Post-Surgery Concerns: Swelling and Frequent Urges After Hemorrhoid Surgery

Postoperative swelling and frequent urge to defecate after minimally invasive hemorrhoid surgery?

Hello, Doctor.
I previously asked about the issue of persistent swelling after minimally invasive hemorrhoid surgery (#179274).
It has now been 42 days post-surgery, and the swelling has slightly improved, but I still have one large and one small lump, about the size of green and yellow beans.
On the other hand, I am very concerned about the constant feeling of needing to have a bowel movement.
Every morning when I wake up, I can naturally have a bowel movement, which consists of well-formed yellow soft stools.
However, there is slight blood at the end of the stool, and I notice fresh blood on the toilet paper when I wipe.
After breakfast, I feel the urge to go again, and I end up having three bowel movements in one morning, feeling like the first one was not completely evacuated, with the subsequent two having progressively less volume.
Usually, after lunch or dinner, I also feel the urge to go, and I typically have some bowel movements.
I apply the medication "Le Yu Zhi" three times a day on the lumps, and I have seen others inquire about the efficacy of "Xi Liao Yu" for reducing swelling.
Additionally, due to stress, I have long-term sleep issues and have been supplementing with serotonin and relaxants to help with sleep.
I have annual stool occult blood tests, which have all been normal.
At this stage, would switching to "Xi Liao Yu" help accelerate the reduction of swelling? Is the persistent feeling of needing to have a bowel movement and frequent bowel movements possibly indicative of a colorectal issue? I am torn between patiently waiting for the wound to heal (but it has already been 42 days!) and quickly going back to see a doctor (the doctor must think I am bothersome / I can't have a colonoscopy with an open wound!).
Thank you, Dr.
Zhang, for your patient clarification!

cc, 40~49 year old female. Ask Date: 2022/03/29

Dr. Zhang Shuhao reply Surgery

You can use Xylocaine gel, but try to avoid applying it directly on the wound.
If you have a persistent urge to defecate, first determine whether it is due to incomplete rectal evacuation or an illusion caused by swelling at the wound site.
Generally, swelling should not significantly affect bowel movements after 42 days.
You can try to relax in warm water and ensure complete evacuation.
If swelling and pain persist or if you have difficulty with bowel movements, consider the possibility of a localized infection or a narrowing issue.
It is advisable to discuss your concerns with your surgeon, as most issues can be managed with medication adjustments.

Reply Date: 2022/03/29

More Info

After undergoing hemorrhoid surgery, it's not uncommon to experience lingering symptoms such as swelling and frequent urges to defecate. Let's break down your concerns and provide some insights based on medical knowledge.

Swelling Post-Surgery
You mentioned that it has been 42 days since your minimally invasive hemorrhoid surgery, and while the swelling has slightly improved, you still notice lumps resembling green and yellow beans. Swelling in the anal region can be attributed to several factors, including:
1. Surgical Trauma: The surgical procedure itself can cause localized swelling as the body responds to the trauma. This is a normal part of the healing process, and it can take several weeks for the swelling to fully subside.

2. Inflammation: Post-operative inflammation can persist due to the body's healing response. This can manifest as lumps or bumps in the area.

3. Hemorrhoidal Tissue: Sometimes, residual hemorrhoidal tissue can remain after surgery, which may contribute to the sensation of swelling.

4. Infection: Although less common, an infection can cause increased swelling and should be ruled out if you experience increased pain, redness, or discharge.

Frequent Urges to Defecate
Your concern about feeling a persistent urge to defecate, even after having formed stools, is noteworthy. This sensation can be caused by:
1. Rectal Sensitivity: After surgery, the rectum may be more sensitive due to inflammation or healing tissue, leading to frequent urges even when the bowel is empty.

2. Changes in Bowel Habits: Post-surgery, your bowel habits may change temporarily. The body can take time to adjust, and you might experience increased frequency or urgency.

3. Psychological Factors: Anxiety about bowel movements, especially after surgery, can lead to a heightened sense of urgency. Stress can also affect bowel habits.

4. Underlying Conditions: While less likely, persistent urges can sometimes indicate underlying conditions such as irritable bowel syndrome (IBS) or other gastrointestinal issues.

Recommendations
1. Follow-Up with Your Surgeon: Given that it has been over six weeks since your surgery, it is advisable to follow up with your surgeon. They can assess the swelling and determine if it is part of the normal healing process or if further intervention is needed.

2. Consider Dietary Adjustments: Ensure you are consuming a high-fiber diet to promote regular bowel movements and prevent straining, which can exacerbate symptoms. Staying hydrated is also crucial.

3. Topical Treatments: You mentioned using a topical treatment (樂癒痣) for the swelling. While this may provide some relief, consult your doctor before switching to another product (like 喜療淤) to ensure it is appropriate for your situation.

4. Monitor Symptoms: Keep track of any changes in your symptoms, such as increased pain, changes in bowel habits, or the presence of blood. If you notice any concerning signs, seek medical attention promptly.

5. Avoid Self-Diagnosis: While it’s natural to worry about potential underlying conditions, self-diagnosing can lead to unnecessary anxiety. Trust your healthcare provider to evaluate your symptoms accurately.

Conclusion
In summary, while some swelling and changes in bowel habits can be expected after hemorrhoid surgery, persistent symptoms warrant a follow-up with your healthcare provider. They can provide reassurance, evaluate your healing progress, and determine if any further treatment is necessary. Remember, your health and peace of mind are paramount, so don't hesitate to reach out for professional guidance.

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