Post-Surgery Bleeding: Causes After Fistula and Hemorrhoid Surgery

After undergoing surgery for a fistula and hemorrhoids, there is a small amount of blood on the toilet paper after bowel movements?

Hello Doctor: I underwent fistula and hemorrhoid surgery on December 25, 2020.
After a follow-up visit on January 19, the doctor confirmed that the wound had healed.
However, at the end of January, I experienced slight bleeding from the anus due to hard stool.
After examination, the doctor noted a new wound.
In early February, after a brief recovery, I began to experience slight bleeding on toilet paper again, triggered by strong bowel movements or hard stools.
The doctor prescribed tetracycline hydrochloride for treatment and advised me to apply it with a cotton swab and to take oral magnesium oxide along with warm sitz baths.
I would like to ask why I am now experiencing recurrent episodes of anal fissures and bleeding, despite having a high-fiber diet and regular warm sitz baths.
I also have a consistent bowel movement every morning that is smooth.

Reeve, 40~49 year old female. Ask Date: 2021/02/14

Dr. Ke Fangxu reply Surgery

If the incision from the fistula surgery is relatively large, a small amount of bleeding postoperatively is considered normal.
However, if constipation occurs, it may affect wound healing.
It is recommended to take warm sitz baths and avoid hard stools.
If the bleeding does not improve, the use of rectal suppositories can be considered, and a colonoscopy may also be warranted.

Reply Date: 2021/02/14

More Info

Post-surgery bleeding, particularly after procedures like fistula and hemorrhoid surgery, can be concerning and often requires careful management and understanding of the underlying causes. In your case, it appears that you have experienced some complications following your surgery, which is not uncommon.
Firstly, it’s important to recognize that surgeries involving the anal region, such as those for fistulas and hemorrhoids, can lead to changes in the tissue and healing process. After surgery, the area may be more sensitive and prone to injury, especially during bowel movements. The fact that you are experiencing bleeding after having hard stools indicates that there may be a few contributing factors at play.

1. New Injury to the Surgical Site: After surgery, the tissues around the anal area can be delicate and may not have fully healed. If you experience hard stools or straining during bowel movements, this can lead to new injuries or aggravate existing ones, resulting in bleeding. It's crucial to maintain soft stools to minimize the risk of trauma to the surgical site.

2. Anal Fissures: Even if you had not experienced anal fissures before your surgery, the changes in your bowel habits and the potential for straining can lead to the development of fissures. These are small tears in the lining of the anus that can cause pain and bleeding, especially during bowel movements.

3. Diet and Hydration: While you mentioned that you are consuming a high-fiber diet and practicing good hydration, it’s essential to ensure that you are also drinking enough fluids to help soften your stools. Sometimes, dietary changes alone may not be sufficient if hydration is lacking.

4. Medication and Treatment: The use of medications like tetracycline and magnesium oxide, along with warm sitz baths, is a good approach to managing discomfort and promoting healing. However, it’s important to follow your doctor’s instructions closely and report any persistent or worsening symptoms.

5. Follow-Up Care: Regular follow-up with your healthcare provider is crucial. If you continue to experience bleeding, it may be necessary to reassess the surgical site and consider additional treatments or interventions. Sometimes, further evaluation with imaging or additional procedures may be warranted to ensure there are no complications such as abscesses or other issues.

In summary, while it is not uncommon to experience some bleeding after fistula and hemorrhoid surgery, especially if there are changes in bowel habits, it is essential to manage your bowel health carefully. Focus on maintaining soft stools, staying well-hydrated, and following your doctor's recommendations for care. If bleeding persists or worsens, do not hesitate to seek further evaluation from your healthcare provider. They may need to perform additional assessments to rule out any complications and provide you with the best course of action for recovery.

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