Post-Laser Hemorrhoid Surgery: Common Concerns and Recovery Issues

Postoperative Issues After Laser Hemorrhoid Surgery

Hello Dr.
Ke, I hope you can answer my questions.
I'm very concerned about various issues during my recovery period.
I underwent laser hemorrhoid surgery on July 16, where a line was inserted into the hemorrhoid to cauterize the veins (approximately like this).

1) One week after the hemorrhoid surgery, I experienced sudden heavy bleeding from my anus, with a large amount of blood clots and fresh blood pouring out.
I was taken to the hospital, where the surgeon found a bleeding point in the internal hemorrhoid at the 6 o'clock position and performed another surgery to ligate that bleeding point.
Do you know why there was heavy bleeding after the surgery?
2) About two weeks post-surgery, the wound at the anus began to heal, but a small, slightly flat, pinkish bump suddenly appeared at a previously uninjured area of the anus.
It is very itchy and feels sharp when touched.
I have been taking sitz baths at least twice a day.
Is this swelling? How long will it take to go away?
3) Since the surgery, the shape of my stools has been flat.
How much longer will it take for them to return to normal? Thank you very much for your answers, and I wish you good health!

Miss Wang, 20~29 year old female. Ask Date: 2020/07/30

Dr. Ke Fangxu reply Surgery

The term "laser" refers to specific types of lasers.
Currently, the lasers commonly used in medical applications for tissue cutting are the thulium laser and the green light laser; however, these are relatively expensive and are rarely used in hemorrhoid surgeries.
Some practitioners also refer to infrared coagulation devices, harmonic scalpels, and circular excision techniques collectively as laser surgery.
It is advisable to clarify which specific surgical method is being employed.

1.
As mentioned earlier, if the specific surgical method is not understood, it is impossible to provide a clear answer to this question.
However, it is often the case that hemorrhoidal blood vessels have not been completely ligated or coagulated, leading to significant bleeding one week post-surgery.
Addressing the bleeding point should resolve the issue.

2.
There may be swelling at the surgical site, and performing warm sitz baths should provide relief.

3.
Changes in stool shape are usually caused by swelling at the surgical site, which exerts pressure.
Generally, normal bowel habits can be expected to return within 2 to 4 weeks.

Reply Date: 2020/07/30

More Info

Post-laser hemorrhoid surgery recovery can indeed be a challenging experience, and it's understandable that you have concerns regarding your recovery process. Let's address your questions one by one, while also providing some general insights into the recovery process after such a procedure.

1. Why Did I Experience Heavy Bleeding After Surgery?
Heavy bleeding after hemorrhoid surgery can occur for several reasons. In your case, it seems that a bleeding point was identified at the 6 o'clock position of the internal hemorrhoid, which necessitated further intervention. Post-operative bleeding can result from several factors, including:
- Inadequate coagulation: Sometimes, the blood vessels may not be fully sealed during the initial surgery, leading to bleeding.

- Increased pressure: Straining during bowel movements or increased intra-abdominal pressure can cause previously sealed vessels to reopen.

- Infection or inflammation: These can also contribute to bleeding if they occur at the surgical site.

It's crucial to monitor for any signs of excessive bleeding and to follow up with your surgeon if such events occur.

2. What Is the Small Bump at the Anal Area?
The small, flat, pink bump you describe could be a few things, including:
- Granulation tissue: This is a normal part of the healing process where new tissue forms. It can appear as a small bump and may be itchy or tender.

- Swelling or edema: Post-surgical swelling can also present as a lump and may take time to resolve.

- Skin tags: Sometimes, skin tags can develop after surgery, especially if there was significant tissue manipulation.

The duration for these symptoms to resolve can vary. Granulation tissue typically heals within a few weeks, but if the bump persists or worsens, it would be wise to consult your surgeon for an evaluation.

3. When Will My Bowel Movements Return to Normal?
Changes in bowel movement shape, such as having flat stools, can occur after hemorrhoid surgery due to several factors:
- Dietary changes: Post-surgery, you may have altered your diet, which can affect stool consistency.

- Healing process: The surgical site may still be healing, which can affect how your body processes and expels stool.

- Muscle function: If there was any manipulation of the anal sphincter or surrounding muscles, it might take time for normal function to return.

Generally, it may take several weeks to a few months for bowel habits to normalize. Ensuring a high-fiber diet, staying hydrated, and possibly using stool softeners can help facilitate this process.

Additional Considerations for Recovery:
- Pain Management: It's common to experience discomfort post-surgery. Over-the-counter pain relievers or those prescribed by your doctor can help manage this.

- Hygiene: Continue with sitz baths as they can promote healing and provide relief from discomfort.

- Follow-up Appointments: Regular follow-ups with your surgeon are essential to monitor your recovery and address any concerns that arise.

In conclusion, while your recovery may have some bumps along the way, it's important to stay in close contact with your healthcare provider. They can provide personalized advice and interventions tailored to your specific situation. If you experience any new or worsening symptoms, do not hesitate to seek medical attention. Wishing you a smooth recovery and improved health!

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