Post-Hemorrhoid Surgery: Struggling with Bowel Movements and Discomfort

It has been over a year since the hemorrhoid surgery, and I am experiencing difficulty with bowel movements and a lack of sensation during defecation?

Hello Doctor, after my hemorrhoid surgery last year following the Lunar New Year (the doctor mentioned that a significant amount of external hemorrhoids were removed), I have been experiencing difficulties during bowel movements.
I have to exert a lot of effort, and sometimes I don’t even feel anything when I pass stool (I have never had issues with constipation or difficulty in bowel movements throughout my life).
The volume of my stool has also increased significantly; previously, I would have a bowel movement every 1-2 days, at most every 3 days, without needing to sit on the toilet for long.
Now, I may go 2-3 times a day (with large amounts each time), and on severe days, it could be even more frequent.
However, the stool is well-formed, and there are no observable issues, but I have to sit on the toilet for a long time.
Although the doctor has prescribed Bisacodyl (2 tablets daily) since the surgery, I am afraid of becoming dependent on it, so I avoid taking it when I feel fine, but the stool volume has not decreased.
After the surgery last year, there was a day when I experienced severe constipation; I had a large bowel movement the day before, but the next day I could not pass stool for four days.
Eventually, the doctor prescribed Lactulose syrup, which helped me to have a bowel movement.
I occasionally experience similar situations now, where I have a large bowel movement one day and then difficulty the next day.
In those cases, I force myself to drink Lactulose (out of fear of not being able to pass stool).
After my surgery, I have found it very difficult to pass stool, even when I exert myself.
During severe instances, I can only follow the doctor’s advice to soak in warm water and manually apply pressure around the anus to help with the bowel movement, but this experience is truly painful and feels abnormal.

Could this indicate a failed surgery? I have seen online articles where others experienced similar issues after surgery, and after consulting several doctors, they discovered that too much tissue was removed during the procedure, leading to difficulties with bowel movements.
However, after undergoing corrective surgery, their bowel movements returned to normal within a few days.
Doctor, could I be in a similar situation? Thank you for your guidance.
Additionally, I am forcing myself to drink at least 2500cc of water daily; will this help improve my situation, or should I seek another colorectal surgeon to investigate further? Thank you very much, Doctor.

Su, 40~49 year old female. Ask Date: 2023/03/23

Dr. Zhang Shuhao reply Surgery

Postoperative difficulty in bowel movements after hemorrhoid surgery may be due to sensory or structural abnormalities.
Sensory abnormalities occur when nerve endings are damaged, leading to an inability to accurately perceive the urge to defecate, which typically improves gradually over time.
Structural abnormalities may arise if the sphincter muscle is injured during hemorrhoid excision, resulting in scarring and subsequent anal stenosis.
Your description seems to align more with this scenario.
If the difficulty in defecation is severe and affects your quality of life, surgical intervention is recommended.
Severe stenosis may require a local flap anal reconstruction surgery, and it is advisable to consult an experienced colorectal or plastic surgeon for the procedure.

Reply Date: 2023/03/23

More Info

After undergoing hemorrhoid surgery, experiencing difficulties with bowel movements and discomfort is not uncommon, but it can be concerning, especially when the symptoms are persistent and distressing. Your situation, characterized by the need to exert significant effort during bowel movements, changes in stool frequency, and the sensation of incomplete evacuation, warrants careful consideration and management.

Firstly, it’s important to understand that hemorrhoid surgery, particularly when extensive, can lead to changes in bowel habits. The surgical removal of hemorrhoids can alter the anatomy of the anal canal, potentially affecting the way stool is expelled. This can lead to increased straining, which may not only be uncomfortable but can also exacerbate the risk of developing new hemorrhoids or anal fissures.
The fact that you are experiencing larger bowel movements more frequently, along with the sensation of needing to push harder, suggests that your bowel habits have indeed changed post-surgery. The use of stool softeners, such as the ones prescribed by your doctor, is a common approach to prevent constipation and ease the passage of stool. However, it’s crucial to find a balance. Over-reliance on laxatives or stool softeners can sometimes lead to dependency, where your bowel becomes less responsive to natural stimuli.

Your concern about potentially having undergone a "failed" surgery is valid, especially if you are experiencing significant discomfort and changes in bowel habits that are not improving. While it is possible that excessive tissue removal during surgery could lead to complications such as anal stenosis (narrowing of the anal canal), it is also important to consider other factors that could be contributing to your symptoms. These include:
1. Postoperative Healing: The surgical site may still be healing, and inflammation can affect bowel function. This can lead to discomfort and changes in bowel habits.

