Post-Operative Care for Stage IV Hemorrhoids and Rectal Prolapse Surgery

Stage IV internal and external hemorrhoids with prolapse, circumferential minimally invasive surgery?

I would like to ask the doctor, on September 17, I underwent a fourth-degree internal and external hemorrhoid prolapse circular minimally invasive surgery.
Post-operative, the wound is severely oozing blood, soaking through sanitary pads.
The pain is intense, making it difficult to stand, lie down, or sit, and at times, I break into a cold sweat.
Walking and climbing stairs are challenging.
I have been doing sitz baths, but they are very painful, and applying medication has not been effective.
I constantly feel the urge to pass gas and notice blood discharge.
Every time I try to tighten my anus, the pain makes me question everything.
When using the restroom, I step on a chair to increase abdominal pressure, but what comes out is mostly blood and clots, sometimes to the point where I can't see any stool.
Painkillers are not effective for me.
I wonder if my usual psychiatric medications might be contributing to this situation.
Doctor, is my condition normal? Are there any methods to alleviate the pain, or do I just have to wait for it to heal on its own?

Xin Lei, 30~39 year old female. Ask Date: 2020/09/19

Dr. Ke Fangxu reply Surgery

1.
If there is severe postoperative bleeding, it may be due to inadequate ligation of blood vessels causing wound seepage.
If bleeding does not stop, a physician should be consulted for evaluation, and if necessary, a reoperation for hemostasis may be required.

2.
In hemorrhoidectomy, since the excision is above the dentate line where there are no cutaneous nerves, it typically does not cause pain.
However, if the excision is not deep enough and is located right at the dentate line, it can lead to the symptoms you are experiencing.
As far as I know, this condition has no solution other than taking analgesics and waiting for the symptoms to subside.
3.
It is best to consult your surgeon promptly for an examination regarding this phenomenon.
4.
If the pain is related to issue 2, it may be necessary to adjust the type or dosage of analgesics.
I recommend that you see your surgeon for a follow-up as soon as possible to prevent excessive bleeding from causing anemia.

Reply Date: 2020/09/19

More Info

Post-operative care following surgery for Stage IV hemorrhoids and rectal prolapse can be quite challenging, especially when complications arise. Your experience of severe pain, bleeding, and difficulty with basic activities such as standing, sitting, and walking is understandably distressing. Here’s a comprehensive overview of what you might expect and some strategies to help manage your symptoms.

Understanding Your Symptoms
1. Severe Pain and Bleeding: It’s not uncommon to experience significant pain after surgery for hemorrhoids and rectal prolapse, particularly if the procedure involved extensive tissue manipulation. The presence of blood, especially if it’s bright red and accompanied by clots, can be alarming. This may indicate that the surgical site is still healing or that there may be some complications such as a hematoma or infection.

2. Sensation of Pressure: The feeling of needing to pass gas or blood can be a result of inflammation in the area, which can cause discomfort and a sense of urgency. This sensation can be exacerbated by the anxiety surrounding your symptoms.

3. Difficulty with Bowel Movements: Pain during bowel movements is common post-surgery. The fear of pain can lead to constipation, which can further complicate your recovery. It’s essential to manage this aspect carefully.

Post-Operative Care Strategies
1. Pain Management: If over-the-counter pain medications are not effective, consult your physician about adjusting your pain management plan. Sometimes, stronger prescription medications or alternative therapies may be necessary. Additionally, ensure that you are taking your medications as prescribed and discuss any potential interactions with your current psychiatric medications.

2. Sitz Baths: Continue with sitz baths as they can help soothe the area. Make sure the water is warm, not hot, and spend about 15-20 minutes in the bath several times a day, especially after bowel movements. This can help reduce pain and promote healing.

3. Dietary Adjustments: Focus on a high-fiber diet to ease bowel movements and prevent constipation. Foods rich in fiber include fruits, vegetables, whole grains, and legumes. Staying well-hydrated is also crucial; aim for at least 8-10 glasses of water a day unless otherwise directed by your physician.

