Post-Surgery Concerns: Managing Bleeding After Hemorrhoid Removal

Post-hemorrhoid surgery

Hello Doctor, I underwent traditional hemorrhoidectomy (internal hemorrhoids) on March 13 of this year, and on April 13, I had the granulation tissue that formed after the surgery removed.
Since then, my bowel movements have been smooth, and I haven't experienced any issues.
However, I still notice blood when I wipe after using the restroom, and sometimes a few drops end up in the toilet.
I have returned for follow-up visits, and the doctors have indicated that the wound is healing well.
They mentioned that the bleeding is from the site of the granulation tissue removal, which was not sutured during the procedure.
The doctors informed me that my tendency to be anxious may contribute to a slower healing process, and they advised me not to worry.
However, the blood when wiping after using the restroom is still quite concerning for me.
I would like to ask if I need to return for another check-up, or if this is considered a normal situation.
(I have confirmed that the bleeding is indeed from the granulation tissue removal site.)

Xiao Bai, 20~29 year old female. Ask Date: 2020/07/14

Dr. Xu Kaixi reply Surgery

As your original physician explained, this is a normal change after the wound healing from hemorrhoid surgery, and it should gradually improve over time.
If you have concerns, you can schedule regular follow-up appointments for examination.

Reply Date: 2020/07/14

More Info

After undergoing hemorrhoid removal surgery, it is not uncommon to experience some bleeding, especially if the wound has not been sutured. In your case, it seems that the bleeding you are experiencing after bowel movements is related to the granulation tissue that formed after the removal of the hemorrhoid. Granulation tissue is a normal part of the healing process, but it can be sensitive and prone to bleeding, particularly when irritated by bowel movements or wiping.

Understanding Post-Surgery Bleeding
1. Normal Healing Process: After surgery, the body goes through a healing process that includes the formation of granulation tissue. This tissue is rich in blood vessels and can bleed easily, especially if it is disturbed. The fact that your doctor has indicated that the healing is progressing well is a positive sign.

2. Bleeding After Bowel Movements: It is not unusual for patients to notice some blood on toilet paper or in the toilet bowl after a bowel movement, particularly in the early stages of recovery. This can be exacerbated by straining during bowel movements or by wiping too aggressively.

3. Factors Affecting Healing: You mentioned that your doctor noted your tendency to be easily stressed, which can indeed affect the healing process. Stress can lead to muscle tension and may even impact blood flow, potentially slowing down recovery. It’s essential to manage stress through relaxation techniques, adequate hydration, and a balanced diet rich in fiber to promote smooth bowel movements.

When to Seek Further Medical Attention
While some bleeding can be expected, it is crucial to monitor the situation closely. Here are some guidelines on when to consider returning to your doctor:
- Increased Bleeding: If you notice a significant increase in the amount of blood, or if the bleeding persists beyond what you have described, it would be wise to consult your physician.

- Signs of Infection: If you experience increased pain, swelling, redness around the surgical site, or fever, these could be signs of infection, and you should seek medical attention promptly.

- Persistent Symptoms: If the bleeding continues for an extended period without improvement, or if you have concerns about the healing process, it’s always better to err on the side of caution and consult your healthcare provider.

Management Strategies
1. Gentle Care: Be gentle when wiping after using the restroom. Consider using moist wipes or a bidet to minimize irritation.

2. Sitz Baths: Taking warm sitz baths can help soothe the area and promote healing. This can also help reduce discomfort and encourage blood flow to the area, which is beneficial for healing.

3. Dietary Adjustments: Ensure you are consuming a high-fiber diet to prevent constipation and straining during bowel movements. Staying well-hydrated is also crucial.

4. Follow-Up Appointments: Regular follow-ups with your healthcare provider are essential to monitor your recovery. If your doctor has advised you that the bleeding is normal, but you still feel concerned, don’t hesitate to ask for a follow-up appointment for peace of mind.

Conclusion
In summary, while some bleeding after hemorrhoid surgery can be normal, it is essential to keep an eye on the situation and consult your doctor if you have any concerns. The healing process can vary from person to person, and your comfort and peace of mind are important. Always prioritize communication with your healthcare provider regarding any changes or concerns you may have during your recovery.

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