Post-Surgery Anal Stenosis: Coping with Narrowing After Hemorrhoid Surgery

Postoperative anal stricture

Hello, doctor.
I underwent hemorrhoid surgery using a LigaSure tissue coagulation device, and it has been almost two months since the procedure.
The surgeon believes that the narrowing of my anus post-surgery is normal and has told me that this is how it will be.
However, I force myself to have a bowel movement every day because I am afraid that hard stools will be difficult to pass.
I still have to exert a lot of effort to have a bowel movement, and the stools are thin, soft, and require significant straining, similar to squeezing toothpaste.
The surgeon mentioned that it doesn't seem too narrow and only advised me to drink more water, as if he doesn't want to address my concerns.
What should I do?

A Pin, 40~49 year old female. Ask Date: 2021/11/01

Dr. Ke Fangxu reply Surgery

There are often inquiries on this platform regarding difficulties in bowel movements following surgery with a tissue coagulation device.
Currently, there is no long-term statistical data on the use of this device for hemorrhoidectomy, making it difficult to determine if true stenosis has occurred.
Generally, it is believed that true stenosis is indicated by difficulty during digital rectal examination.
Traditional surgical methods tend to have fewer occurrences of this issue, but it cannot be definitively concluded that the device is the cause.
At this time, the only recommendation is to increase dietary fiber intake and continue to monitor the situation.

Reply Date: 2021/11/01

More Info

Post-surgery anal stenosis, particularly after hemorrhoid surgery, can be a challenging and uncomfortable condition to deal with. It is understandable that you are experiencing significant distress due to the narrowing of the anal canal, which can lead to difficulties in bowel movements and discomfort. Here are some insights and recommendations based on your situation.

Understanding Anal Stenosis After Hemorrhoid Surgery
Anal stenosis refers to the narrowing of the anal canal, which can occur after surgical procedures such as hemorrhoidectomy. This condition can result from scar tissue formation, inflammation, or changes in the anal sphincter muscle. While some degree of narrowing may be expected after surgery, significant stenosis can lead to complications, including constipation, pain during bowel movements, and fecal impaction.

Symptoms and Coping Strategies
Given your description, it seems you are experiencing a few key symptoms:
1. Difficulty Passing Stool: You mentioned that you have to exert considerable effort to have a bowel movement, which can be painful and frustrating.

2. Narrow Stool: The stool being thin and requiring force to expel can indicate that the anal canal is indeed narrowed.

Here are some strategies to help manage your symptoms:
1. Dietary Adjustments:
- Increase Fiber Intake: Consuming a high-fiber diet can help soften stools and make them easier to pass. Foods rich in fiber include fruits, vegetables, whole grains, and legumes.

- Stay Hydrated: Drinking plenty of water is crucial. Aim for at least 8-10 glasses a day to help keep stools soft.

2. Stool Softeners and Laxatives:
- Over-the-counter stool softeners (like docusate sodium) can help reduce the strain during bowel movements. If necessary, a mild laxative may also be used, but it’s essential to consult your healthcare provider before starting any new medication.

3. Regular Bowel Habits:
- Establish a routine for bowel movements. Try to go at the same time each day, allowing yourself enough time to relax and not rush.

4. Pelvic Floor Exercises:
- Engaging in pelvic floor exercises can help strengthen the muscles around the anal canal, potentially improving control and comfort during bowel movements.

5. Warm Sitz Baths:
- Taking warm sitz baths can help relax the anal sphincter and reduce discomfort associated with bowel movements.

When to Seek Further Help
If your symptoms persist despite these measures, or if you experience severe pain, bleeding, or signs of infection, it is crucial to follow up with your healthcare provider. Here are some considerations for further evaluation:
1. Consult a Specialist: If your current surgeon is not addressing your concerns adequately, consider seeking a second opinion from a colorectal specialist. They can provide a more in-depth evaluation of your condition and discuss potential treatments.

2. Possible Interventions: Depending on the severity of the stenosis, treatments may include:
- Dilation: A procedure to gently widen the anal canal.

- Surgical Revision: In some cases, a minor surgical procedure may be necessary to correct significant stenosis.

3. Physical Therapy: Some patients benefit from pelvic floor physical therapy, which can help with muscle relaxation and coordination during bowel movements.

Conclusion
It is essential to address your concerns about anal stenosis after hemorrhoid surgery proactively. While some narrowing may be normal, significant difficulties with bowel movements warrant further investigation and intervention. By implementing dietary changes, using stool softeners, and seeking appropriate medical advice, you can work towards improving your symptoms and quality of life. Don’t hesitate to advocate for your health and seek the care you need to feel comfortable and well.

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