Post-PPH Surgery: Persistent Discomfort and Treatment Options Explained

Post-PPH (Procedure for Prolapse and Hemorrhoids) surgery?

Hello Dr.
Ke, I previously had grade III internal hemorrhoids, and I often experienced a feeling of heaviness in my anus.
Shortly after using the restroom, I would feel the urge to go again, accompanied by a sensation of pressure as if gas was trapped and unable to escape.
I thought that undergoing a PPH (Procedure for Prolapse and Hemorrhoids) surgery would relieve this heaviness, but ten days post-surgery, the sensation persists.
I still frequently feel the urge to defecate, and although I have been able to pass stool, I constantly feel as though I haven't fully emptied my bowels.
This leads to a tight, anxious feeling throughout my body, as if I need to use the restroom.
This has been disruptive to my daily life.
I have been taking medication for irritable bowel syndrome, but there has been no improvement.
It feels as if something is being held open in my anus, and the only relief comes from straining to tighten my pelvic muscles.
I have undergone surgery, taken IBS medication, and even antidepressants, yet the tightness and heaviness in my anus continue to disrupt my life.
Additionally, this condition causes my lower body to feel fatigued.
I would like to ask Dr.
Ke what kind of treatment I should pursue.
Perhaps the heaviness after surgery is normal, but it feels just as uncomfortable as before the surgery.
I feel like crying.
😭 Please, could you provide me with some advice? Thank you.

yazi, 30~39 year old female. Ask Date: 2021/09/02

Dr. Ke Fangxu reply Surgery

In the previous email response, it was mentioned that these symptoms could be related to PPH (Postpartum Hemorrhage).
If surgery is scheduled for late August, it is advisable to observe for a while longer, as this is not an appropriate time for any interventional procedures.
There have been cases where patients, due to excessive discomfort, requested the surgeon to remove the anastomosis staples.
You may discuss the feasibility of this with the physician at Tai-An Hospital.

Reply Date: 2021/09/02

More Info

Post-PPH surgery discomfort, particularly persistent feelings of pressure and the sensation of incomplete bowel movements, can be distressing and frustrating. It’s important to understand that while PPH (Procedure for Prolapse and Hemorrhoids) surgery is designed to alleviate symptoms associated with hemorrhoids, it does not guarantee an immediate resolution of all symptoms, especially in the early postoperative period.

Firstly, it is not uncommon for patients to experience discomfort, pressure, or a feeling of fullness in the rectal area following PPH surgery. This can be attributed to several factors, including the healing process of the surgical site, residual swelling, and the adjustment of the surrounding tissues. The sensation of needing to have a bowel movement, even after having one, can also be linked to the body's response to changes in the rectal area post-surgery.
The feeling of tightness or pressure in the anal region can be exacerbated by factors such as anxiety, which is not uncommon after surgery, especially if you have a history of gastrointestinal issues like irritable bowel syndrome (IBS). The connection between your gastrointestinal symptoms and the psychological impact of surgery can create a cycle of discomfort that is challenging to break.
In terms of treatment options, it is crucial to maintain open communication with your healthcare provider. They can assess your symptoms and determine if they are within the normal range of postoperative recovery or if further intervention is necessary. Here are some potential avenues for managing your symptoms:
1. Follow-Up Appointments: Regular follow-ups with your surgeon or gastroenterologist can help monitor your recovery. They can evaluate whether your symptoms are due to normal healing or if there are complications that need addressing.

2. Pain Management: If you are experiencing significant discomfort, your doctor may recommend pain management strategies, including medications that can help alleviate discomfort and reduce anxiety.

3. Dietary Adjustments: A high-fiber diet and adequate hydration can help ensure softer stools, which may reduce straining during bowel movements and alleviate some of the pressure you are feeling. Consider consulting a nutritionist for tailored dietary advice.

4. Pelvic Floor Therapy: Engaging in pelvic floor therapy can be beneficial. A physical therapist specializing in pelvic health can provide exercises and techniques to help relax the pelvic floor muscles, which may reduce the sensation of tightness and pressure.

5. Psychological Support: Given that you mentioned experiencing symptoms of depression, it may be helpful to seek support from a mental health professional. They can provide coping strategies and support to help manage the emotional aspects of your recovery.

6. Medication Review: Since you are taking medication for IBS and depression, it may be worthwhile to review these with your healthcare provider. Sometimes, medications can have side effects that exacerbate gastrointestinal symptoms.

7. Avoid Straining: It’s essential to avoid straining during bowel movements, as this can lead to further discomfort and complications. If you find yourself needing to push, consider using a stool softener or a gentle laxative, as advised by your doctor.

Lastly, while it is understandable to feel anxious about your symptoms and their persistence, it is essential to give your body time to heal. Recovery from surgery can take time, and while some symptoms may linger, they often improve with appropriate care and management. If your symptoms do not improve or worsen, do not hesitate to reach out to your healthcare provider for further evaluation and support.

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