Post-Surgery Concerns for Hemorrhoid Treatment: What to Expect

Hemorrhoid surgery issues

Hello, doctor.
I would like to ask about post-operative issues related to hemorrhoids.
I visited the doctor due to difficulty in bowel movements, blood in my stool, and pain.
The doctor diagnosed me with stage IV mixed hemorrhoids and recommended traditional surgery.
Since traditional surgery is more painful and has a longer recovery period, I opted for a self-funded tissue coagulation knife (the doctor mentioned that the pain level would be about three points lower than traditional surgery) and that the blood loss would be significantly less than with traditional surgery.
After the surgery, the doctor informed me that I had five large internal hemorrhoids, but he only removed the three largest ones because he was concerned that complete removal might lead to fecal incontinence in the future.

Now, half a month post-surgery, I am experiencing pain after bowel movements, and I feel that the internal hemorrhoids are protruding.
I have tried to push them back in, but I am unable to do so! During bowel movements, I also feel a significant stretching sensation in the anal area, although I am passing normal soft stools.
I suspect that I might have anal stenosis post-surgery, so I would like to consult with you, doctor.

Chen, 40~49 year old female. Ask Date: 2021/06/14

Dr. Ke Fangxu reply Surgery

This issue should be addressed by a surgeon to determine if there is anal stenosis, as a personal examination by the physician is necessary for diagnosis.
There may be some specific complications after tissue coagulation knife surgery, so please discuss thoroughly with your surgeon before deciding on the treatment plan.

Reply Date: 2021/06/14

More Info

Post-surgery concerns following hemorrhoid treatment, especially after a traditional surgical procedure, can be quite common and understandably distressing. It’s important to address your concerns with a comprehensive understanding of what to expect during the recovery process and the potential complications that may arise.

Firstly, it is not unusual to experience pain and discomfort after hemorrhoid surgery, particularly if you had a significant number of internal hemorrhoids removed. The pain you are experiencing during bowel movements can be attributed to several factors, including inflammation at the surgical site, the healing process, and the sensitivity of the area post-operation. It is also common for patients to feel a sensation of fullness or pressure in the anal area, especially if there are still residual hemorrhoids or if the surgical site is healing.

Regarding your concern about the internal hemorrhoids protruding after surgery, this can happen. If you feel that the hemorrhoids are "popping out" and cannot be pushed back in, it may indicate that the remaining hemorrhoids are still swollen or that there is some degree of prolapse. This can occur if the remaining hemorrhoids are still engorged with blood or if the surrounding tissue is inflamed.
You mentioned that you are experiencing pain during bowel movements despite passing soft stools. This could suggest that there is still some irritation or inflammation in the anal canal or rectum. It is crucial to maintain a soft stool consistency to minimize straining during bowel movements, as straining can exacerbate pain and lead to further complications.

In terms of your suspicion about anal stenosis (narrowing of the anal canal), this is a possibility, especially if you are experiencing significant discomfort and difficulty with bowel movements. Stenosis can occur as a result of scarring from surgery or from the healing process itself. If you suspect this, it is essential to consult your surgeon or a gastroenterologist for a thorough examination. They may perform a digital rectal exam or an anoscopy to assess the situation.

Here are some recommendations for managing your post-surgery symptoms:
1. Pain Management: Continue to take pain medications as prescribed. Over-the-counter options like acetaminophen or ibuprofen can also help manage pain and inflammation.

2. Sitz Baths: Regular sitz baths can provide relief. Soaking in warm water for 15-20 minutes several times a day can help soothe the area and promote healing.

3. Dietary Adjustments: Ensure you are consuming a high-fiber diet, including fruits, vegetables, and whole grains, to help maintain soft stools. Staying well-hydrated is also crucial.

4. Avoid Straining: When you feel the urge to have a bowel movement, do not delay. Use a stool softener if necessary, and avoid straining, as this can worsen your symptoms.

5. Follow-Up Care: It is vital to keep your follow-up appointments with your surgeon. If your symptoms persist or worsen, or if you notice significant bleeding, you should seek medical attention promptly.

6. Topical Treatments: Your doctor may recommend topical anesthetics or anti-inflammatory creams to help alleviate pain and discomfort.

In conclusion, while some discomfort and complications can be expected after hemorrhoid surgery, persistent pain, difficulty with bowel movements, or any new symptoms should be evaluated by your healthcare provider. They can provide tailored advice and treatment options based on your specific situation. Remember, recovery can take time, and it’s essential to be patient with your body as it heals.

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