Post-Surgery Anal Discomfort: Persistent Pressure and Urgency

Post-hemorrhoidectomy anal fullness and urge to defecate?

Dr.
Ke: Hello, on August 20, I consulted about persistent anal heaviness and the feeling of urgency four months after hemorrhoid surgery.
You suggested seeking a second opinion to check for possible anal stenosis as a complication.
Recently, I visited the colorectal surgery department at Shin Kong Hospital and consulted with Dr.
Chou Yen-Hui.
He informed me that I had undergone a colonoscopy in mid-March.
After listening to my symptoms and performing a digital rectal examination and anoscopy, he found no signs of anal stenosis or abscess, and everything appeared normal.
Dr.
Chou was also puzzled as to why I have continued to experience heaviness and urgency since the surgery, but he did not recommend any further tests.
He prescribed a suppository called Yi Zhi Kang, advising me to use one each night for a month to see if it improves my condition.

May I ask, Dr.
Ke: Is there any way to determine the cause of this heaviness and urgency using diagnostic tools? Dr.
Chou mentioned that Yi Zhi Kang suppositories are relatively safe for continuous use for a month without issues, but I am still somewhat concerned.
What are your thoughts on this? Are there other treatment options available for post-operative anal heaviness and urgency? This situation is truly distressing and painful!

Miss Hou, 60~69 year old female. Ask Date: 2019/08/30

Dr. Ke Fangxu reply Surgery

1.
A rectal pressure test can be performed to check for issues with the sphincter, and a defecography can be done to assess the coordination of the pelvic floor muscles.
However, these specialized tests may only be available at larger hospitals.

2.
If the symptoms improve with the treatment, then it is advisable to continue using it.
I also have patients who have been using this type of suppository long-term.
However, if the efficacy is poor, then long-term use may not be meaningful.

Reply Date: 2019/08/30

More Info

Post-surgery anal discomfort, particularly after hemorrhoid surgery, can be a challenging issue for many patients. The symptoms you describe, such as persistent pressure and a sense of urgency to defecate, can be distressing and may significantly impact your quality of life. Understanding the underlying causes and exploring potential treatments is essential for managing these symptoms effectively.

After hemorrhoid surgery, it is not uncommon for patients to experience discomfort or changes in bowel habits. The surgical procedure can lead to inflammation, changes in the anal canal, or even alterations in the surrounding tissues, which may contribute to sensations of pressure or urgency. In your case, it is reassuring that your recent evaluations, including a digital rectal exam and anoscopy, did not reveal any signs of complications such as anal stenosis or abscess formation. This suggests that the surgical site is healing appropriately.

The sensation of pressure and urgency you are experiencing could be attributed to several factors:
1. Inflammation and Healing: Post-surgical inflammation can cause discomfort and a feeling of fullness in the anal area. As the tissues heal, this sensation may gradually improve.

2. Nerve Sensitivity: Surgery can sometimes lead to increased sensitivity in the anal region. This heightened sensitivity can result in a persistent feeling of urgency, even when the bowel is not full.

3. Changes in Bowel Habits: After surgery, some patients may experience changes in their bowel habits, including increased frequency or urgency. This can be due to dietary changes, anxiety about bowel movements, or the effects of pain medications.

4. Muscle Spasm: The anal sphincter muscles may experience spasms post-surgery, leading to discomfort and a sensation of urgency.

Regarding the use of the suppository you mentioned (益痔康), it is generally considered safe for short-term use. These medications often contain ingredients that can help reduce inflammation and promote healing. However, it is essential to follow your doctor's instructions and monitor your symptoms closely. If you notice any worsening of your symptoms or new side effects, you should contact your healthcare provider.

In terms of additional treatment options, here are a few strategies that may help alleviate your symptoms:
- Dietary Adjustments: Ensure you are consuming a high-fiber diet to promote regular bowel movements and prevent straining. Adequate hydration is also crucial.

- Warm Sitz Baths: Taking warm baths can help soothe the anal area and reduce discomfort.

- Pelvic Floor Exercises: Strengthening the pelvic floor muscles may help improve control and reduce symptoms of urgency.

- Pain Management: Over-the-counter pain relievers may help manage discomfort, but consult your doctor before taking any new medications.

- Follow-Up Care: If symptoms persist despite these measures, consider scheduling a follow-up appointment with your healthcare provider. They may recommend further evaluation or alternative treatments, such as physical therapy focused on pelvic floor rehabilitation.

In conclusion, while persistent anal discomfort after hemorrhoid surgery can be frustrating, it is essential to remain in communication with your healthcare provider. They can help you navigate your symptoms and determine the best course of action for your recovery. If your symptoms do not improve with conservative measures, further evaluation may be warranted to rule out any underlying issues.

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