Post-Surgery Anal Pain: Complications After PPH Procedure

Postoperative pain at the anal wound?

Hello, doctor! Six months ago, I underwent PPH surgery for internal hemorrhoids at the hospital.
A month after the surgery, I experienced a stabbing and cutting sensation at the surgical site, along with some swelling.
When I returned to the hospital for a follow-up, the doctor mentioned that the wound was slightly eroded and advised that with more rest, it would heal on its own.
Now, nearly five months have passed, and I still hesitate to sit for too long, but the stabbing and cutting sensations persist and have become more pronounced.
Additionally, I experience some pain during bowel movements.
Could this be a sign of an infection at the surgical site? Why has it not improved despite such a long period of rest?

Mr. Zhang, 30~39 year old female. Ask Date: 2020/12/23

Dr. Ke Fangxu reply Surgery

After PPH surgery, some patients may experience this phenomenon, which is often related to the resection site being too close to the dentate line.
If the wound is healing well and there is no bleeding, no special treatment is necessary.
If the pain is severe and affects daily life, a very small number of physicians may assist with the removal of the stapler.
Currently, it is recommended to first try treatment with ointments and suppositories.
If symptoms persist without improvement, a reassessment by the surgical physician is advised.

Reply Date: 2020/12/23

More Info

Post-surgery anal pain, particularly after a PPH (Procedure for Prolapse and Hemorrhoids) procedure, can be a concerning issue for many patients. Your experience of persistent pain, described as a needle-like or cutting sensation, along with swelling and discomfort during bowel movements, is not uncommon. However, it raises important questions regarding potential complications, healing processes, and the need for further medical evaluation.

Firstly, it is essential to understand that the PPH procedure is designed to treat hemorrhoids by removing excess tissue and ligating the blood vessels that supply them. While it is generally considered a less invasive option compared to traditional hemorrhoidectomy, it is not without its complications. Common post-operative issues include pain, bleeding, and infection. The pain you are experiencing could be attributed to several factors, including:
1. Healing Process: After any surgical procedure, the body requires time to heal. The sensation of pain or discomfort can persist for weeks or even months as the tissues regenerate. However, if the pain is intensifying rather than improving, it may indicate an underlying issue.

2. Infection: The presence of a persistent, localized pain, especially if accompanied by swelling or discharge, could suggest an infection at the surgical site. Infections can occur if bacteria enter the wound, leading to inflammation and prolonged healing times. Signs of infection may include increased redness, warmth, swelling, or pus-like discharge.

3. Scar Tissue Formation: Sometimes, the body forms scar tissue as part of the healing process, which can lead to discomfort or a sensation of tightness in the anal area. This can contribute to the feeling of a foreign body or pressure.

4. Nerve Sensitivity: The surgical procedure may have affected nearby nerves, leading to heightened sensitivity or pain in the area. This can manifest as sharp, stabbing pains that may feel like a needle or cutting sensation.

5. Anal Stricture: In some cases, the surgical site may heal in a way that causes narrowing of the anal canal (anal stricture), leading to difficulty with bowel movements and associated pain. This condition can require further intervention.

Given your symptoms and the duration of your discomfort, it is crucial to follow up with your healthcare provider. They may recommend a thorough examination to assess the surgical site for signs of infection or other complications. Diagnostic imaging or additional procedures may be necessary to evaluate the extent of healing and to rule out issues such as anal stricture or abscess formation.

In terms of management, your doctor may suggest conservative treatments such as topical analgesics, sitz baths, or stool softeners to ease bowel movements and reduce pain. If an infection is suspected, antibiotics may be prescribed. In cases where conservative measures fail, further surgical intervention may be necessary to address complications.

It is understandable to feel anxious about your recovery, especially after enduring discomfort for an extended period. Open communication with your healthcare provider is essential to ensure that you receive appropriate care and support throughout your healing journey. Remember, while some pain is expected after surgery, persistent or worsening symptoms warrant further investigation to ensure optimal recovery and quality of life.

Similar Q&A

Post-PPH Surgery: Persistent Discomfort and Treatment Options Explained

Hello Dr. Ke, I previously had grade III internal hemorrhoids, and I often experienced a feeling of heaviness in my anus. Shortly after using the restroom, I would feel the urge to go again, accompanied by a sensation of pressure as if gas was trapped and unable to escape. I thou...

Dr. Ke Fangxu reply Surgery
In the previous email response, it was mentioned that these symptoms could be related to PPH (Postpartum Hemorrhage). If surgery is scheduled for late August, it is advisable to observe for a while longer, as this is not an appropriate time for any interventional procedures. Ther...

Post-Surgery Pain and Swelling After Anal Polyp Removal: What to Expect

I would like to ask Dr. Ke: I underwent a PPH (Procedure for Prolapse and Hemorrhoids) surgery in 2021, but I feel that my condition did not fully improve afterward. Less than a year later, I experienced pain and protrusion from the anal area during bowel movements, which require...

Dr. Ke Fangxu reply Surgery
Common issues associated with PPH (Procedure for Prolapse and Hemorrhoids) circular resection surgery include: first, the resection site being too low, resulting in persistent wound pain; second, suboptimal removal of hemorrhoidal tissue; and third, inadequate management of recta...

Post-PPH Surgery: Understanding Pain and Recovery Challenges

Hello doctor, I am on the third day post-PPH surgery and my anus still feels very swollen and painful. Isn't it said that by the third day, one can return to normal activities? I find it difficult to even sit down, and I constantly feel a sensation of having a foreign body i...

Dr. Xu Kaixi reply Surgery
Hello: Regardless of the type of surgery for hemorrhoids, there will be a wound after hemorrhoid removal. It is normal to experience pain and slight bleeding during the recovery phase, especially within the first three days post-surgery. You can continue to monitor the situation ...

Post-Operative Care Tips to Avoid Anal Stenosis After PPH Surgery

Hello, Dr. Ke! A few days ago, I underwent a titanium screw removal surgery at the hospital. The surgeon made an incision from 2 PM to 6 PM, removed three titanium screws, and then sutured the area. Currently, I no longer feel any pinching sensation in the related area. Previousl...

Dr. Ke Fangxu reply Surgery
If the incision is not a complete circle, the risk of stenosis is relatively low. The physician should only remove the titanium screws that are positioned lower. The patient cannot actively reduce the risk of stenosis; currently, they just need to take good care of the wound.