Post-Surgery Complications: Excessive Bleeding After Hemorrhoid Banding

Post-operative bleeding volume is excessive after hemorrhoid ligation?

Hello Dr.
Ke,
In July, I experienced fresh blood spraying out while using the restroom for several days.
After seeing a doctor, I underwent three hemorrhoid ligation surgeries (with three-week intervals).

For the first surgery, I felt pain for about one night, but it was manageable afterward.
A few days post-surgery, there was only a little blood at the end of my bowel movements.

For the second surgery, the pain increased significantly (like a cutting sensation).
About a day later, my external hemorrhoid became very swollen, and I experienced extreme pain after bowel movements, requiring me to lie down for a while to recover.
This condition lasted about two weeks before the swelling subsided, during which I had to use pads due to frequent discharge of foul-smelling blood.
After the swelling went down, I noticed an additional piece of pink, elastic tissue around the external hemorrhoid, which was painful when pressed.
At this point, I started experiencing bleeding whenever I used the toilet (both for urination and defecation), with continuous dripping.
Before the third surgery, I mentioned the above issues (extreme pain and the additional tissue), but the doctor only advised me to massage the original external hemorrhoid and dismissed my concerns about the pain.
I am certain that this extra tissue appeared after the second surgery.
After standing up post-surgery, I felt a strange sensation at the surgical site, as if a rubber band had slipped off.
When I expressed my discomfort, the doctor reassured me that it was fine, and I was inexplicably sent on my way.
I had the surgery around 4 PM, and the discomfort transitioned to a sore feeling in my buttocks by evening.
Later, when I felt the urge to defecate, I discovered a rubber band had fallen off while wiping.
Since the rubber band fell off the day before yesterday, I have experienced bleeding during bowel movements yesterday and today, resembling the dripping before the ligation, unlike the first surgery where there was only blood at the end of the stool.
I have a few questions for you, Dr.
Ke:
1.
I understand that swelling of external hemorrhoids after internal hemorrhoid surgery is normal, but is it typical to experience extreme pain after bowel movements following the second surgery?
2.
What could the additional piece of pink, elastic, and painful tissue be after the second surgery? Is it possible for it to go down? (It has been three weeks already...)
3.
I know that a small amount of fresh blood post-surgery is normal, but my bleeding resembles the dripping before the ligation, unlike the first time.
If the ligation was successful, could there still be such bleeding? Is it possible that both rubber bands loosened post-surgery, meaning they weren't secured at all? (I felt as if a rubber band had fallen off after standing up, but I'm not sure.) However, I did experience soreness post-surgery; if nothing was ligated, would I still feel something?
I apologize for asking these questions, but I felt that the doctor who examined me did not take my concerns seriously.
Thank you, Dr.
Ke, and I wish you all the best.

Mantou, 20~29 year old female. Ask Date: 2021/08/27

Dr. Ke Fangxu reply Surgery

1.
If hemorrhoid ligation is performed too close to the dentate line, it can result in severe pain as a complication.
If the pain is unbearable, it is necessary to remove the rubber band ligature.

2.
This issue cannot be addressed without a personal examination.
You may consult the physician who performed the ligation to see if there is any improvement.

3.
Mild bleeding after rubber band ligation is normal; as long as there is no significant bleeding that cannot be controlled, medication can be used for treatment.
If the bleeding does not stop, a surgical procedure for suturing and hemostasis may be required.
If there is only a small amount of bleeding after bowel movements, it can be monitored.
However, if there is no improvement after a week, you should seek further evaluation and treatment from a physician.

Reply Date: 2021/08/27

More Info

Post-surgery complications, particularly after hemorrhoid banding, can be concerning and often lead to a variety of symptoms that may cause anxiety for patients. In your case, it seems you have experienced significant discomfort and complications following your hemorrhoid banding procedures. Let’s address your questions one by one, while also providing some context regarding the potential complications associated with hemorrhoid surgeries.

1. Post-operative Pain: It is not uncommon for patients to experience varying degrees of pain after hemorrhoid banding. The pain can be influenced by several factors, including the extent of the hemorrhoids, the technique used during the procedure, and individual pain tolerance. While some discomfort is expected, extreme pain, especially if it feels like a "cutting" sensation, may indicate complications such as thrombosis of the external hemorrhoids or infection. If the pain is severe and persistent, it is crucial to consult your healthcare provider for a thorough evaluation.

2. New Growth Post-Surgery: The pink, elastic tissue that has developed after your second procedure could be a few things. It might be a remnant of the hemorrhoid that was not fully removed, or it could be a new growth, such as a skin tag or a thrombosed external hemorrhoid. Skin tags can develop after surgery as a result of the healing process. While some of these growths may resolve over time, others may persist and require further treatment. It is essential to have this area evaluated by your doctor to determine the exact nature of the tissue and whether any intervention is necessary.

3. Excessive Bleeding: Post-operative bleeding can occur, but the amount and duration can vary significantly among patients. The fact that you are experiencing bleeding similar to before the banding suggests that there may be an issue with the effectiveness of the procedure. If the rubber bands have slipped off or if the hemorrhoids were not adequately ligated, it could lead to continued bleeding. The sensation you described, akin to a rubber band slipping, could indicate that the ligation was not successful. It is important to report this to your healthcare provider, as they may need to reassess the situation and possibly perform additional procedures to address the bleeding.

In summary, while some post-operative discomfort and minor bleeding can be expected after hemorrhoid banding, the severity of your symptoms warrants further investigation. It is crucial to communicate openly with your healthcare provider about your concerns, especially if you feel that your issues are not being adequately addressed. You may want to seek a second opinion if you feel your current provider is not taking your symptoms seriously.
In terms of recovery, maintaining a high-fiber diet, staying hydrated, and avoiding straining during bowel movements can help facilitate healing and reduce the risk of further complications. If you continue to experience significant pain, bleeding, or any new symptoms, do not hesitate to seek immediate medical attention. Your health and comfort should always be a priority.

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