Post-Hemorrhoid Surgery: Managing Pain and Complications

Post-hemorrhoid surgery

Hello, doctor.
I would like to ask you some questions.
I had hemorrhoid surgery a few days ago using a tissue coagulator and was discharged after two days in the hospital.
However, on the day after discharge, I noticed that the wound seemed to have split open, possibly due to my movements or straining while using the toilet.
During my hospital stay and on the first day after discharge, I experienced minimal pain, but on the second day, sitting on a chair caused unbearable pain, and using the toilet was so painful that I could hardly walk.
Even wiping after a bowel movement caused excruciating pain.
That night, I asked my husband to help me apply medication and take pictures.
While applying the medication, one of the stitches came out directly from the tissue, even though the knot was still intact, and the photos clearly showed that the wound had enlarged significantly.
The next day, I saw the doctor, who said that the stitch had come out and that the wound had not split open.
I would like to ask the doctor:
1.
Is it possible for a stitch to come out directly from the tissue even if the knot is still intact?
2.
If the wound has indeed split open, would it need to be re-stitched, or can it heal naturally?
3.
The doctor advised against applying medication since I just had surgery, but due to the wound appearing to split open, my husband applied iodine.
Is this acceptable? Should I apply iodine after soaking in a sitz bath?
4.
I have noticed a slight discharge of pus from the wound over the past few days.
Is this normal?
5.
Yesterday, I noticed that the wound seemed to be swollen, but it is already the fourth day post-surgery.
It was not swollen in the first three days.
Is this swelling on the fourth day normal?
6.
After the surgery, my anus looked very neat and smooth, but now, due to the stitch coming out, there is a protrusion of tissue.
Does this increase the likelihood of hemorrhoid recurrence in the future?
Thank you, doctor.

Ms. Hu, 20~29 year old female. Ask Date: 2021/04/10

Dr. Yu Mingchang reply Surgery

Please come back for a follow-up appointment.
The stitches will dissolve on their own.

Reply Date: 2021/04/10

More Info

Post-hemorrhoid surgery pain management and complications can be quite challenging, especially in the initial days following the procedure. It’s not uncommon for patients to experience significant discomfort after surgery, particularly when it comes to bowel movements or sitting for extended periods. Here’s a comprehensive overview of your concerns based on the information provided.

1. Suture Issues: It is possible for sutures to come loose or fall out prematurely, especially if they are absorbable sutures. If the knot remains intact, it may not necessarily indicate a problem; however, if the suture has detached from the tissue, it could lead to complications. It’s essential to monitor the wound closely for signs of infection or further dehiscence (wound separation).

2. Wound Dehiscence: If the wound has indeed opened up, the management will depend on the extent of the opening. In some cases, small openings can heal on their own, but larger ones may require re-suturing. Your surgeon will be the best judge of this, so follow-up appointments are crucial to assess the healing process.

3. Topical Treatments: Applying iodine or any antiseptic to the wound should be done cautiously. While keeping the area clean is essential, overuse of antiseptics can irritate the tissue and delay healing. It’s best to follow your surgeon's advice regarding wound care. If they advised against applying ointments, it’s important to adhere to that guidance unless instructed otherwise.

4. Pus and Infection: The presence of a small amount of pus can be concerning, as it may indicate an infection. However, some drainage can be normal post-surgery. Signs of infection include increased redness, swelling, warmth, and fever. If you notice any of these symptoms, it’s crucial to contact your healthcare provider.

5. Swelling: Swelling can occur after surgery, especially around the surgical site. If the swelling is mild and there are no other concerning symptoms, it may be part of the normal healing process. However, if the swelling increases or is accompanied by pain or redness, it could indicate an infection or other complications.

6. Risk of Recurrence: The appearance of tissue protruding from the surgical site can be concerning. If the surgical site does not heal properly, there is a potential risk for recurrence of hemorrhoids. Maintaining a healthy bowel regimen, avoiding straining during bowel movements, and following up with your surgeon for ongoing assessments will be essential in minimizing this risk.

In summary, managing pain and complications after hemorrhoid surgery involves careful monitoring of the surgical site, adherence to post-operative care instructions, and timely follow-up with your healthcare provider. Pain management can include over-the-counter pain relievers, warm baths, and stool softeners to ease bowel movements. If you experience severe pain, signs of infection, or any other concerning symptoms, do not hesitate to seek medical attention. Your recovery is paramount, and addressing these issues promptly can help ensure a smoother healing process.

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