Post-Hemorrhoid Surgery: Bleeding During Bowel Movements

Bleeding during bowel movements after hemorrhoid surgery is common?

I underwent hemorrhoidectomy on June 13th.
For the first two weeks, I experienced pain and bleeding during bowel movements.
Although the pain gradually decreased over the following months, I have continued to experience bleeding up to now.
I have a bowel movement approximately once a day and have been taking stool softeners, but the bleeding is still noticeable, amounting to a few drops.
After a bowel movement, I use about one tissue for wiping.
Is this considered normal? What care should I take to promote healing and prevent ongoing bleeding? Thank you.

Liu Xiansheng, 30~39 year old female. Ask Date: 2020/09/28

Dr. Ke Fangxu reply Surgery

Theoretically, the wound from hemorrhoid surgery should be completely healed within a month, and there should be no further bleeding.
If bleeding persists for more than two months post-surgery, it may be due to residual internal hemorrhoids.
In such cases, a physician can perform rubber band ligation in an outpatient setting.
If a colonoscopy was not conducted prior to the surgery, it may be advisable to undergo one to rule out other potential causes of bleeding.

Reply Date: 2020/09/28

More Info

After undergoing hemorrhoid surgery, it is not uncommon to experience some bleeding during bowel movements, especially in the initial weeks following the procedure. The presence of blood can be concerning, but it is essential to understand the context and the healing process involved.

In the first few weeks post-surgery, it is typical for patients to experience pain and some bleeding due to the surgical site being sensitive and healing. The bleeding you describe, where you notice drops of blood and a small amount on toilet paper, may be within the realm of normal, especially if it is not accompanied by severe pain or other alarming symptoms such as heavy bleeding or signs of infection (like fever or increasing redness around the surgical site).

However, persistent bleeding that continues for months after surgery warrants further evaluation. While some patients may experience minor bleeding as they heal, ongoing bleeding could indicate several issues, including:
1. Incomplete Healing: The surgical site may still be healing, and irritation during bowel movements can cause minor bleeding. This is particularly true if the stool is hard or if there is straining during bowel movements.

2. Anal Fissures: These are small tears in the lining of the anus that can occur post-surgery, especially if there is any straining or if the stool is hard. Fissures can cause significant pain and bleeding during bowel movements.

3. Infection: If the surgical site becomes infected, it may lead to increased pain, swelling, and bleeding. Signs of infection include fever, increased redness, and discharge.

4. Recurrence of Hemorrhoids: In some cases, hemorrhoids can recur after surgery, leading to similar symptoms as before.

To promote healing and minimize the risk of ongoing bleeding, consider the following recommendations:
- Dietary Adjustments: Continue to consume a high-fiber diet to ensure soft stools. Foods rich in fiber include fruits, vegetables, whole grains, and legumes. Staying well-hydrated is also crucial, as it helps soften the stool.

- Stool Softeners: If you are not already doing so, consider using over-the-counter stool softeners to help ease bowel movements and reduce straining.

- Regular Bowel Habits: Try to establish a regular bowel routine. Avoid delaying bowel movements when you feel the urge, as this can lead to harder stools.

- Sitz Baths: Taking warm sitz baths can help soothe the area and promote blood flow, which may aid in healing. It can also provide relief from pain and discomfort.

- Avoid Straining: When having a bowel movement, avoid straining or holding your breath, as this can increase pressure in the anal area and lead to bleeding.

- Follow-Up with Your Surgeon: If the bleeding persists or worsens, it is essential to follow up with your surgeon or healthcare provider. They may want to examine the surgical site to rule out any complications or to provide additional treatment options.

In summary, while some bleeding post-hemorrhoid surgery can be normal, ongoing bleeding should be evaluated by a healthcare professional. By following a fiber-rich diet, staying hydrated, and maintaining good bowel habits, you can support your recovery and minimize the risk of complications. Always consult your doctor if you have concerns about your healing process or if you notice any changes in your symptoms.

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