Post-Bowel Movement Discomfort: Leakage After Surgery

One hour after defecation, there is a noticeable leakage of stool from the anal area?

Hello Dr.
Ke: I had a fistula and hemorrhoid surgery at the end of last year, and so far the wound healing has been quite good (the fistula wound has formed a fibrous scar).
However, after using the restroom and cleaning myself with water, I experience a burning and stinging sensation around the anal area about an hour later, and I notice a small amount of residual feces around the anus (possibly seepage?).
I visited a colorectal specialist at the hospital for a digital examination, and the doctor said there was no significant issue, attributing the seepage to not having fully emptied my bowels.
This leakage only occurs after a bowel movement and does not happen again until the next bowel movement after I clean myself again.
Could you please advise if this is due to not fully emptying my bowels or if it might be related to an issue from the previous surgery? How should I address this? Thank you, doctor!

Xiao Mi, 30~39 year old female. Ask Date: 2020/06/17

Dr. Ke Fangxu reply Surgery

In patients who have undergone fistula surgery, a small number may experience anal deformity due to sphincterotomy, and some may have decreased anal sphincter tone.
However, your symptoms may not necessarily be caused by the surgery, as individuals without prior surgery can also experience similar issues.
It is important to have a thorough examination by a physician to determine the cause.
If the issue is only mild fecal leakage, it is generally not a concern; simply avoiding overly soft stools can help improve this condition.
Medications may also be used to enhance anal sphincter tone.

Reply Date: 2020/06/17

More Info

Post-bowel movement discomfort, particularly the sensation of burning and leakage, can be a common issue following anal surgery, such as the fistula and hemorrhoid procedures you underwent. It’s important to understand that your symptoms may stem from a combination of factors related to the surgical site, healing process, and possibly changes in bowel habits.

Firstly, the sensation of burning or stinging after bowel movements can be attributed to several factors. After surgery, the anal area may be more sensitive due to inflammation or nerve irritation. The presence of scar tissue from the surgery can also contribute to discomfort, as it may alter the normal function of the anal sphincter and surrounding tissues. This can lead to a feeling of incomplete evacuation, which might explain the residual stool you notice after using the restroom.

The leakage you describe, occurring after bowel movements, is often related to the mechanics of bowel evacuation. If the anal sphincter is not functioning optimally due to surgical changes, it may not close completely, leading to minor leakage. This can be exacerbated by the consistency of your stool; softer stools may be more likely to cause leakage than firmer ones.
Your doctor’s assessment that there are no significant issues upon examination is reassuring, but it does not eliminate the discomfort you are experiencing. Here are some strategies that may help alleviate your symptoms:
1. Dietary Adjustments: Ensure that your diet is high in fiber to promote regular, well-formed bowel movements. This can help reduce straining and the likelihood of incomplete evacuation. Consider incorporating fruits, vegetables, whole grains, and adequate hydration into your diet.

2. Post-Defecation Hygiene: After bowel movements, consider using a gentle cleansing method. Instead of just water, you might find that using a moist wipe or a bidet can help ensure that the area is clean without causing irritation.

3. Sitz Baths: Taking warm sitz baths can help soothe the anal area and promote relaxation of the sphincter muscles. This can be particularly beneficial after bowel movements to alleviate burning sensations.

4. Pelvic Floor Exercises: Engaging in pelvic floor exercises can strengthen the muscles around the anus and improve control. Kegel exercises, which involve contracting and relaxing the pelvic floor muscles, may be beneficial.

5. Consultation with a Specialist: If your symptoms persist or worsen, it may be worthwhile to seek a second opinion from a colorectal specialist. They can provide further evaluation and may suggest additional treatments or interventions, such as biofeedback therapy or medications to manage discomfort.

6. Medication: Over-the-counter topical treatments, such as hydrocortisone cream or witch hazel pads, may provide temporary relief from burning sensations.

In conclusion, while your symptoms may be related to the surgical changes and the healing process, there are several strategies you can employ to manage discomfort and improve your bowel habits. If these measures do not lead to improvement, further evaluation by a healthcare professional is warranted to rule out any underlying issues and to explore additional treatment options.

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