Post-Surgery Anal Issues: and Managing Persistent Problems

Two questions one year after anal surgery?

Dear Doctor,
I had constipation issues when I was younger and underwent surgery for hemorrhoids/fissures two years ago.
Six months later, I experienced pus discharge from my anus and was diagnosed with my first anal fistula.
When I asked the doctor about the cause, he was uncertain but proceeded with surgery.
Another six months later, I felt discomfort in my anus, which turned out to be another fistula on the opposite side.
The doctor mentioned that this fistula was quite deep and might have been caused by an old fissure injury.
In other words, I have had three anal surgeries within a year and a half, with the last one being about a year ago.

Despite having undergone three surgeries, I have been careful with my bowel habits.
I eat green vegetables daily and try to maintain a daily bowel movement (over the past year, I have had fewer than ten bowel movements every other day).
After bowel movements, I wash with warm water, and there is no blood in my stool.
However, I have two persistent problems that trouble me.

The first issue is that one hour after a bowel movement, I always feel dirty (because after the first wash, I use toilet paper to dry off, ensuring that I am clean at that moment).
I have to try to wash again after an hour, but due to work commitments, I cannot do this consistently.
The second issue is that I often feel a bloated and sticky sensation in my anus, and using wet wipes does not seem to help.

I have seen a doctor once during this time, and he told me that externally, my anus looks normal aside from the surgical scars, which are naturally hard.
I would like to ask you what my issues might be and what I can do to improve these two problems.
Thank you for taking the time to read my concerns.

Note: I suspect that I may have anal sphincter weakness after the surgeries and that excessive cleaning of the anus might be causing other issues.
I apologize for the nature of this inquiry, but it does affect my daily life.
I understand that after three surgeries, it may not be possible to return to my original state, but I hope to find ways to lessen the impact on my life.
Thank you once again.

Qiújiàozhě, 40~49 year old female. Ask Date: 2021/02/15

Dr. Ke Fangxu reply Surgery

These two issues seem to be related, possibly due to having undergone multiple anal surgeries in a short period, which may have resulted in decreased anal sphincter pressure.
To confirm this phenomenon, an anal manometry test would be necessary.
However, it appears that there are no significant discomforts aside from a strange sensation, and there are no signs of incontinence.
It may be advisable to prescribe medications to strengthen anal sphincter pressure, and it seems that no further specific treatment is required.

Reply Date: 2021/02/15

More Info

Post-surgery anal issues, particularly after multiple procedures for hemorrhoids and anal fissures, can be quite complex and distressing. Your experience of undergoing three surgeries in a relatively short time frame indicates that you have been through significant trauma in that area, which can lead to various complications, including the issues you are currently facing.

Understanding Your Symptoms
1. Persistent Soiling: The fact that you experience soiling an hour after a bowel movement could be related to several factors. One possibility is that the surgeries you underwent may have affected the anal sphincter muscles, leading to a condition known as anal incontinence. This can occur if the sphincter is weakened or if there is scarring that affects its function.
2. Feeling of Discomfort: The sensation of your anus feeling "full" or "sticky" could be due to residual moisture or irritation from frequent cleaning. Over-washing can lead to irritation of the skin around the anus, which might cause a feeling of discomfort or a sensation of needing to clean more often.

Potential Causes
- Sphincter Dysfunction: As you suspected, there may be some degree of weakness in the anal sphincter due to the surgeries. This can lead to difficulties in controlling bowel movements, especially if the sphincter has been damaged or scarred during the procedures.

- Scar Tissue: The formation of scar tissue from multiple surgeries can also contribute to discomfort and altered sensation in the anal region. Scar tissue can be less elastic and may not function as well as normal tissue.

- Hygiene Practices: While maintaining hygiene is crucial, excessive cleaning can disrupt the natural balance of the skin and lead to irritation. It’s important to find a balance that keeps the area clean without causing additional irritation.

Recommendations for Improvement
1. Consult a Specialist: Given your history and ongoing symptoms, it would be beneficial to consult a colorectal specialist or a gastroenterologist who can perform a thorough examination. They may recommend tests such as an anal manometry to assess the function of your sphincter muscles.

2. Pelvic Floor Therapy: Engaging in pelvic floor therapy can help strengthen the muscles around the anus and improve control. A physical therapist specialized in pelvic health can provide exercises tailored to your needs.

3. Dietary Adjustments: Continue to maintain a high-fiber diet to ensure regular bowel movements. Staying hydrated is also crucial, as it can help prevent constipation and reduce straining during bowel movements.

4. Gentle Cleaning Techniques: Instead of using toilet paper or wipes that may irritate the area, consider using a bidet or a gentle rinse with warm water. After cleaning, pat the area dry with a soft towel rather than rubbing it.

5. Skin Care: Use barrier creams or ointments that can protect the skin around the anus from moisture and irritation. Products containing zinc oxide or petroleum jelly can be helpful.

6. Medication: If you experience significant discomfort or irritation, discuss with your doctor the possibility of using topical treatments or medications that can help alleviate these symptoms.

Conclusion
While it’s understandable to feel frustrated and concerned about your symptoms, it’s important to remember that many patients experience changes after anal surgeries. With the right approach and professional guidance, you can work towards managing your symptoms effectively. Don’t hesitate to reach out to your healthcare provider to discuss your concerns and explore further treatment options. Your quality of life is important, and there are steps you can take to improve your situation.

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