Post-Surgery Complications: Wound Healing After Hemorrhoid Surgery

Postoperative wound expansion and difficulty healing after external hemorrhoid ultrasound knife surgery!

Hello, Doctor! Thank you for taking the time to respond to my message! The situation is as follows: My husband, who is 48 years old, has diabetes and hyperlipidemia.
Recently, he suddenly developed a painful protrusion at the anal area, about the size of two finger joints.
He consulted a colorectal surgeon at the hospital, who diagnosed it as an external hemorrhoid and prescribed a topical medication (Hiyu hemorrhoid ointment) and pain-relieving anti-inflammatory medication, advising a follow-up in three days.
During these three days, the external hemorrhoid was less painful but remained swollen without any reduction in size.
Since it affected his daily life, he requested surgical intervention.
He opted for a self-paid procedure costing 30,000 NTD, using a half-body anesthesia and ultrasound knife.
After admission, he was given laxatives to cleanse his bowels and was instructed to fast overnight before the surgery the next morning.
Two hours post-surgery, he was able to urinate.
After a sitz bath that evening, the gauze he inserted fell out.
He was discharged the following day.
The nurse informed him that he needed to take sitz baths at least four times daily, including after bowel movements.
After each sitz bath, he was advised to dry the area with a towel or a hairdryer on a cool setting before applying the Hiyu hemorrhoid ointment.
He wore triangular underwear with sanitary pads.
Seven days post-surgery, during a follow-up visit, he informed the doctor that the wound had expanded to about the size of a 50 NTD coin, and the doctor said this was normal but did not examine the wound.
He was prescribed another 14 days' worth of anti-inflammatory pain medication and stool softeners.
Now, ten days later, the wound, which was originally 3x1 cm, has increasingly expanded radially to 4x4 cm, with dark red coffee-colored discharge and significant pain.
It seems that the sanitary pad may have caused redness and swelling around the wound area.
My husband initially thought that the self-paid ultrasound knife surgery would lead to an easier recovery.
Could you please advise if this situation is normal? Thank you.

Miss Lian, 40~49 year old female. Ask Date: 2021/11/19

Dr. Ke Fangxu reply Surgery

It may be caused by a rupture of the wound from the ultrasound knife.
At this time, the only options are to enhance sitz baths and apply topical medications.
If there is pain or inflammation, oral medications can also be added for treatment while waiting for the wound to heal.
Attempting to suture the wound at this stage could likely lead to complications such as infection.

Reply Date: 2021/11/19

More Info

After hemorrhoid surgery, particularly in patients with underlying conditions such as diabetes and hyperlipidemia, it is crucial to monitor for complications that may affect wound healing. Your husband's situation, where the surgical site is expanding and exhibiting dark red discharge, raises several concerns that warrant further evaluation.

Understanding Post-Surgery Complications
1. Wound Healing and Infection: The expansion of the wound from 3x1 cm to 4x4 cm, along with the presence of dark red discharge, could indicate a few possibilities:
- Infection: Surgical wounds can become infected, especially in patients with diabetes, which can impair healing. Signs of infection include increased redness, swelling, warmth, and discharge that may be purulent or discolored.

- Dehiscence: This refers to the reopening of a surgical wound. It can occur due to excessive tension on the wound edges, infection, or inadequate healing. The fact that the wound is expanding suggests that this might be a possibility.

- Hematoma: Accumulation of blood under the skin can also cause swelling and discoloration. This is more common in patients who are on anticoagulants or have bleeding disorders.

2. Postoperative Care: The instructions provided by the nursing staff regarding sitz baths and wound care are essential for promoting healing and preventing infection. However, if the wound is worsening, it may be necessary to reassess the care regimen.
- Sitz Baths: These are beneficial for hygiene and can help reduce discomfort. However, if the wound is not healing, the frequency or technique may need to be adjusted.

- Wound Dressing: Ensure that the dressing is changed regularly and that the area is kept clean and dry. If the sanitary pads are causing irritation, consider using a different type of dressing that may be less abrasive.

3. Follow-Up Care: It is crucial to have a follow-up appointment with the surgeon or a healthcare provider who can directly assess the wound. They may need to:
- Perform a physical examination to evaluate the extent of the wound and check for signs of infection.

- Possibly obtain cultures of the discharge to identify any infectious organisms.

- Adjust medications if necessary, especially if there is a need for antibiotics or stronger pain management.

4. Managing Underlying Conditions: Given your husband's diabetes, it is essential to maintain good glycemic control, as high blood sugar levels can significantly impair wound healing. Regular monitoring of blood glucose levels and adherence to dietary and medication regimens are critical.

Recommendations
- Immediate Medical Attention: Given the symptoms described, it is advisable to seek immediate medical attention. A healthcare professional should evaluate the wound to determine the appropriate course of action.

- Wound Care: Continue with sitz baths as advised, but ensure that the area is not overly saturated, which could lead to maceration of the skin. Use a gentle, non-irritating cleanser and avoid any harsh chemicals.

- Pain Management: If the pain is significant, discuss with the physician about adjusting pain management strategies, as uncontrolled pain can hinder recovery.

- Monitoring Symptoms: Keep a close watch on any changes in the wound, including increased pain, fever, or changes in discharge color or odor, and report these to the healthcare provider promptly.

In conclusion, while some postoperative discomfort and changes in the wound are expected, the degree of expansion and the nature of the discharge you describe are concerning. It is essential to have a healthcare professional evaluate the situation to ensure proper healing and address any complications that may arise.

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