Post-Surgery Constipation Concerns After Hemorrhoidectomy: Seeking Solutions

Hello Dr. Ke, I would like to ask about post-operative issues related to hemorrhoid surgery?

Hello Dr.
Ke, I would like to ask you about my situation.
I underwent an excision surgery for internal and external hemorrhoids on February 11.
Since the surgery, I have been relying on stool softeners to have a bowel movement.
After February 28, I experienced severe constipation for four days (it was so severe that even after using an enema twice, I still couldn't pass stool.
I went to the emergency room where the doctor prescribed a suppository, but it didn't help either.
The emergency doctor asked if my diet had changed and noted that my food intake had decreased since the surgery because I was afraid of pain from eating more, which led to further intentional reduction in my food intake.
The emergency doctor suspected that my low food intake was causing the constipation).
Later, I returned to the doctor who performed my hemorrhoid surgery, and after taking Lactulose syrup three times, I was able to resolve the constipation issue.
Now, I take two stool softener tablets before bed each night.
Although I do have a bowel movement the next day, the stool is completely unformed, and I also experience abdominal pain.
I tried reducing to one tablet, but that resulted in even less stool output, and it seems more difficult to pass.
When I take two stool softeners, I have about 3-4 bowel movements a day.
When I take one tablet, I always feel the urge to go, averaging about 1-2 bowel movements a day (the amount varies; sometimes it's a lot, but often I feel like I have the urge to go, and when I try to push, only a little comes out, and it doesn't pass smoothly.
It feels like it gets stuck at the anal opening, unlike before the surgery when I could pass stool easily (although I didn't go every day before the surgery, I would at least have a bowel movement every two days, and the stool was large and formed, with a clay-yellow color).
Doctor, I am now feeling anxious about my bowel movements since the surgery.
I fear that I won't be able to go every day.
Is this a normal part of the recovery process after surgery? If I push too hard, the stool can cause small tears at the anal opening, leading to a few drops of blood, along with a feeling of swelling and pain in the anal area (the doctor also prescribed a topical ointment for the wounds and mentioned that I have a tear on the left side, but if I have too many bowel movements, it tears again, which is very bothersome).
I am currently drinking at least 2000cc of water daily and trying to eat more vegetables and fruits.
Are there any other ways I can improve this situation? I am really feeling very worried and anxious.
Thank you, Dr.
Ke, for taking the time to read this.
I am very grateful to you.

Suney Chou, 40~49 year old female. Ask Date: 2022/03/21

Dr. Ke Fangxu reply Surgery

It is normal to experience abnormal sensations around the anus shortly after hemorrhoid surgery.
If there are difficulties with bowel movements, it is recommended to consume an adequate amount of dietary fiber and fluids.
If difficulties persist, a stool softener may be added.
During this period, it is important to avoid constipation and minimize the time spent on the toilet.
Spicy and irritating foods should be temporarily avoided.
Warm sitz baths may help alleviate symptoms.
Generally, normal function is expected to return within a month after surgery.
If problems continue, a follow-up with a physician is advised.

Reply Date: 2022/03/21

More Info

Post-surgery constipation, especially after a hemorrhoidectomy, is a common concern that many patients face. The surgical procedure can lead to changes in bowel habits due to several factors, including pain, anxiety about bowel movements, dietary changes, and the effects of anesthesia and pain medications. Here’s a comprehensive overview of your situation and some potential solutions.

Understanding Your Symptoms
1. Constipation Post-Surgery: After a hemorrhoidectomy, it’s not unusual for patients to experience constipation. This can be exacerbated by the fear of pain during bowel movements, leading to a cycle of avoidance that can worsen constipation. The fact that you are relying on stool softeners and still experiencing difficulty indicates that your bowel function is still adjusting post-surgery.

2. Dietary Changes: It seems that your reduced food intake post-surgery, due to fear of pain, has contributed to your constipation. A diet low in fiber can lead to harder stools, making them more difficult to pass. It’s crucial to maintain a balanced diet rich in fiber, which can help form softer, bulkier stools.

3. Hydration: You mentioned drinking over 2000cc of water daily, which is excellent. Adequate hydration is essential for preventing constipation, as it helps soften the stool. Continue to prioritize water intake, especially if you are increasing your fiber consumption.

4. Pain and Anxiety: The pain you experience during bowel movements can create anxiety, which can further complicate your bowel habits. It’s important to address both the physical and psychological aspects of your recovery.

Recommendations for Improvement
1. Dietary Adjustments: Focus on a high-fiber diet that includes fruits, vegetables, whole grains, and legumes. Foods like prunes, apples, and pears are particularly effective in promoting bowel movements. Gradually increase your fiber intake to avoid gas and bloating.

2. Regular Exercise: If your doctor permits, engage in light physical activity. Walking can stimulate bowel function and help alleviate constipation.
3. Stool Softening Agents: Continue using stool softeners as prescribed, but discuss with your doctor about adjusting the dosage or trying different types if you find that your current regimen is not effective.
4. Scheduled Bowel Movements: Try to establish a routine for bowel movements. Setting aside time each day, preferably after a meal, can help train your body to have regular bowel movements.

5. Relaxation Techniques: Since anxiety can exacerbate constipation, consider relaxation techniques such as deep breathing exercises, meditation, or gentle yoga to help reduce stress around bowel movements.

6. Follow-Up with Your Doctor: Since you are experiencing pain and bleeding during bowel movements, it’s crucial to keep your healthcare provider informed. They may want to evaluate your surgical site to ensure there are no complications, such as fissures or infections, that could be contributing to your symptoms.

7. Consider Probiotics: Incorporating probiotics into your diet may help restore healthy gut flora and improve bowel regularity. Yogurt, kefir, and probiotic supplements can be beneficial.

Conclusion
It’s understandable to feel anxious about your bowel movements following surgery, especially with the discomfort you’re experiencing. However, many patients go through similar adjustments post-hemorrhoidectomy, and with the right strategies, you can improve your situation. Keep an open line of communication with your healthcare provider, and don’t hesitate to seek further assistance if your symptoms persist or worsen. Your recovery is a process, and with patience and the right approach, you can regain your normal bowel function.

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