Post-Surgery Pain Management: Dealing with Diarrhea After Hemorrhoidectomy

Postoperative pain

Hello Doctor, I underwent a complete excision of internal and external hemorrhoids on October 11th, and today is the fifth day post-surgery.
The procedure was performed using an energy device.
For the first three days, I took a stool softener with each meal, but I still couldn't have a bowel movement.
Therefore, on the afternoon of the third day, I took a packet of Chinese herbal medicine containing rhubarb and increased the dosage of my Western stool softener by two pills before bed.
On the morning of the fourth day, I finally had a bowel movement (diarrhea with a small amount).
I'm not sure if it coincided with the onset of my menstrual period.
After successfully having a bowel movement on the fourth morning, I stopped all stool softeners, but I have continued to experience diarrhea for the past two days.
Whenever I feel the urge to go, I almost can't make it to the bathroom in time, and I experience severe cramping afterward.
Warm sitz baths and pain medication do not completely alleviate the pain.
After cleaning the affected area, I still notice some fecal leakage shortly after.
I'm very concerned about the risk of infection at the surgical site.
Doctor, should I temporarily stop drinking and eating to resolve the diarrhea issue?

Xiao Bao, 30~39 year old female. Ask Date: 2019/10/16

Dr. Ke Fangxu reply Surgery

After hemorrhoid surgery, it is crucial to avoid both constipation and diarrhea, as either condition can affect wound healing and cause discomfort.
Regardless of the surgical method used, doctors typically prescribe stool softeners postoperatively.
If you are using a combination of Western and traditional Chinese medicine, it may indeed lead to diarrhea.
It is recommended to increase your intake of dietary fiber and fluids, and temporarily discontinue the stool softeners.
Pain and anal control issues should improve within 1 to 2 weeks.
If there is no improvement, you should consult your surgeon for further evaluation and treatment.

Reply Date: 2019/10/16

More Info

After undergoing a hemorrhoidectomy, managing post-surgery pain and complications such as diarrhea can be quite challenging. It’s important to approach this situation with a clear understanding of the potential causes and appropriate management strategies.

Firstly, it’s crucial to recognize that diarrhea following surgery can be due to several factors. In your case, the use of laxatives and herbal medications like Da Huang (rhubarb) may have contributed to the loose stools. While these medications are often used to promote bowel movements, they can sometimes lead to diarrhea, especially if taken in excess or if the body is particularly sensitive to them. Additionally, the stress of surgery, changes in diet, and hormonal fluctuations during your menstrual cycle could also play a role in your gastrointestinal symptoms.

1. Managing Diarrhea: It is not advisable to stop drinking fluids entirely, as dehydration can occur, especially after surgery. Instead, consider adjusting your diet to include bland foods that are easier on your digestive system. Foods such as bananas, rice, applesauce, and toast (often referred to as the BRAT diet) can help firm up stools. Avoid high-fiber foods, dairy products, and greasy or spicy foods until your symptoms improve.

2. Pain Management: The pain you are experiencing after bowel movements could be due to irritation of the surgical site, especially if diarrhea is causing frequent and harsh bowel movements. Continue with warm sitz baths, as they can provide relief by promoting blood flow to the area and reducing discomfort. Over-the-counter pain medications, such as acetaminophen or ibuprofen, can also help manage pain, but consult your doctor before taking any new medications.

3. Preventing Infection: Your concern about potential infection is valid, especially with the presence of diarrhea and the risk of fecal contamination of the surgical site. Ensure that you maintain good hygiene by gently cleaning the area after each bowel movement and using a mild, unscented soap. If you notice any signs of infection, such as increased redness, swelling, or discharge from the surgical site, contact your healthcare provider immediately.

4. Consulting Your Doctor: Given the ongoing diarrhea and pain, it would be prudent to reach out to your healthcare provider. They can assess your condition and may recommend stool tests to rule out infections or other gastrointestinal issues. They might also adjust your pain management plan and provide specific recommendations tailored to your situation.

5. Dietary Adjustments: Since you have already stopped the softeners, monitor your bowel movements closely. If diarrhea persists, consider reintroducing a mild stool softener under the guidance of your doctor, but in a controlled manner. It’s also essential to stay hydrated; consider electrolyte solutions if diarrhea continues.

In summary, while it’s understandable to be concerned about diarrhea and pain post-surgery, managing these symptoms effectively involves dietary adjustments, proper hydration, pain management strategies, and close communication with your healthcare provider. Your recovery is paramount, and addressing these issues promptly can help ensure a smoother healing process.

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