Post-Laser Hemorrhoid Surgery: Common Concerns and Recovery Issues

Post-operative issues after laser hemorrhoid surgery?

Hello Dr.
Ke, I hope you can address my concerns regarding various issues during my recovery period.
I underwent laser hemorrhoid surgery on July 16, which involved inserting a line into the hemorrhoid to cauterize the vein (approximately like this).

1) One week after the hemorrhoid surgery, I experienced a sudden and significant rectal bleeding, with a large amount of blood clots and fresh blood pouring out.
I was taken to the hospital, where the surgeon examined me and found a bleeding point in the internal hemorrhoid at the 6 o'clock position.
They performed another surgery to ligate that bleeding point.
Do you know why there was such significant bleeding after the surgery?
2) About two weeks post-surgery, the wound at the anal area began to heal, but a small, slightly flat, pinkish bump suddenly appeared in an area that previously had no wounds.
It is very itchy and feels sharp when touched.
I have been taking sitz baths at least twice daily.
Is this swelling? How long might it take to resolve?
3) Since the surgery, my stool has been consistently flat.
How much longer might it take for it to return to its normal shape?
Thank you very much for your response, 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, they are relatively expensive and are rarely used in hemorrhoid surgeries.
Some practitioners also refer to infrared coagulation devices, harmonic scalpels, and circular excision techniques as laser surgeries.
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 the hemorrhoidal blood vessels were not completely ligated or coagulated, leading to significant bleeding about a week post-surgery.
Addressing the bleeding point should resolve the issue.

2.
It is possible that swelling at the surgical site is contributing to the problem; performing warm sitz baths may provide relief.

3.
Changes in stool shape are generally caused by swelling and pressure at the surgical site, and normal bowel function typically resumes 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 information about the recovery process after such a procedure.

1. Why did I experience significant bleeding after surgery?
Post-operative bleeding 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 likely contributed to the bleeding you experienced. After laser hemorrhoid surgery, the tissue is still healing, and any strain, such as from bowel movements, can disrupt the healing process and lead to bleeding. Additionally, if the blood vessels were not adequately cauterized during the initial procedure, this could also result in post-operative bleeding. It’s crucial to follow your surgeon's post-operative care instructions, including dietary recommendations to avoid constipation, which can lead to straining during bowel movements.

2. What is the small, itchy, painful bump at the anal area?
The small, flat, pink bump you described could be a few things, including a thrombosed hemorrhoid, a skin tag, or simply edema (swelling) from the surgical site. It’s not uncommon for patients to develop small bumps or tags after hemorrhoid surgery as the tissue heals. The itching and pain you’re experiencing may be due to irritation or inflammation in the area. Continuing with sitz baths is a good practice, as they can help soothe the area and promote healing. However, if the bump persists or worsens, it would be wise to consult your surgeon for a thorough examination to rule out any complications.

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, including changes in bowel habits, diet, and the healing process itself. It’s essential to maintain a high-fiber diet and stay well-hydrated to promote healthy bowel movements. If you’re experiencing persistent changes in stool shape or consistency, it may be beneficial to consult with your healthcare provider. They can assess whether any additional interventions are needed to help restore normal bowel function.

In summary, recovery from laser hemorrhoid surgery can involve various challenges, including bleeding, discomfort, and changes in bowel habits. It’s essential to maintain open communication with your healthcare provider and report any concerning symptoms. Regular follow-ups can help ensure that your recovery is on track and that any complications are addressed promptly.
Additionally, while the healing process can vary from person to person, many patients find that their symptoms improve significantly within a few weeks. Patience and adherence to post-operative care instructions are key to a successful recovery. If you have any further concerns or if your symptoms worsen, do not hesitate to reach out to your surgeon for guidance. Wishing you a smooth recovery and good health!

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