Post-Surgery Complications: Anal Tightness After Hemorrhoid Surgery

Postoperative complications of hemorrhoid surgery?

Hello, Doctor: About a month ago, I underwent minimally invasive surgery for hemorrhoids, which involved approximately 17,000 procedures.
Although a month has passed, I still feel that my anus is very tight and narrow when having a bowel movement.
During sitz bath therapy, I find that I cannot insert my finger, and I clearly feel swelling, pain, and tightness.
A few days ago, I experienced constipation and went to a large hospital for an enema.
The doctor performed a colonoscopy and stated that there is no issue with anal stenosis.
However, when I returned home, I still couldn't insert even my finger, and my stools are small and hard, making it very difficult to pass them.
As a gay man, I pay extra attention to this area.
So, Doctor, isn't it usually the case that minimally invasive surgery has a quicker recovery time? If the doctor says I do not have anal stenosis, why do I still feel some swelling and tightness in my anus? Is this due to my body constitution, or is it an effect of anal fissures or the surgery?

Huang Wei-zhe, 10~19 year old female. Ask Date: 2022/09/03

Dr. Chen Ronghong reply Surgery

Whether traditional or minimally invasive hemorrhoid surgery, as long as the anal sphincter is not damaged, there should be no postoperative stricture issues.
However, some so-called minimally invasive surgeries may use multiple incisions, leading to wounds that are too close together.
This can result in scarring and loss of elasticity, causing difficulties in bowel movements.
It is advisable to take warm sitz baths and use anti-inflammatory and stool softening medications, as sometimes swelling reduction can lead to improvement.
It is also important to schedule a follow-up appointment with the original surgeon to assess the condition of the wounds.
If there is slight narrowing, physical methods for anal dilation can be employed, but it is recommended that this be done under the guidance of a physician.

Reply Date: 2022/09/03

More Info

After undergoing a minimally invasive hemorrhoid surgery about a month ago, it's understandable to have concerns regarding post-operative symptoms such as anal tightness and discomfort during bowel movements. While minimally invasive techniques are designed to reduce recovery time and complications, individual experiences can vary significantly based on several factors.

Firstly, it's important to recognize that the sensation of tightness or discomfort in the anal region can be attributed to several factors post-surgery. Even if a physician has ruled out anal stenosis (narrowing of the anal canal), other issues may still be at play. These can include:
1. Inflammation and Swelling: After any surgical procedure, inflammation is a common response. The tissues around the surgical site may remain swollen for some time, leading to a sensation of tightness. This can also contribute to discomfort during bowel movements.

2. Scar Tissue Formation: Surgery can lead to the formation of scar tissue, which may alter the normal elasticity of the anal canal. This can result in a feeling of tightness or restricted movement, even if the canal itself is not narrowed.

3. Muscle Spasms: The anal sphincter muscles may experience spasms post-surgery, which can cause discomfort and a sensation of tightness. This is often a protective response to pain or discomfort in the area.

4. Bowel Habits: If you are experiencing constipation or hard stools, this can exacerbate feelings of tightness and discomfort. Straining during bowel movements can lead to further irritation of the surgical site and may contribute to the sensation of tightness.

5. Psychological Factors: Anxiety about bowel movements, especially after surgery, can lead to muscle tension in the anal region, which may be perceived as tightness.

Given your situation, here are some recommendations to consider:
- Dietary Adjustments: Ensure that you are consuming a high-fiber diet to promote softer stools. Foods rich in fiber, such as fruits, vegetables, and whole grains, can help prevent constipation and reduce straining during bowel movements.

- Hydration: Drinking plenty of water is crucial for maintaining bowel health and preventing constipation.

- Warm Sitz Baths: Continuing with sitz baths can help alleviate discomfort and promote relaxation of the anal muscles. Warm water can soothe the area and reduce inflammation.

- Consultation with a Specialist: If symptoms persist, it may be beneficial to follow up with a gastroenterologist or a colorectal surgeon. They can conduct a thorough examination and may suggest treatments such as physical therapy for pelvic floor relaxation or medications to manage muscle spasms.

- Pain Management: Over-the-counter pain relief medications may help manage discomfort, but it's essential to consult with your physician before taking any new medications.

- Monitoring Symptoms: Keep track of your symptoms, including any changes in bowel habits, pain levels, or the sensation of tightness. This information can be helpful for your healthcare provider in determining the best course of action.

In conclusion, while minimally invasive surgery typically leads to quicker recovery, individual healing processes can vary. Factors such as inflammation, scar tissue, and muscle spasms can contribute to ongoing discomfort. If your symptoms do not improve or worsen, seeking further medical evaluation is advisable to rule out any complications and to receive tailored treatment recommendations.

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