Anal Sphincter Issues After Hemorrhoid Surgery

Sphincter issues

Hello, doctor.
I am the patient from case #188320 regarding post-operative hemorrhoids and anal sphincter weakness.
I had my hemorrhoid surgery at Taichung Medical Center, where the surgeon informed me after reviewing my MRI that one side of my anal sphincter is thinner.
During the digital examination, he mentioned that the muscle is still present, but he couldn't understand why I am experiencing pain and post-defecation leakage.
Therefore, he recommended that I go to a hospital in Taipei for a rectal pressure test and ultrasound.

I am concerned that my sensitive condition might involve issues of medical negligence, as the doctors in Taipei did not inform me of the extent of the damage; they only mentioned the above points and did not address any potential impairment of the perineal nerve function, suggesting only dietary control and self-training.
They did mention that "the thickness of the perineum is intact."
1.
I am unsure if this is related to the function of the perineal nerve since the doctors in Taipei did not advise me on follow-up visits or further management.

2.
If I have the results from the rectal pressure test and ultrasound, can the MRI images also be evaluated by other doctors to identify the issues?
3.
Would you recommend that I take the imaging results back to the surgeon who performed my operation for consultation?
Thank you for your response, and I appreciate your guidance.

Niming, 30~39 year old female. Ask Date: 2022/11/02

Dr. Zhang Shuhao reply Surgery

1.
The perineal nerve is responsible for the sensory and motor functions of the sphincter muscles and the anal canal.
To diagnose incontinence caused by sphincter dysfunction, it is essential to rule out any issues related to nerve sensory abnormalities.
2.
You can consult other colorectal surgeons with your report.
3.
If you are already seeing a specialist at a large hospital, it is advisable to first consult your original surgeon.
If you still have concerns, you may also seek a second opinion from a more experienced physician within the same institution.

Reply Date: 2022/11/02

More Info

After undergoing hemorrhoid surgery, it's not uncommon for patients to experience issues related to the anal sphincter, including weakness, pain, and incontinence. These symptoms can be distressing and may lead to concerns about potential complications or the adequacy of the surgical procedure. Let's break down your questions and provide some insights based on medical knowledge.

1. Anal Sphincter Function and Perineal Nerve Damage: The anal sphincter is crucial for maintaining continence, and any damage to the sphincter muscles or the nerves that innervate them can lead to symptoms like pain and leakage. The perineal nerves are responsible for the sensory and motor functions of the anal region. If the MRI indicated that one side of the sphincter is thinner, it could suggest some degree of atrophy or damage. However, the fact that the doctor mentioned the muscle is still present is a positive sign. The thickness of the perineal body can indeed correlate with nerve function, but it is not the sole determinant. If the perineal body is intact, it may indicate that the structural support is still there, but functional assessments (like the rectal pressure test) are necessary to evaluate how well the sphincter is working.

2. Interpreting Diagnostic Tests: The rectal pressure test and ultrasound can provide valuable information about the function of the anal sphincter and the presence of any abnormalities. These tests can help determine if there is a significant weakness in the sphincter muscles or if there are other underlying issues contributing to your symptoms. Consulting with another physician who specializes in colorectal surgery or gastroenterology can be beneficial. They can interpret the results of your MRI, rectal pressure tests, and ultrasound to provide a comprehensive understanding of your condition.

3. Follow-Up with the Surgeon: It is advisable to bring all imaging and test results back to the surgeon who performed your hemorrhoid surgery. They are familiar with your surgical history and can provide insights into whether your current symptoms are related to the surgery. They may also suggest further interventions or therapies based on the findings from your tests. Open communication with your healthcare provider is crucial, especially if you feel that your concerns have not been adequately addressed.

In addition to these points, it is essential to manage your symptoms through dietary modifications and pelvic floor exercises as recommended. These can help improve bowel habits and strengthen the pelvic floor muscles, which may alleviate some of the incontinence issues.
If you continue to experience significant pain or leakage, or if your symptoms worsen, do not hesitate to seek further medical advice. Persistent symptoms after surgery warrant thorough investigation to rule out complications such as anal fissures, abscesses, or other conditions that may require additional treatment.

In conclusion, your concerns about anal sphincter function after hemorrhoid surgery are valid, and it’s important to pursue further evaluation and treatment options. Engaging with your healthcare providers, asking questions, and advocating for your health will be key in navigating your recovery process.

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