Post-Surgery Recovery: Managing Bowel Issues After Hemorrhoid Surgery

Inquiry about recovery status 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 fecal leakage and pain at the surgical site, which made it difficult for him to have a bowel movement.
Under the treatment of the attending physician with oral anti-inflammatory medication and topical ointment, the pain has now resolved.
The catheter has been removed, and he can urinate independently.
However, since the wound has healed, he has been experiencing ongoing bowel irregularities.
Currently, he feels the urge to defecate whenever he walks, and after every meal, he also experiences the urge to go.
When he feels the urge, he usually has a bowel movement.
This has led him to avoid moving, and he spends most of the day in bed, trying not to walk.
Additionally, sometimes the urge comes very suddenly, to the point where he cannot control it, resulting in accidents before he can reach the bathroom.
He has multiple bowel movements each day.
Due to his previous difficulties with bowel movements post-surgery, the attending physician has prescribed a stool softener, which he takes once a day.
To facilitate smoother bowel movements, he is currently consuming a low-residue, soft diet.
We have discussed these issues with the attending physician, but the doctor has advised that recovery takes time and to be patient.
I would like to ask if this recovery process after hemorrhoid surgery is normal.
Is there a connection between the enlarged prostate and the abnormal bowel movements? Because of his enlarged prostate, my father needs to use the bathroom almost every two hours, and he experiences the urge to defecate during these trips.
Given his age, it may take longer for him to recover than for younger individuals, but this situation is severely affecting his quality of life.
We also suspect that there may have been surgical complications that could have damaged the sphincter or nerves, leading to anal abnormalities.
I would greatly appreciate any advice you could provide.
Thank you very much!

JJ, 40~49 year old female. Ask Date: 2023/07/14

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, there is a sensation of urgency but difficulty in completely emptying the bowels, resulting in frequent trips to the restroom.
The possible reasons are: 1.
Abnormal sensation of urgency: The surgery may involve the removal of some intestinal mucosa, which could affect peripheral nerves.
Additionally, if there is swelling at the surgical site or if the hemorrhoids were particularly large prior to surgery, this could lead to abnormal sensations of urgency.
This condition can occasionally occur after standard hemorrhoid surgery and typically improves over time.
2.
The use of stool softeners, combined with a diet low in fiber, can lead to poorly formed stools, making it difficult to pass them completely due to fear of straining post-surgery.
In this case, it is important to adjust the composition of the stool softeners and to ensure adequate fiber intake and hydration to facilitate bowel movements.
Regarding the surgical aspect, hemorrhoidectomy rarely causes significant damage to the anal sphincter.
If there are concerns, the best approach is to directly discuss your questions with the attending physician to ensure effective doctor-patient communication and to resolve any misunderstandings.

Reply Date: 2023/07/14

More Info

Post-surgery recovery, especially after procedures like hemorrhoid surgery, can be a complex and challenging process, particularly for elderly patients. Your father's experience following the PPH (Procedure for Prolapse and Hemorrhoids) surgery is not uncommon, but it does raise several important considerations regarding his recovery and ongoing bowel issues.

Firstly, it is essential to understand that after any surgical procedure involving the rectal area, patients may experience changes in bowel habits. This can include increased urgency, frequency of bowel movements, and even incontinence, particularly if there has been any trauma to the anal sphincter or surrounding nerves during surgery. Given your father's age and the additional factor of benign prostatic hyperplasia (BPH), which can complicate urinary and bowel function, it is understandable that he is experiencing these difficulties.

The fact that your father has had a urinary catheter for a month post-surgery and is now able to urinate independently is a positive sign of recovery. However, the ongoing issues with bowel movements, such as the urgency and frequency, can be distressing and may significantly impact his quality of life. The use of stool softeners is a common recommendation to help ease the passage of stool, especially after surgery, and it seems that this has been implemented in your father's care.

Regarding the relationship between BPH and bowel issues, there can indeed be a connection. The prostate gland is located near the rectum, and enlargement can lead to increased pressure in the pelvic area, potentially affecting bowel habits. Additionally, the anxiety and fear of not being able to control bowel movements can lead to a cycle of avoidance, where the patient becomes less active, which can further exacerbate constipation and bowel irregularities.

It is crucial to monitor your father's symptoms closely. If he continues to experience significant urgency and incontinence, it may be worth discussing with his healthcare provider the possibility of further evaluation. This could include an assessment of the anal sphincter function, possibly through anal manometry, or imaging studies to rule out any structural issues that may have arisen from the surgery.

In terms of dietary management, continuing with a low-residue, soft diet is advisable, but it is also important to ensure he is adequately hydrated. Sometimes, increasing fiber intake gradually can help regulate bowel movements, but this should be approached cautiously, especially if he has had issues with constipation in the past. Consulting with a dietitian may provide additional tailored dietary strategies to improve his bowel health.

Lastly, patience is key in the recovery process. Healing from surgery can take time, especially in older adults. However, if your father's symptoms do not improve or worsen, it is essential to advocate for further evaluation and possibly a referral to a gastroenterologist or a colorectal specialist. They can provide more specialized care and interventions that may help alleviate his symptoms and improve his quality of life.

In summary, while some degree of bowel irregularity is expected after hemorrhoid surgery, the severity and persistence of your father's symptoms warrant further investigation. Collaboration with his healthcare team, dietary adjustments, and possibly additional therapies may be necessary to support his recovery and enhance his overall well-being.

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