Post-Surgery Swelling After Internal Hemorrhoid Ligation: What to Expect?

Post-operative swelling after hemorrhoid ligation?

Hello doctor, I originally had an internal hemorrhoid that became enlarged and difficult to resolve, so I underwent a hemorrhoid ligation procedure, a total of three sessions, every three weeks.
By the time of the second ligation, the first hemorrhoid had mostly reduced in size.
However, two weeks after the third ligation, I noticed that the area where the first hemorrhoid was located had swollen again.
The swelling varies; sometimes it is significant (similar to the original size) and other times it is slightly smaller.
Unlike before the procedure, where the swelling would consistently be large after a bowel movement and take several days to subside, now it typically reduces back to normal within about 1 to 2 hours.
Do I still need to undergo a fourth ligation procedure?

Luo, 30~39 year old female. Ask Date: 2022/08/28

Dr. Zhang Shuhao reply Surgery

Repeated hemorrhoid ligation may result in diminished effectiveness.
It is advisable to start with warm sitz baths, supplemented with oral anti-inflammatory medications and topical hemorrhoid ointments.
If prolapse continues to be a problem, surgical intervention should be considered.

Reply Date: 2022/08/28

More Info

After undergoing internal hemorrhoid ligation, it's common to experience some degree of swelling and discomfort as part of the healing process. The ligation procedure involves placing a rubber band around the base of the hemorrhoid, which cuts off its blood supply, causing it to shrink and eventually fall off. However, the healing process can vary significantly from person to person, and several factors can influence the degree of swelling and the overall recovery experience.

In your case, it seems that after the second ligation, the first hemorrhoid had nearly resolved, which is a positive sign. However, the recurrence of swelling in the same area after the third ligation could be attributed to several factors. It is not uncommon for the area to swell temporarily after bowel movements, especially if there is any straining or if the stool is hard. The fact that the swelling subsides within a couple of hours is also a good indicator that it may not be a cause for immediate concern.

Here are some considerations regarding your situation:
1. Healing Process: After ligation, the body needs time to heal. Swelling can be a normal part of this process, especially if there is any irritation or inflammation in the area. The fact that the swelling is not as persistent as before is a positive sign.

2. Bowel Movements: Ensure that you are maintaining a diet high in fiber and staying well-hydrated to prevent constipation. Straining during bowel movements can exacerbate swelling and discomfort. If you find that you are still experiencing significant discomfort or swelling, consider discussing stool softeners or other dietary adjustments with your healthcare provider.

3. Follow-Up with Your Doctor: It's essential to keep your healthcare provider informed about your symptoms. If the swelling persists or worsens, or if you experience increased pain, bleeding, or any other concerning symptoms, you should consult your doctor. They may recommend further evaluation to determine if additional treatment, such as a fourth ligation, is necessary.

4. Post-Operative Care: Following your doctor's post-operative care instructions is crucial. This may include recommendations for sitz baths, topical treatments, or medications to manage pain and inflammation.
5. Monitoring Symptoms: Keep track of any changes in your symptoms. If the swelling becomes more pronounced or if you notice any new symptoms, such as bleeding or severe pain, it is essential to seek medical attention promptly.

In summary, while some swelling after internal hemorrhoid ligation can be expected, the pattern you describe—where the swelling is less persistent and resolves relatively quickly—is encouraging. However, it is always best to communicate with your healthcare provider about your concerns and symptoms to ensure that you receive the appropriate care and guidance moving forward. They will be able to assess whether further intervention is necessary based on your individual healing process and any potential complications.

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