4. Gentle Activity: While it may be painful, gentle movement can help improve circulation and promote healing. Avoid heavy lifting or strenuous activities, but try to walk short distances as tolerated.

5. Wound Care: Keep the surgical area clean and dry. Follow your surgeon's instructions regarding wound care, and do not hesitate to contact them if you notice increased redness, swelling, or discharge, which could indicate an infection.

6. Follow-Up Appointments: Ensure you attend all follow-up appointments with your surgeon. They can assess your healing progress and address any concerns regarding your symptoms. If you feel that your pain or bleeding is worsening, do not wait for your scheduled appointment; reach out to your healthcare provider immediately.

When to Seek Immediate Help
- Excessive Bleeding: If you experience heavy bleeding that soaks through pads or requires you to change them frequently, seek medical attention.

- Signs of Infection: Fever, increased redness, swelling, or discharge from the surgical site can indicate an infection.

- Severe Pain: If your pain escalates to a level that is unmanageable despite medication, contact your healthcare provider.

Conclusion
Your recovery from surgery for Stage IV hemorrhoids and rectal prolapse will take time, and it’s essential to be patient with yourself. While some discomfort is expected, significant pain or complications should be addressed promptly. Open communication with your healthcare team is vital to ensure that you receive the appropriate care and support during your recovery. Remember, you are not alone in this process, and there are resources available to help you through your healing journey.

Similar Q&A

Post-Surgery Concerns: Understanding Changes After Hemorrhoid Surgery

Hello: In early December of 1999, I underwent surgery for rectal bleeding accompanied by prolapse (fourth-degree hemorrhoids). After the surgery, my bowel movements became thin and difficult to pass. Although the doctor attempted treatment using digital dilation, there has been l...

Dr. Wang Qichao reply Surgery
Some patients who undergo radical surgery for hemorrhoids may experience anal stenosis. Initially, this can be managed with anal dilation combined with stool softeners. If the stenosis is severe and dilation does not provide relief, partial incision of the internal sphincter or t...

Managing Post-Surgery Care After Hemorrhoid Surgery: A Patient's Guide

Hello, doctor. I have been experiencing significant bleeding and have had to repeatedly visit the emergency room for re-suturing after my mixed hemorrhoid surgery two weeks ago, despite following all the postoperative care instructions provided. I am unsure how to manage this sit...

Dr. Ke Fangxu reply Surgery
Answer: The likelihood of postoperative bleeding after hemorrhoid surgery is very low and is generally believed to be related to the absorption of sutures. If bleeding occurs and has already been addressed with two suturing procedures, it is unlikely to happen again and should no...

Postpartum Rectal Prolapse: Understanding Symptoms and Treatment Options

Hello Doctor: I am a first-time mother who just gave birth naturally two weeks ago. Due to excessive straining during delivery, my colorectal doctor mentioned that I have a condition known as "rectal prolapse," with three pieces of tissue protruding from the anal openin...

Dr. Ke Fangxu reply Surgery
If hemorrhoids protrude and cannot be pushed back in, it is classified as grade IV hemorrhoids. In this situation, medication may reduce the size, but it will not completely resolve the issue. If complete resolution is desired, surgical intervention is the only option. However, i...

Post-Surgery Complications: Managing Wound Healing After Hemorrhoid Surgery

Hello Doctor: Almost three months ago, I underwent laser surgery for hemorrhoids, as the hemorrhoids had prolapsed outside the anus, and the doctor also excised the prolapsed portion. However, I feel that the wound has not fully healed, as I experience a light yellow tissue fluid...

Dr. Zhang Shuhao reply Surgery
If there is a fan-shaped wound, it indicates that the anally internal mucosal sutures have not healed and are in an open state. This is a common postoperative condition; as long as the wound is kept clean and not overly stimulated, it will gradually heal over time. The symptoms y...