Post-Surgery Bowel Issues: Managing Constipation After Hemorrhoid Surgery

Postoperative bowel issues after hemorrhoid surgery?

I'm really out of options for asking questions, and my follow-up appointment is quite far away.
Let me explain the situation: On May 16, I went for a follow-up appointment to have my stitches removed and mentioned my constipation issue to the doctor.
He immediately suggested a stool softener and instructed me to get an enema.
The pain from the enema was excruciating.
After completing the enema, I waited for 8 minutes but had no urge to go.
The doctor also mentioned that glycerin could be used, so I decided to let the enema solution out and try glycerin at home.
However, it seemed like the glycerin couldn't be inserted properly.
I'm not sure if it's because of the internal hemorrhoid or something else, but it was painful to try to insert it further.
I reluctantly used it a couple of times and finally managed to pass the first stool, which provided some relief.

Now, on the second day, the constipation has returned.
I've tried squatting on the toilet several times, but it feels the same.
I attempted glycerin again, but I couldn't insert it halfway through.
All attempts have failed.
I would like to ask the doctor if I should consider switching to another physician because this situation is really uncomfortable.
I have constipation but can't relieve it, and sitting in a warm water bath hasn't helped either.
What should I do in this situation? I really don't want to go back and endure the pain of having my rectum forcibly dilated for a bowel movement.
It was so painful that I cried out, albeit softly.
Are there any effective methods to resolve this, or should I consider changing doctors?

Xiao Zhu, 40~49 year old female. Ask Date: 2022/05/17

Dr. Zhang Shuhao reply Surgery

If fecal impaction occurs, it is necessary to first evacuate the rectum of retained stool before administering stool softeners.
Therefore, the doctor's approach is correct, although it may not have been clearly explained.
In the coming days, a soft diet should be consumed, and hydration should be increased.
If bowel movements are not achieved, a follow-up appointment should be made for a rectal irrigation and to assess the condition of the wound.
If there is a wound, self-administered enemas are not recommended.
If considering a change of physician, it is advisable to prioritize a senior physician within the same hospital, as they are more likely to understand your condition.

Reply Date: 2022/05/17

More Info

Experiencing bowel issues after surgery, particularly hemorrhoid surgery, can be quite distressing. It's important to understand that post-operative constipation is a common issue that many patients face. This can be attributed to several factors, including changes in diet, pain management medications, and the surgical procedure itself.

Firstly, after any surgical procedure involving the rectum or anus, such as hemorrhoid surgery, patients often experience discomfort and pain during bowel movements. This can lead to a fear of straining, which in turn can exacerbate constipation. Pain medications, especially opioids, can also contribute to constipation by slowing down bowel motility. Therefore, it’s crucial to manage pain effectively while also addressing bowel health.

In your case, it seems that you have tried various methods to alleviate constipation, including glycerin suppositories and enemas. While these can be effective, they may not always provide immediate relief, especially if there is significant discomfort or if the anal area is still healing from surgery. Here are some strategies that may help you manage your post-surgery constipation more effectively:
1. Dietary Changes: Increasing your fiber intake can significantly help with bowel regularity. Foods rich in fiber include fruits, vegetables, whole grains, and legumes. Additionally, staying well-hydrated is essential. Aim for at least 8-10 glasses of water a day, as this can help soften the stool.

2. Stool Softeners: Over-the-counter stool softeners, such as docusate sodium, can help make bowel movements easier. These can be used in conjunction with dietary changes to improve stool consistency.

3. Gentle Laxatives: If dietary changes and stool softeners are not effective, consider using a gentle laxative. Products containing polyethylene glycol (like Miralax) can help draw water into the stool and promote bowel movements without causing cramping.

4. Warm Baths: Taking warm baths can help relax the anal sphincter and reduce discomfort during bowel movements. This can make it easier to pass stool.

5. Physical Activity: Gentle physical activity, such as walking, can stimulate bowel function. If you are able, try to incorporate some light exercise into your daily routine.

6. Follow-Up with Your Surgeon: If you continue to experience significant pain or difficulty with bowel movements, it is essential to follow up with your surgeon or a gastroenterologist. They can assess whether there are any complications from the surgery, such as strictures or other issues that may be contributing to your symptoms.

7. Consider a Second Opinion: If you feel that your concerns are not being adequately addressed, seeking a second opinion from another healthcare provider can be beneficial. A different perspective may provide you with new options or treatments.

In conclusion, managing post-surgery bowel issues requires a multifaceted approach that includes dietary modifications, appropriate use of medications, and possibly follow-up care with your healthcare provider. It's vital to communicate openly with your doctor about your symptoms and any concerns you have, as they can help tailor a treatment plan that works for you. Remember, recovery takes time, and it's important to be patient with your body as it heals.

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