Post-Surgery Care and Concerns After Hemorrhoid Surgery: A Guide

Post-hemorrhoid surgery

Hello Dr.
Ke, I underwent a mixed nevus and anal protrusion excision surgery on May 29th, and it has been about 50 days since then.
I would like to ask the following questions:
1.
During my follow-up appointment in the fourth week post-surgery, the doctor mentioned that both the internal and external wounds had healed.
Was this assessment made using an anoscope or through a digital examination?
2.
From July 14th to July 18th, while exercising or practicing Kegel exercises, I noticed some fecal leakage from the anus (when I lightly pressed with toilet paper, there was a small amount of yellow stool).
Is this considered anal incontinence? I am a bit concerned.

3.
Currently, I do not experience pain when walking or after bowel movements, and there is no discharge.
However, when sitting, I sometimes feel a prickling pain.
Is this normal?
4.
What symptoms might indicate an anal fistula resulting from infection after nevus surgery?

Xiao Ling, 50~59 year old female. Ask Date: 2023/07/18

Dr. Ke Fangxu reply Surgery

1.
Digital examination is sufficient for diagnosis.

2.
This phenomenon can occur even if it is not normal, especially during exertion.

3.
It is normal.

4.
Redness, swelling, heat, pain, along with purulent discharge or a wound that does not heal for a long time.

Reply Date: 2023/07/18

More Info

Post-surgery care after hemorrhoid surgery is crucial for ensuring a smooth recovery and minimizing complications. Here’s a comprehensive guide addressing your concerns and providing additional insights into post-operative care.

1. Wound Healing Assessment: During your follow-up appointment at the four-week mark, your doctor likely used either a proctoscope or a digital examination to assess the healing of the internal and external wounds. A proctoscope allows for a more detailed view of the anal canal and rectum, which is essential for evaluating the surgical site. If your doctor confirmed that both wounds have healed, that is a positive sign indicating that your body is recovering well.

2. Concerns About Leakage: The incident you described between July 14-18, where you noticed some yellowish discharge after exercising or practicing pelvic floor exercises, could be concerning. This may not necessarily indicate full-blown fecal incontinence, but it could suggest a temporary loss of control or sensitivity in the anal area, which can happen post-surgery. It’s essential to monitor this symptom closely. If it persists or worsens, you should consult your healthcare provider for further evaluation. They may recommend pelvic floor rehabilitation exercises or other interventions to strengthen the anal sphincter.

3. Pain and Discomfort: Experiencing a "stinging" sensation while sitting, even if you are not in pain after bowel movements, can be normal as your body continues to heal. The surgical site may still be sensitive, and sitting for prolonged periods can exacerbate this discomfort. It’s advisable to use a cushion when sitting to alleviate pressure on the area. Additionally, practicing good hygiene and using soothing topical treatments as recommended by your doctor can help ease discomfort.

4. Symptoms of Infection: If an infection were to occur following a hemorrhoidectomy, symptoms might include increased pain, swelling, redness around the surgical site, fever, or the presence of pus or unusual discharge. If you notice any of these symptoms, it is crucial to seek medical attention promptly. An anal fistula, which can develop as a complication of surgery, may present with symptoms such as persistent drainage, pain, or swelling near the anus. If you suspect this, a follow-up with your surgeon is necessary for proper diagnosis and treatment.

Additional Care Tips:
- Dietary Adjustments: To prevent constipation and straining during bowel movements, maintain a high-fiber diet and stay well-hydrated. Foods rich in fiber include fruits, vegetables, whole grains, and legumes. Consider using a stool softener if recommended by your doctor.

- Activity Level: Gradually increase your activity level as tolerated, but avoid heavy lifting or strenuous exercises until cleared by your physician. Gentle walking can promote circulation and aid in recovery.

- Pain Management: If you experience discomfort, over-the-counter pain relievers such as acetaminophen or ibuprofen can be helpful. However, always consult your doctor before taking any medication post-surgery.

- Follow-Up Appointments: Regular follow-ups with your healthcare provider are essential to monitor your recovery and address any concerns that may arise. Be proactive in discussing any new symptoms or changes you experience.

In summary, while some discomfort and minor issues can be expected after hemorrhoid surgery, it’s essential to stay vigilant and communicate openly with your healthcare provider about your recovery. By following these guidelines and maintaining a healthy lifestyle, you can support your healing process effectively.

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