Post-Surgery Concerns: Managing Hematoma and Pain After Hemorrhoid Surgery

Postoperative care for hemorrhoids and anal fissures?

Hello, I underwent traditional hemorrhoid and anal fissure surgery on February 24th, and it has been over forty days since the procedure.
However, I still have a hematoma near the anus that is slightly larger than a thumbnail.
One day, when I accidentally pressed on it while sitting down, blood and fluid leaked out, which reduced the size of the hematoma somewhat.
However, due to the wound, having a bowel movement causes significant pain when the stool comes into contact with it.
After a few days, it seemed like the wound had healed (as there was no pain during bowel movements), but soon after, the hematoma swelled up again.
This cycle has happened a total of five times.
The hematoma is quite painful when pressed.
My questions are as follows:
1.
During my follow-up visit, the doctor mentioned that the hematoma is due to the surgical wound not healing yet.
Is it normal for the wound to still not be healed after over forty days?
2.
During the follow-up, the doctor performed a digital rectal examination, which was extremely painful.
Is it normal to still experience pain after over forty days?
3.
The doctor prescribed "Bacitracin ointment" and "Gentamicin ophthalmic ointment" for me to apply to the wound.
Is it safe to apply these two different ointments simultaneously? Could mixing them cause any issues?
4.
The doctor advised me to take sitz baths and to add 10cc of Povidone-iodine to the bathwater.
However, after adding Povidone-iodine to the warm water, there is a strong, irritating smell, and I feel a bit dizzy during the sitz bath.
Is it possible to use less Povidone-iodine?
5.
Recently, the hematoma has become firmer.
Is there a possibility that this hematoma could be an anal abscess?

s, 50~59 year old female. Ask Date: 2021/04/11

Dr. Ke Fangxu reply Surgery

1.
Anorectal surgery typically results in complete wound healing within about a month post-operation; your situation is indeed somewhat unusual.

2.
It is not entirely normal.

3.
Using a combination of an antifungal ointment and an antibiotic ointment should not pose any issues.

4.
When using povidone-iodine, it is important not to add too much to avoid overly high concentrations that could irritate the wound; especially in a small sitz bath, it is recommended that the water color be close to an amber golden hue.

5.
It is indeed possible; it is advisable to have the surgeon examine you again for better assessment.

Reply Date: 2021/04/11

More Info

After undergoing hemorrhoid and anal fissure surgery, it's not uncommon to experience complications such as hematomas and pain. Your situation, where you have a persistent hematoma and pain during bowel movements, raises several important considerations. Let's address your questions one by one.

1. Hematoma and Wound Healing: It is concerning that you have had a hematoma for over 40 days post-surgery. Typically, hematomas should gradually resolve within a few weeks. If the hematoma persists, it may indicate that the surgical site has not healed properly or that there is ongoing bleeding. Factors such as your overall health, blood clotting ability, and adherence to post-operative care can affect healing. If the hematoma is causing significant pain or discomfort, it may require further evaluation by your surgeon.
2. Pain During Digital Examination: Experiencing pain during a digital examination 40 days post-surgery can be expected, especially if the area is still healing. However, if the pain is severe or worsening, it could indicate complications such as infection or inadequate healing. It's essential to communicate this pain to your doctor, as they may need to assess the surgical site more thoroughly.

3. Use of Topical Medications: Regarding the use of "褐黴素乳膏" (Clotrimazole cream) and "紫菌素眼用軟膏" (Gentamicin eye ointment), it is generally advisable to consult your physician before combining medications. While both medications may be effective for their respective indications, mixing them without professional guidance could lead to reduced efficacy or increased irritation. Always follow your doctor's instructions regarding medication use.

4. Sitz Bath with Povidone-Iodine: The use of povidone-iodine in your sitz bath is intended to help prevent infection. However, if you are experiencing a strong odor and dizziness, it may be wise to reduce the amount used. While povidone-iodine is effective, it can be irritating in higher concentrations. Discuss with your doctor the possibility of using a smaller amount or an alternative antiseptic solution that may be less irritating.

5. Hardening of the Hematoma: The hardening of the hematoma could suggest that it is organizing or that there may be a developing abscess, such as an anal abscess. An abscess can occur if there is an infection in the area, leading to the accumulation of pus. Symptoms of an abscess may include increased pain, swelling, redness, and possibly fever. It is crucial to have this evaluated by your healthcare provider, as abscesses often require drainage and antibiotic treatment.

In summary, your ongoing symptoms warrant close monitoring and possibly further intervention. It is essential to maintain open communication with your healthcare provider about your pain levels, the condition of the hematoma, and any new symptoms that arise. They may recommend imaging studies or additional treatments to address your concerns effectively. Remember, post-operative recovery can vary significantly among individuals, and your healthcare team is best equipped to provide personalized advice based on your specific situation.

Similar Q&A

Post-Hemorrhoid Surgery: Understanding and Managing Hematoma Pain

Hello Doctor: Two days ago, on April 6th, I underwent hemorrhoid surgery, where one internal hemorrhoid was ligated and one mixed hemorrhoid was excised using Ligasure. The following morning, the nurse observed that the anal area appeared normal. After discharge, I was only given...

Dr. Ke Fangxu reply Surgery
The benefits of using Ligasure include reduced blood loss; however, postoperative pain is similar to that of traditional surgery, typically diminishing after about a week. 1. The pain may be due to simple wound swelling; if a hematoma is present, a dark blue-black lump may be obs...

Post-Surgery Recovery Issues: Managing Pain and Bleeding After Hemorrhoid Surgery

Hello Dr. Ke, I underwent traditional hemorrhoid surgery in June 2015, during which both internal and external hemorrhoids were excised. However, my recovery has not been satisfactory. I have a regular bowel movement once a day, but I notice some blood on the stool, particularl...

Dr. Ke Fangxu reply Surgery
Mild bleeding within one month after hemorrhoid surgery is considered normal. During this period, it is recommended to avoid constipation and to take warm sitz baths frequently. However, if there is heavy bleeding or if the bleeding lasts longer than one month, it is important to...

Post-Hemorrhoid Surgery: Common Concerns and Pain Management

Hello, doctor. It has been four days since my external hemorrhoidectomy, and I am still experiencing unbearable pain. The area around the wound is swollen around half of the anus. I have been lying in bed and relying on painkillers to manage my daily activities. However, I read t...

Dr. Ke Fangxu reply Surgery
Personally, I have not undergone outpatient hemorrhoidectomy because postoperative swelling and pain are inevitable. Mild bleeding and discharge are also considered normal. During this time, it is not recommended to apply ointments to avoid compromising wound cleanliness. Frequen...

Post-Surgery Concerns: Understanding Pain After Hemorrhoid Surgery

Hello Dr. Ke, I underwent hemorrhoid surgery at the end of July, and it has been over two months since the procedure. Occasionally, I experience a sharp pain near the anus, and there is a soreness starting about 1 cm above the anal area. The soreness occurs daily and can last all...

Dr. Ke Fangxu reply Surgery
Based on your description, it may be difficult to determine the issue. It might be necessary to conduct a rectal examination or an endoscopy to confirm the diagnosis. Generally, this is not related to surgery; otherwise, symptoms would have occurred postoperatively. Sometimes, it...