Post-Surgery Complications: Managing Pain and Scar Tissue After Hemorrhoid Surgery

Post-hemorrhoid surgery

Hello, three years ago I had a mole removed, and during the healing process, I experienced inflammation of the sutures.
There is excess skin around the anal area, and within a year, I developed pain in the scar tissue that radiates to my left thigh, making it difficult to sit or stand for extended periods (about 50-60 minutes before pain starts).
The pain subsides only when lying down.
I have tried taking erythromycin and applying ointments, but there has been little improvement.
A doctor mentioned keloids, but there are no signs of keloids on the skin of my hands.
I received an injection to treat the keloid, which initially caused a blister-like swelling, and I was told it would shrink as my body absorbed it.
However, it ultimately appeared slightly larger than before the injection.
After the injection, I experienced 9 months of pain relief, but now the pain has returned.
I am uncertain whether to receive another keloid injection due to concerns: 1.
Will steroid treatment make the skin inside the anus thinner and more fragile, reducing its defensive capabilities? 2.
If the medication wears off and I experience pain again in less than 9 months, is long-term reliance on steroid treatment appropriate? 3.
Will it cause the original scar to stretch again? 4.
Is there a possibility of developing a fistula? 5.
Is it possible to have keloids at the anal area even if the skin on the rest of the body does not show keloid formation? 6.
Are there alternative treatment options for this condition? I am feeling anxious and would appreciate your clarification.
Thank you.

Xiao Mei, 40~49 year old female. Ask Date: 2020/10/06

Dr. Ke Fangxu reply Surgery

I have never heard of a case of anal keloids, nor have I seen anyone receive steroid injections in the anal area.
I recommend that you visit a large hospital and consult a colorectal surgeon for a proper diagnosis before proceeding with any treatment.
Personally, I am more inclined to suspect a fistula, but it is essential for a physician to conduct a personal examination to confirm the diagnosis.

Reply Date: 2020/10/06

More Info

Post-surgery complications, particularly after hemorrhoid surgery, can be quite challenging to manage, especially when dealing with pain and scar tissue. Your situation, involving pain that radiates to the left thigh and the development of scar tissue, is not uncommon. Let's address your concerns systematically.

1. Scar Tissue and Pain Management: The formation of scar tissue, particularly in sensitive areas like the anal region, can lead to discomfort and pain. This is often due to the body's natural healing process, which can sometimes result in excessive scar formation, known as hypertrophic scars or keloids. The pain extending to your thigh could be a result of nerve irritation or entrapment due to the scar tissue. It’s essential to consult with a healthcare provider who specializes in pain management or a surgeon familiar with post-operative complications to explore options such as physical therapy, nerve blocks, or other pain management strategies.

2. Corticosteroid Injections: You mentioned receiving injections for keloids, which can be effective in reducing scar tissue and associated pain. However, your concerns about corticosteroids are valid. Long-term use of corticosteroids can lead to skin thinning and may compromise the skin's integrity. It's crucial to have a thorough discussion with your doctor about the risks and benefits of repeated corticosteroid injections. They can help you weigh the potential for pain relief against the risk of skin thinning and other side effects.

3. Dependence on Corticosteroids: Relying on corticosteroids for pain management can lead to a cycle of dependency. If your pain recurs before the expected duration of relief from the injection, it may indicate that the underlying issue has not been fully addressed. Your doctor may suggest alternative treatments, such as silicone gel sheets, laser therapy, or even surgical revision of the scar if it is significantly affecting your quality of life.

4. Fistula Formation: The concern about a possible fistula is important. Fistulas can develop after surgery, especially if there was an infection or if the healing process was complicated. Symptoms of a fistula may include persistent drainage, pain, or swelling. If you notice any unusual symptoms, it’s crucial to seek medical evaluation promptly.

5. Keloids in Sensitive Areas: Keloids can occur in any area of the body, including the anal region. While they are more common on the chest and shoulders, they can develop anywhere there is scar tissue. The absence of keloids on other parts of your body does not preclude their formation in sensitive areas.

6. Alternative Treatments: Besides corticosteroid injections, there are other treatment options for managing scar tissue and pain. These include:
- Silicone Gel Sheets: These can help flatten and soften scars over time.

- Laser Therapy: This can reduce the appearance of scars and improve skin texture.

- Physical Therapy: A physical therapist can provide exercises and modalities to help alleviate pain and improve function.

- Surgical Revision: In some cases, surgical intervention may be necessary to remove excessive scar tissue.

In conclusion, your situation requires a comprehensive approach that includes pain management, monitoring for potential complications, and exploring various treatment options. It’s essential to maintain open communication with your healthcare provider, who can guide you through the best course of action tailored to your specific needs. If you feel that your concerns are not being adequately addressed, seeking a second opinion from a specialist in colorectal surgery or a pain management expert may provide additional insights and options.

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