Post-Surgery Bleeding After Hemorrhoidectomy: When to Seek Help?

Postoperative bleeding after hemorrhoid surgery?

I would like to consult a doctor.
I underwent a mixed hemorrhoidectomy on September 30.
Starting on October 5, I experienced bleeding and blood clots during bowel movements, to the extent that the entire toilet was stained red.
Each time I exerted myself or passed gas, there was blood, occurring four times in total, but only once did I pass stool.
On the morning of October 6, I had a bowel movement due to a stool softener, and there were no issues at that time.
In the afternoon, I returned for a follow-up appointment and informed the doctor about the bleeding.
The doctor mentioned that the wound had some minor tearing but was not serious, removed the stitches from the anal area, and advised that the wound would heal on its own.
I was instructed to apply topical ointment and continue taking stool softeners.
However, that evening, I still felt the urge to have a bowel movement, but again, it resulted in blood staining the toilet.
Interestingly, there was no bleeding while soaking in a sitz bath.
Am I straining too much during bowel movements? Should I seek further medical evaluation, or is there a solution to this issue? Thank you, doctor.

Ruì Mǐ, 20~29 year old female. Ask Date: 2020/10/06

Dr. Ke Fangxu reply Surgery

Some physicians may perform vascular ligation during hemorrhoidectomy because a small number of patients may experience bleeding at the site of the hemorrhoidal artery resection.
If the bleeding is persistent, it may require a return to the operating room for suturing and hemostasis.
If there is continuous bleeding daily and the volume is significant, it is important to seek medical attention promptly to prevent excessive blood loss.

Reply Date: 2020/10/06

More Info

After undergoing a hemorrhoidectomy, it is not uncommon to experience some bleeding, especially in the initial recovery phase. However, the amount and frequency of bleeding you are describing—where the toilet is significantly stained with blood during bowel movements—raises some concerns that warrant further evaluation.

When to Seek Help
1. Heavy Bleeding: If you are experiencing bright red blood that saturates the toilet bowl, this could indicate a more significant issue than just normal post-operative bleeding. While some bleeding is expected, particularly if you are straining during bowel movements, the volume you describe is concerning.

2. Persistent Symptoms: Since you mentioned that the bleeding has occurred multiple times (four times) and is associated with straining, it is essential to monitor how frequently this happens. If the bleeding continues or worsens, you should seek medical attention.

3. Signs of Infection: If you notice any signs of infection, such as increased pain, swelling, fever, or unusual discharge from the surgical site, you should contact your healthcare provider immediately.

4. Changes in Bowel Habits: If you experience a significant change in your bowel habits, such as severe constipation or diarrhea, or if you are unable to pass stool, this could also be a reason to seek medical help.

Possible Causes of Bleeding
- Surgical Site Issues: The bleeding may be due to the surgical site not healing properly, which can happen if there is excessive straining during bowel movements. This can lead to what is known as a "wound dehiscence," where the surgical incision opens up.

- Straining: If you are straining to have a bowel movement, this can exacerbate bleeding. It is crucial to maintain soft stools to minimize the need for straining.

- Internal Hemorrhoids: Sometimes, internal hemorrhoids can remain after surgery and may cause bleeding if they become irritated or inflamed.

Recommendations for Management
1. Dietary Adjustments: Ensure you are consuming a high-fiber diet to promote softer stools. Foods rich in fiber include fruits, vegetables, whole grains, and legumes. Staying well-hydrated is also essential.

2. Stool Softeners: Continue using stool softeners as prescribed by your physician. These can help reduce straining during bowel movements.

3. Avoid Straining: Try to avoid straining when you feel the urge to have a bowel movement. If you find it difficult to pass stool, consider using a footstool to elevate your feet while sitting on the toilet, which can help facilitate easier bowel movements.

4. Follow-Up Appointment: Given your ongoing symptoms, it would be prudent to schedule a follow-up appointment with your surgeon or healthcare provider. They may want to perform a physical examination or possibly a sigmoidoscopy to assess the surgical site and rule out any complications.

5. Monitor Symptoms: Keep a close eye on your symptoms. If the bleeding persists or worsens, or if you develop any new symptoms, do not hesitate to seek medical attention.

Conclusion
While some bleeding can be expected after a hemorrhoidectomy, the amount and frequency you are experiencing suggest that further evaluation is necessary. It is always better to err on the side of caution when it comes to post-surgical complications. By following the recommendations above and maintaining open communication with your healthcare provider, you can help ensure a smoother recovery process.

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