Post-Surgery Concerns: Hemorrhoid Treatment and Recovery

Postoperative issues related to hemorrhoid surgery?

Hello Dr.
Ke: Seven years ago, I had a hemorrhoid protruding from my anus during a bowel movement.
I visited a clinic where the doctor inserted a finger into my anus and said there were several hemorrhoids inside that needed to be ligated.
The doctor used a device to open the anus and manually tied off about 7-10 hemorrhoids with something like rubber bands at the external anal opening.
The postoperative pain was severe, and after 7-10 days, the hemorrhoids fell off.
However, for the next three months, I had to visit the clinic from Monday to Saturday for anal massage (to prevent anal stenosis).
During this time, the doctor also made an incision around the anus, claiming it was to prevent narrowing.
Later, I consulted other doctors who used instruments to examine the inside of my anus and found a large hemorrhoid still present.
I did not address this hemorrhoid.
I have a couple of questions: 1.
I read online that internal hemorrhoid ligation should only be done one at a time and that it should be performed with instruments deep inside the anus, with the hemorrhoids tied off inside the anal canal.
Is the method of manually ligating multiple hemorrhoids at the external anal opening incorrect? 2.
Now, when I place a mirror on the ground and squat down to look at my anus (with my legs in an M shape), if I slightly tighten my anus, its shape still resembles that of a flower (according to the Wikipedia page on the anus).
However, when I relax my anus, I can see the red tissue inside, and the anus does not resemble a flower shape.
Compared to before the surgery, it feels like my anus is looser.
Is there an issue with the shape and tightness of my anus? Could this be related to having the hemorrhoids outside the anal opening for 7-10 days? Thank you.

tom, 40~49 year old female. Ask Date: 2020/02/01

Dr. Ke Fangxu reply Surgery

1.
Hemorrhoidal ligation primarily targets internal hemorrhoids.
I have heard that some people perform ligation for external hemorrhoids, but I have not personally undergone this procedure, so I cannot comment on it.

2.
The anal resting pressure needs to be measured with specialized instruments to determine if it is normal; it cannot be assessed by visual inspection.
Without preoperative and postoperative measurements of anal resting pressure for comparison, it is not possible to assert whether it is related to the previous surgery.

Reply Date: 2020/02/01

More Info

Post-surgery concerns regarding hemorrhoid treatment and recovery can be quite complex, especially when considering the various techniques used in hemorrhoidectomy and the potential complications that may arise. Based on your description, it seems you have undergone a rubber band ligation procedure for multiple hemorrhoids, which is a common and generally effective treatment for hemorrhoids. However, your experience raises some important questions regarding the appropriateness of the technique used and the subsequent changes you are observing.

1. Technique of Hemorrhoid Treatment: The method of rubber band ligation is typically performed on internal hemorrhoids, which are located above the dentate line and are not usually visible externally. The procedure involves placing a rubber band around the base of the hemorrhoid to cut off its blood supply, causing it to shrink and eventually fall off. It is unusual and not standard practice to ligate multiple hemorrhoids at once, especially if they are external. This could lead to increased pain and complications. If your treatment involved ligating external hemorrhoids, this may not have been the most appropriate method, as external hemorrhoids typically require different management, such as excision or other surgical techniques.

2. Changes in Anal Appearance and Tone: The changes you are observing in the shape and tightness of your anus could be attributed to several factors, including the surgical technique used, the healing process, and potential scarring. After surgery, it is not uncommon for patients to experience some degree of swelling, changes in skin texture, or alterations in the appearance of the anal area. The feeling of looseness or changes in the shape of the anus may also be related to the healing process and the body's natural response to surgery.
It is important to note that the anal sphincter muscles play a crucial role in maintaining continence and controlling the shape of the anal opening. If there was any trauma to these muscles during the procedure or if there has been significant swelling or scarring, this could impact the tightness of the anal canal.
3. Postoperative Care and Follow-Up: Given your concerns, it is essential to follow up with a qualified healthcare provider, preferably a colorectal surgeon, who can assess your situation more thoroughly. They may perform a physical examination and possibly recommend imaging studies to evaluate the condition of your anal canal and surrounding tissues.
In terms of recovery, it is crucial to maintain a high-fiber diet and stay hydrated to prevent constipation, which can exacerbate hemorrhoid symptoms. Additionally, gentle exercises and avoiding straining during bowel movements can aid in recovery.
4. Potential Complications: Complications from hemorrhoid surgery can include pain, bleeding, infection, and changes in anal function. If you are experiencing persistent pain, significant changes in bowel habits, or any other concerning symptoms, it is vital to seek medical attention promptly.

In conclusion, while rubber band ligation is a common treatment for hemorrhoids, the technique and postoperative care are critical for optimal recovery. Your observations about the changes in your anal area warrant a professional evaluation to ensure that there are no complications and to discuss any further treatment options if necessary. Always prioritize open communication with your healthcare provider regarding your concerns and symptoms to achieve the best possible outcome.

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