From your description, it seems that you have developed a significant scar tissue formation at the surgical site, which is not uncommon. Scarring can lead to a sensation of fullness or pressure, and in some cases, it can be painful, especially during bowel movements. The fact that you are experiencing a strong urge to defecate, accompanied by pain, suggests that the area is still sensitive and may be reacting to the passage of stool.
It’s important to note that the healing process can take several months, and the body needs time to adapt to the changes post-surgery. The new tissue that forms can be delicate and may not yet be fully accustomed to the stress of bowel movements. Your surgeon’s advice to monitor the situation for a few more months is reasonable, as many patients find that their symptoms gradually improve over time.

However, if the pain is severe and impacting your quality of life, it may be worth seeking a second opinion or further evaluation. Persistent pain and discomfort could indicate other issues, such as anal fissures or even the development of a fistula or abscess, which can occur in the postoperative period.
Regarding your concern about a deep-seated abscess, symptoms can vary. While classic signs include redness, swelling, and pain, some abscesses may not present with these symptoms, especially if they are located deeper within the tissue. The sensation of heaviness or pressure you are experiencing could potentially be related to an abscess, but it is not definitive without further examination.

In terms of management, here are some suggestions that may help alleviate your symptoms:
1. Dietary Adjustments: Ensure you are consuming a high-fiber diet to promote softer stools, which can reduce strain during bowel movements. Staying well-hydrated is also crucial.

2. Pain Management: Over-the-counter pain relievers such as ibuprofen or acetaminophen may help manage discomfort. However, consult your doctor before taking any medication.

3. Warm Baths: Soaking in warm water (sitz baths) can provide relief and promote blood flow to the area, which may aid in healing.

4. Topical Treatments: Your doctor may recommend topical anesthetics or hydrocortisone creams to reduce inflammation and pain.

5. Follow-Up Care: Regular follow-up with your surgeon is essential. If your symptoms do not improve or worsen, further diagnostic tests such as imaging or a physical examination may be warranted.

In conclusion, while it is common to experience some discomfort after hemorrhoid surgery, persistent and severe symptoms warrant further investigation. It is crucial to maintain open communication with your healthcare provider and advocate for your health. If you feel that your concerns are not being adequately addressed, seeking a second opinion can provide additional insights and options for your recovery.

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