Post-Surgery Concerns After Traditional Hemorrhoid Removal: What to Expect

Traditional surgery for internal and external hemorrhoids, postoperative issues?

Hello, Doctor.
My condition is that after bowel movements, a lump comes out that I can push back in; it seems to be a small piece of tissue related to an external hemorrhoid.
It's not very large and doesn't significantly affect my daily activities.
The doctor initially suggested a ligation procedure, but I opted for traditional surgical excision for a more permanent solution.
I underwent traditional electrosurgical excision for both internal and external hemorrhoids on June 19.
I have several questions:
1.
On the third day post-surgery, I looked at my anal area with a mirror and noticed a small red area that feels a bit hard, but I didn’t see any stitches.
Is this likely the area of the external hemorrhoid, the wound after electrosurgery?
2.
Since the surgery on June 19, it has been five days.
I had normal bowel movements on June 20 and 21, with the stool being hard at the tip but soft afterward.
The post-bowel movement pain was manageable.
However, today, June 23, after eating dragon fruit, my stool was softer than the previous days.
I didn’t exert more effort during the bowel movement, but it was significantly more painful than before, to the point where I lost the urge to continue.
While rinsing, I felt something protruding from my anus, similar to what I mentioned in question 1.
It felt like a lump, with small hard areas that I believe are related to the internal hemorrhoid wound.
Due to the pain, I couldn't push it back in, and using a sitz bath didn’t relieve the discomfort.
The internal hemorrhoid wound didn’t retract until I adopted a kneeling position after rinsing.

3.
What should I do if the internal hemorrhoid wound protrudes and I cannot push it back in?
4.
Is it normal for the internal hemorrhoid wound to protrude after a bowel movement?
5.
Why does the wound protrude? Is it because the internal hemorrhoid wasn’t completely removed, or could there be other reasons?
6.
Given my current situation, will I still experience protrusion after bowel movements once the wound has healed?
Thank you, Doctor, for taking the time to read and respond to my concerns.
I really appreciate it.

Niming, 20~29 year old female. Ask Date: 2023/06/23

Dr. Ke Fangxu reply Surgery

First, traditional excision of external hemorrhoids and electrosurgery are different surgical methods, so without knowing your exact surgical procedure, it may not be possible to fully answer your question.
1.
It is possible.
2.
If the wound is very painful and cannot be pushed back, then you can only take more sitz baths and use pain-relieving and anti-inflammatory medications to alleviate the symptoms.
3.
4.
What you are describing may be residual hemorrhoidal tissue protruding from a wound.
If that is the case, it indeed suggests insufficient removal of hemorrhoidal tissue.
However, as mentioned earlier, without knowing the exact surgical method, it is also impossible to determine if this is a normal phenomenon.
5.
It is possible.

Reply Date: 2023/06/23

More Info

After undergoing traditional hemorrhoid removal surgery, it is common to have concerns about the healing process and what to expect in terms of symptoms and recovery. Based on your description, it seems you are experiencing some complications that warrant further explanation and guidance.

1. Post-Surgery Symptoms: The small, red, hard area you observed at the anal opening could indeed be related to the surgical site. After hemorrhoid surgery, it is not unusual for the area to appear swollen or for there to be some residual tissue that feels firm. This could be part of the healing process, but it is essential to monitor it for any signs of infection or excessive swelling.

2. Prolapse of Hemorrhoidal Tissue: The sensation of tissue protruding after a bowel movement can be concerning. If you find that the tissue does not return to its normal position, it may indicate that the internal hemorrhoid tissue is still present or that there is a degree of prolapse. If you cannot manually push it back in, it is crucial to avoid straining during bowel movements, as this can exacerbate the issue.

3. Pain During Bowel Movements: Experiencing pain during bowel movements, especially after surgery, can be attributed to several factors, including the hardness of the stool, the healing process of the surgical site, or even the presence of residual hemorrhoidal tissue. It is vital to maintain a soft stool consistency to minimize discomfort. This can be achieved through dietary changes, such as increasing fiber intake and staying well-hydrated.

4. Why Tissue Prolapses: The prolapse of tissue after bowel movements can occur for various reasons. If the internal hemorrhoids were not entirely removed, or if there is still some swelling or inflammation, this could lead to the tissue protruding. Additionally, straining during bowel movements can increase pressure in the anal area, causing the tissue to bulge out.

5. Future Concerns: It is difficult to predict whether you will continue to experience this issue after your wounds have healed. If the internal hemorrhoids were not completely excised, there is a possibility that they could recur. Regular follow-ups with your surgeon or a gastroenterologist are essential to monitor your recovery and address any ongoing symptoms.

Recommendations for Recovery:
- Dietary Adjustments: Focus on a high-fiber diet, including fruits, vegetables, and whole grains, to promote softer stools. Consider using stool softeners if necessary, but consult your physician before starting any new medication.

- Hydration: Drink plenty of fluids to help keep your stool soft and reduce the risk of constipation.

- Pain Management: Over-the-counter pain relievers, such as acetaminophen or ibuprofen, can help manage discomfort. However, consult your doctor before taking any medication post-surgery.

- Sitz Baths: Continue using sitz baths to soothe the area and promote healing. Warm water can help reduce pain and swelling.

- Follow-Up Care: Schedule regular follow-ups with your healthcare provider to monitor your recovery and address any complications. If you notice signs of infection (increased redness, swelling, or discharge), contact your doctor immediately.

- Avoid Straining: When using the restroom, avoid straining, as this can worsen symptoms and lead to further complications.

In summary, while some discomfort and complications can arise after hemorrhoid surgery, proper care and monitoring can significantly aid in recovery. If symptoms persist or worsen, it is crucial to seek medical advice to ensure appropriate management and prevent further issues.

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