Post-Surgery Pain Management: Severe Discomfort After Hemorrhoid Surgery

After hemorrhoid surgery, there is severe pain for about 3-4 hours after bowel movements, and pain relievers are ineffective in alleviating the pain?

Hello, Doctor: I am a patient who underwent surgery for stage IV mixed hemorrhoids.
In the seven days following the surgery, I have had four bowel movements, each accompanied by severe pain that lasts for about four hours.
During this time, I have been taking pain medication regularly and even added an extra painkiller (along with a stool softener) before bowel movements.
I have also tried taking a warm sitz bath for ten minutes before using the toilet, but this has not alleviated the pain or its duration.
Every night before bed, I take two stool softeners, and I find it easy to pass gas, often feeling the urge to have a bowel movement after meals.
The stools are generally soft and formed (flat) with blood, but there is no bleeding after the bowel movement.
Is this level of pain normal? Why are the pain medications ineffective? Thank you! The pain medications I am taking are: a stool softener and Pain Relief Capsules.

Aman, 40~49 year old female. Ask Date: 2020/06/30

Dr. Ke Fangxu reply Surgery

Post-operative pain from hemorrhoid surgery typically lasts for 1-2 weeks, with significant reduction in pain expected by the second week.
It is recommended to take stool softeners post-surgery to maintain daily bowel movements and avoid straining, which can cause pain and bleeding at the surgical site.
You are taking two different types of pain medications: Tong An tablets, which contain two central analgesics (acetaminophen + tramadol), and Pain Relief capsules, which are a non-steroidal anti-inflammatory drug (Mefenamic Acid).
Each medication works through different mechanisms and is considered quite potent.
Pain medications can only alleviate pain but cannot completely eliminate it.
If you underwent traditional excisional surgery, the pain will gradually lessen.
However, if you had a circular excision procedure, the situation may be different.

Reply Date: 2020/06/30

More Info

Post-surgery pain management, particularly after hemorrhoid surgery, can be a challenging experience for many patients. Your situation, where you are experiencing significant pain during bowel movements even a week post-operation, is not uncommon but certainly concerning. Let's delve into the reasons behind your discomfort and explore potential management strategies.

Firstly, it is essential to understand that hemorrhoid surgery, especially for advanced cases like mixed hemorrhoids (internal and external), can lead to considerable postoperative pain. This pain can be attributed to several factors:
1. Surgical Trauma: The surgical procedure involves cutting and removing tissue, which can lead to inflammation and pain as the body heals. The area around the anus is particularly sensitive, and any surgical intervention can exacerbate discomfort during bowel movements.

2. Bowel Movements: After surgery, the act of passing stool can be painful due to the pressure exerted on the surgical site. Even with soft stools, the sensation of passing stool can trigger pain, especially if there is any residual swelling or sensitivity in the area.

3. Muscle Spasms: The anal sphincter muscles may go into spasms post-surgery, which can contribute to pain during and after bowel movements. This can create a cycle of fear and tension, making bowel movements even more painful.

4. Inadequate Pain Control: While you are taking pain medications, it is possible that the dosage or type may not be sufficient for your level of discomfort. Pain management after surgery often requires a tailored approach, and what works for one person may not work for another.

Given your description of the pain lasting for hours and the use of pain medications, here are some recommendations to consider:
1. Medication Review: Consult with your healthcare provider about your current pain management regimen. It may be beneficial to adjust the dosage or switch to a different pain medication that may be more effective for your specific pain type. Opioids, for instance, can be prescribed for more severe pain, but they come with their own risks and side effects.

2. Stool Softeners and Laxatives: You mentioned using softeners, which is excellent. Ensuring that your stools remain soft is crucial to minimizing pain during bowel movements. If you find that your current regimen is not effective, discuss with your doctor about possibly increasing the dosage or trying different types of stool softeners or laxatives.

3. Warm Sitz Baths: You are already using warm sitz baths, which can help relax the anal muscles and reduce pain. Continue this practice, as it can provide temporary relief. Consider doing it multiple times a day, especially before bowel movements.

4. Dietary Adjustments: Ensure you are consuming a high-fiber diet to promote softer stools. Foods rich in fiber, such as fruits, vegetables, and whole grains, can help ease bowel movements. Staying well-hydrated is also essential.

5. Physical Activity: Gentle physical activity can help stimulate bowel function and reduce constipation. However, avoid any strenuous activities that may strain the surgical site.

6. Follow-Up Care: If your pain persists or worsens, it is crucial to follow up with your surgeon or healthcare provider. They may want to assess the surgical site for any complications, such as infection or excessive scarring, which could be contributing to your pain.

In conclusion, while postoperative pain after hemorrhoid surgery can be expected, the severity and duration you are experiencing warrant further evaluation and possibly a reassessment of your pain management strategy. Open communication with your healthcare provider is key to finding an effective approach to alleviate your discomfort and promote healing.

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