Post-Hemorrhoid Surgery: Persistent Bowel Urges and Discomfort

Post-hemorrhoid surgery

Hello Dr.
Ke, I am the patient with consultation number 153303.
I had hemorrhoid surgery last December, and it has been six months since then.
During this time, I constantly feel the urge to have a bowel movement, and it feels like something is stuck in my anus.
Sometimes I can pass stool, and sometimes I cannot.
Even after I do manage to have a bowel movement, I still feel the urge to go again.
The stool is not hard, but I have to exert effort to pass it.
What could be the cause of this situation?
When I returned for a follow-up, the doctor who did not perform the surgery mentioned that he felt a hard mass in the anal area, which might be related to the uterus or ovaries, and advised me to see a gynecologist.
I saw four gynecologists, and they all said it was normal and that it was the cervix.
I would like to know if the cervix can be felt from the anus.
When I squat and insert my finger, I can feel something pressing against it, which might be putting pressure on my rectum and causing the constant urge to have a bowel movement.

Later, I returned to the colorectal surgeon who performed my surgery, and he also confirmed that it was the cervix.
He said that even if it is present, it is only slightly low and should not affect my urge to defecate.
However, I am genuinely suffering from this constant urge to have a bowel movement.
During the late stages of pregnancy, I thought it was due to pressure from hemorrhoids, but after the surgery, the urge has intensified.
The surgeon mentioned that I might be more sensitive now and prescribed a topical ointment, Cataflam, and Peichia orally, and advised me to do pelvic floor exercises or sit cross-legged.
However, I feel that there has been no improvement.
Will I have to live with this condition for the rest of my life?
I have symptoms, but the tests do not reveal any issues, so I am often labeled as neurotic.
However, I truly feel the urge to defecate.
Dr.
Ke, do you have any good suggestions that could help me? I would be very grateful.

Xiao Yu, 40~49 year old female. Ask Date: 2020/06/24

Dr. Ke Fangxu reply Surgery

The sensation of urgency and heaviness in the rectum can be caused not only by rectal lesions but also by pelvic tumors or uterine pressure on the rectum.
If a colonoscopy has not been performed, it is advisable to undergo this examination first.
If the colon and rectum are found to be normal, a gynecological evaluation should be requested, as larger uterine fibroids can also cause such sensations due to pressure.
If a gynecological ultrasound has been done and shows no issues, the next step would be to perform a pelvic CT scan.
If that also shows no abnormalities, then there is more reason for reassurance.
If there is increased anal pressure, medication can be prescribed, along with Kegel exercises to strengthen the pelvic floor muscles, which will likely provide some benefit.

Reply Date: 2020/06/24

More Info

It sounds like you are experiencing a challenging situation following your hemorrhoid surgery. The persistent urge to have a bowel movement, along with the discomfort you describe, can be quite distressing. Let's break down the potential causes and management strategies for your symptoms.

Firstly, after hemorrhoid surgery, it is not uncommon for patients to experience changes in bowel habits and sensations. The surgical procedure can lead to increased sensitivity in the anal region, which may cause a heightened awareness of bowel movements. This sensitivity can sometimes manifest as a feeling of pressure or the sensation that you need to have a bowel movement even when your bowels are empty.
Additionally, the presence of scar tissue from the surgery can lead to changes in how the anal canal functions. Scar tissue can sometimes cause tightness or discomfort, which may contribute to the feeling of needing to pass stool. It’s also possible that the surgery may have altered the normal function of the anal sphincter, leading to difficulties in bowel movements.

Regarding the hard area that was felt during the examination, it is important to clarify that the anatomy of the pelvic region can sometimes lead to confusion. The uterus and cervix are located in close proximity to the rectum, and it is possible for a healthcare provider to palpate these structures during a rectal examination. However, it is unlikely that the cervix itself would be causing the sensation of needing to have a bowel movement. If multiple gynecologists have assessed this and deemed it normal, it is a good indication that there is no underlying gynecological issue contributing to your symptoms.

Your description of needing to strain to have a bowel movement, even when the stool is not hard, suggests that there may be a functional issue at play. This could be related to pelvic floor dysfunction, where the muscles that control bowel movements do not coordinate properly. This can lead to feelings of incomplete evacuation and the sensation of needing to go frequently.

Here are some strategies that may help alleviate your symptoms:
1. Dietary Adjustments: Ensure you are consuming a high-fiber diet, which can help regulate bowel movements and reduce straining. Foods rich in fiber include fruits, vegetables, whole grains, and legumes. Staying well-hydrated is also crucial.

2. Pelvic Floor Exercises: Engaging in pelvic floor exercises, such as Kegel exercises, can help strengthen the muscles involved in bowel control. These exercises can improve coordination and function over time.

3. Scheduled Bowel Movements: Try to establish a regular schedule for bowel movements. This can help train your body and may reduce the urgency you feel.

4. Relaxation Techniques: Stress and anxiety can exacerbate gastrointestinal symptoms. Techniques such as deep breathing, meditation, or yoga may help reduce overall tension.

5. Follow-Up with Specialists: Since your symptoms persist, it may be beneficial to consult with a gastroenterologist who specializes in functional bowel disorders. They can conduct further assessments to rule out any underlying conditions and provide targeted treatment options.

6. Medications: If your symptoms are significantly impacting your quality of life, discussing medication options with your healthcare provider may be worthwhile. There are medications that can help with bowel motility and reduce discomfort.

7. Physical Therapy: A pelvic floor physical therapist can provide specialized exercises and techniques to help improve bowel function and alleviate discomfort.

In conclusion, while your symptoms are understandably concerning, they are not uncommon after hemorrhoid surgery. With appropriate management and follow-up care, many patients find relief from their symptoms over time. It is essential to maintain open communication with your healthcare providers and advocate for your health as you navigate this process.

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