Chronic Pain and Inflammation After Hemorrhoid Surgery: Seeking Relief

Six months after hemorrhoid surgery, recurrent inflammation is causing difficulty in walking and sitting normally?

Since undergoing a hemorrhoid ligation surgery at the clinic in early April, I returned for a second surgery (excision of internal and external hemorrhoids) in mid-April (16 days later) to remove the remaining hemorrhoids.
However, after climbing stairs, I experienced swelling below the anus.
About a week later, I underwent a third procedure for bloodletting.
Two months later, I felt a pulling sensation inside the anus and returned to the clinic for an examination, but the doctor found no visible suture ends (the sutures had fallen off).
Since the last examination, the pain has intensified, making it difficult to sit normally; I can mostly only lie down.
Since the first surgery, I have been soaking in warm water more than four times a day, but I continue to experience recurrent inflammation and swelling (pain occurs in various directions, but more often in the vertical direction).
Over time, this has led to an inability to stand, lie down, or sit comfortably.
Even now, I have not been able to return to my normal routine, and I am afraid that another examination might cause further harm.
I would like to ask the doctor what might be causing this prolonged healing process and what methods can help reduce inflammation so that I can return to my normal life.

Ms. Chen, 50~59 year old female. Ask Date: 2020/09/29

Dr. Ke Fangxu reply Surgery

I am unsure how surgery can be performed in a clinic without complete anesthesia, and I do not know whether you underwent a procedure for only external hemorrhoid removal or a complete excision of both internal and external hemorrhoids.
However, theoretically, it should not take this long to recover.
It is advisable to consult a colorectal surgeon at a hospital to investigate the underlying cause, so that appropriate treatment can be determined and the next steps can be decided.

Reply Date: 2020/09/29

More Info

Chronic pain and inflammation following hemorrhoid surgery can be a distressing experience, and it’s understandable that you are seeking relief and answers. Based on your description, it seems you have undergone multiple procedures, including ligation and excision of hemorrhoids, which can lead to a variety of postoperative complications. Here’s a comprehensive overview of potential causes for your ongoing pain and inflammation, as well as suggestions for management.

Potential Causes of Chronic Pain and Inflammation
1. Surgical Trauma: Each surgical procedure can cause trauma to the surrounding tissues, leading to inflammation. The repeated surgeries you’ve undergone may have compounded this effect, resulting in prolonged healing times.

2. Infection: Postoperative infections can occur, even if there are no visible signs. Symptoms may include increased pain, swelling, and discharge. If you notice any unusual discharge or fever, it’s crucial to consult your healthcare provider.

3. Scar Tissue Formation: After surgery, scar tissue can develop, which may lead to discomfort and a sensation of pulling or tightness. This can be particularly true if the healing process is complicated by inflammation.

4. Nerve Irritation: Surgical procedures in the anal region can sometimes irritate nearby nerves, leading to chronic pain. This can manifest as a burning or pulling sensation.

5. Hemorrhoid Recurrence: If the underlying issues that led to the formation of hemorrhoids are not addressed, there is a possibility of recurrence, which can cause similar symptoms as before.

6. Psychological Factors: Chronic pain can also have psychological components. Anxiety about pain or fear of further procedures can exacerbate the perception of pain.

Management Strategies
1. Pain Management: Over-the-counter pain relievers such as ibuprofen or acetaminophen can help manage pain. However, consult your doctor before starting any medication, especially if you have other health conditions or are taking other medications.

2. Warm Sitz Baths: Continuing with warm sitz baths can help soothe the area, reduce inflammation, and promote healing. Aim for at least 15-20 minutes several times a day, especially after bowel movements.

3. Dietary Adjustments: A high-fiber diet can help prevent constipation, reducing strain during bowel movements, which can aggravate pain. Consider incorporating fruits, vegetables, and whole grains into your diet, and ensure adequate hydration.

4. Topical Treatments: Over-the-counter creams or ointments designed for hemorrhoid relief may provide symptomatic relief. Look for products containing hydrocortisone or witch hazel.

5. Physical Therapy: If pain persists, consider consulting a physical therapist who specializes in pelvic floor therapy. They can provide exercises and techniques to help alleviate pain and improve function.

6. Follow-Up Care: Regular follow-up with your healthcare provider is essential. If you feel uncomfortable with internal examinations, communicate this to your doctor. They may be able to provide alternative methods of assessment or reassurance.

7. Consider a Specialist: If your symptoms do not improve, it may be beneficial to seek a second opinion from a colorectal surgeon or a pain management specialist. They can offer additional insights and treatment options.

8. Mental Health Support: Chronic pain can take a toll on mental health. Consider speaking with a mental health professional if you find that anxiety or depression is affecting your quality of life.

Conclusion
Chronic pain and inflammation after hemorrhoid surgery can be multifactorial, and it’s essential to approach this issue holistically. By addressing both the physical and psychological aspects of your pain, you can work towards regaining a normal lifestyle. Always keep an open line of communication with your healthcare providers, and don’t hesitate to advocate for your health and well-being.

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