2. Diet and Hydration: Maintaining adequate hydration is essential for digestive health. Drinking sufficient water (around 2500cc or more daily, as you mentioned) can help soften stool and promote regular bowel movements. Additionally, a high-fiber diet can facilitate smoother bowel movements.

3. Pelvic Floor Dysfunction: Sometimes, the muscles involved in bowel movements can become tense or dysfunctional post-surgery, leading to difficulties in passing stool. Pelvic floor physical therapy may be beneficial in such cases.

4. Psychological Factors: Anxiety about bowel movements, especially after surgery, can lead to a cycle of fear and avoidance, which can exacerbate constipation and discomfort.

Given your ongoing symptoms, it would be prudent to consult with a colorectal surgeon or a gastroenterologist who specializes in post-surgical complications. They can perform a thorough evaluation, which may include a physical examination and possibly imaging studies, to determine if there are any anatomical issues or complications from the surgery that need to be addressed.

In the meantime, here are some strategies you might consider to help manage your symptoms:
- Dietary Adjustments: Focus on a diet rich in fiber (fruits, vegetables, whole grains) to promote regular bowel movements. Gradually increase fiber intake to avoid gas and bloating.

- Hydration: Continue to drink plenty of fluids, as this can help soften stool and make it easier to pass.

- Regular Exercise: Gentle physical activity can stimulate bowel function and help alleviate constipation.

- Scheduled Bathroom Time: Establish a routine for bowel movements, allowing yourself time to relax and not rush the process.

- Warm Baths: Soaking in warm water can help relax the anal muscles and may ease discomfort during bowel movements.

In conclusion, while your symptoms are concerning, they are not uncommon after hemorrhoid surgery. However, it is essential to address them proactively with the help of a healthcare professional to ensure that any underlying issues are identified and managed appropriately. Your health and comfort are paramount, and seeking further evaluation is a wise step toward finding relief.

Similar Q&A

Post-Hemorrhoid Surgery: Understanding Bowel Movement Difficulties

I had hemorrhoid surgery at the beginning of July, and since then, I have been experiencing difficulty with bowel movements. If I go a day without a bowel movement, it feels like the stool is right at the anal opening, and I have to exert a lot of effort to pass it. Additionally,...

Dr. Ke Fangxu reply Surgery
It has been over two months since the surgery, and the surgical wound should have healed by now. However, if there was a history of constipation prior to the surgery, the constipation may not improve due to the surgery. It is still important to pay attention to dietary habits and...

Post-Surgery Constipation After Hemorrhoid Surgery: What to Do?

Hello, doctor. It has been three days since my surgery, and I have not had a bowel movement yet. Since I underwent surgery for both internal and external hemorrhoids, and I have multiple severe wounds, I feel the urge to go but am afraid to strain due to sharp pain at the wound s...

Dr. Ke Fangxu reply Surgery
After hemorrhoid surgery, pain and bleeding are normal phenomena. At this time, it is necessary to take stool softeners to assist with bowel movements. If there is still reluctance to defecate due to psychological factors, one can try to relieve oneself while sitting in warm wate...

Post-Hemorrhoid Surgery: Struggling with Bowel Movements?

One week after hemorrhoid surgery, I still have difficulty passing stool. I feel the urge to go, but I can't seem to get it out at the anal opening. I've been soaking in warm water and taking the stool softeners prescribed by my doctor, but the problem persists. As a re...

Dr. Ke Fangxu reply Surgery
After hemorrhoid surgery, it is common to experience this phenomenon for a short period. During this time, you can soak in water and then change the water to soak again. Generally, this condition improves significantly within two weeks.

Post-Surgery Recovery: Managing Bowel Issues After Hemorrhoid Surgery

Hello Doctor, my father (79 years old) underwent minimally invasive surgery for hemorrhoids (PPH hemorrhoidectomy) on March 1st of this year. Due to his enlarged prostate issue, he had a urinary catheter for about a month post-surgery. For the first two months, he experienced fec...

Dr. Zhang Shuhao reply Surgery
Generally, hemorrhoidectomy wounds heal within a few weeks, and there should be no issues with incontinence. Benign prostatic hyperplasia may lead to short-term urinary difficulties post-surgery, but it does not affect bowel movements in the long term. Based on the description, t...