Post-Hemorrhoid Surgery: Managing Persistent Leakage and Discomfort

Post-hemorrhoid surgery, there may be leakage of mucus and fecal matter?

Hello, doctor.
I had hemorrhoid surgery on the ninth day postpartum, and it has been one year and eight months since then.
Besides discomfort in the anal area, I have been experiencing leakage of intestinal mucus and fecal matter after bowel movements for over a year.
Even after ensuring I am clean, I still experience leakage of mucus and feces 10 to 30 minutes later.
Sometimes, I even have leakage issues without having a bowel movement.
I do not feel any sensation during the leakage.
Over the past year, I have seen nine doctors, most of whom performed a digital examination and said there were no issues.
I went to Taipei Veterans General Hospital for rectal pressure testing and ultrasound, where the doctor mentioned anal sphincter weakness, indicating that my function is somewhat lower than normal, but he said the muscle is not torn.
At St.
Martin's Hospital, the rectal assessment showed similar results, and I also underwent electromyography, where the doctor indicated nerve damage, attributing it to childbirth.
I subsequently underwent approximately 136 sessions of electrical stimulation therapy, which did not improve my condition; instead, it caused more pain in the anal area.
I later consulted a doctor at Chung-Hsing Hospital, who noted my increased pain from the electrical therapy and advised me to stop it.
Finally, Dr.
Jiang at Chung-Hsing Hospital performed a digital examination and said my function was adequate, with no anal relaxation.
A colonoscopy showed no issues, and the doctor noted that my anal appearance looked intact.
He asked if I could hold in gas, to which I replied that sometimes I can, and sometimes I cannot.
He said it is normal to be able to hold in gas, and that liquid should also be contained, so he could not explain my situation.
The doctor suggested I wait and see, and there have been no follow-ups since.
Thank you for reading my lengthy description.
I would like to ask:
1.
I still have discomfort in the anal area, and one side feels hard and painful when pressed.
Is this due to scarring, or could it be muscle? (The doctor at St.
Martin's mentioned that my internal anal sphincter is very thin in one-third of its area, but he said it is due to my bowel movement issues, so I wonder if the hard area I feel is scar tissue or muscle?)

2.
If it is scar tissue, is there a chance it could soften over time?

3.
Do severe hemorrhoids really lead to a higher likelihood of leakage issues post-surgery? I deal with mucus and fecal matter every day after bowel movements, and what troubles me most is that there is still leakage after wiping, causing fear in my daily life.

4.
Is the leakage after wiping due to muscle weakness?

5.
Would daily pelvic floor exercises help improve my condition?

6.
Due to severe postpartum hemorrhoids, the appearance of my anus is asymmetrical, with one side protruding more (the examining doctor said it is not prolapse).
After surgery, there is a dent in one area of the anus, resembling a missing piece of tissue.
Over time, this dent has slightly flattened, possibly due to the asymmetry of the anus.
Could this dent be causing the leakage?
I would like to ask the doctor for any suggestions on what I can do, as I have been facing the fear of leakage every day for the past year and eight months after surgery at a major medical center, following an evaluation by a rectal specialist.
It has been very difficult for me.
Thank you for your patience in reading my questions.

Niming, 30~39 year old female. Ask Date: 2023/08/18

Dr. Ke Fangxu reply Surgery

If you have already visited so many medical centers and undergone all the examinations, then I may not be able to help much.
1.
It could be scar tissue.
2.
It may soften over time.
3.
Leakage issues after hemorrhoid surgery typically only last for a month; once the wound has completely healed, it should return to normal.
4.
It is possible.
5.
Surgery may cause anal deformity, which is specifically referred to as keyhole deformity; however, this generally does not occur on the sides.
I am unsure if your situation is indeed caused by a dent leading to leakage.
If this phenomenon occurs only after bowel movements and there is no leakage at other times, then like other physicians, I would not recommend any further intervention; just ensure proper hygiene after bowel movements.

Reply Date: 2023/08/18

More Info

Post-hemorrhoid surgery complications, such as persistent leakage and discomfort, can be distressing and significantly impact quality of life. Based on your detailed description, it seems you have been through a comprehensive evaluation and treatment process, which is commendable. Let's address your concerns systematically.

1. Hardness and Pain in the Anal Area: The hard area you feel upon pressing could be due to scar tissue formation post-surgery. Scar tissue can sometimes feel firmer than surrounding tissue, and if it is pressing against nerves or other structures, it could cause discomfort or pain. It’s also possible that you are palpating the underlying muscle, particularly if there is muscle weakness or atrophy. Consulting with a specialist in pelvic floor disorders might provide further insights.

2. Scar Tissue Softening: Scar tissue can change over time, but it often does not completely revert to its original state. Physical therapy, particularly pelvic floor therapy, may help in softening the scar tissue and improving function. Techniques such as massage or specific exercises might be beneficial, but this should be guided by a healthcare professional.

3. Post-Surgery Leakage: Severe hemorrhoids can lead to changes in anal function, including the ability to control bowel movements. After surgery, some patients may experience changes in sensation or muscle control, which can lead to leakage of mucus or stool. This is often due to a combination of factors, including muscle weakness, nerve damage, or changes in the anal canal's structure.

4. Muscle Weakness and Leakage: Yes, muscle weakness can contribute to the inability to retain stool or gas, leading to leakage. If the internal anal sphincter is compromised, it may not function effectively, resulting in involuntary leakage. Strengthening exercises, such as Kegel exercises, may help improve muscle tone and control, but they should be performed under the guidance of a healthcare provider.

5. Kegel Exercises: Regularly performing Kegel exercises can indeed help strengthen the pelvic floor muscles, which may improve your ability to control bowel movements and reduce leakage. However, it's essential to ensure you are doing them correctly to avoid further complications.

6. Asymmetry and Concerns Post-Surgery: The asymmetry and the appearance of the anal area post-surgery can be concerning. Changes in the anal anatomy can affect function, including the ability to control bowel movements. If there is a significant change in the structure, it might be worth discussing surgical options for correction with a colorectal surgeon.

7. Management Strategies: In addition to pelvic floor therapy and Kegel exercises, consider dietary modifications to ensure softer stools, which can reduce straining and discomfort. Staying hydrated and consuming a high-fiber diet can help. Additionally, using barrier creams or ointments post-bowel movement may help protect the skin and reduce irritation.

8. Psychological Impact: The fear of leakage can lead to anxiety and affect your daily life. It may be beneficial to speak with a mental health professional who can help you cope with the emotional aspects of your condition.

9. Follow-Up Care: Continuous follow-up with your healthcare provider is crucial. If you feel that your current treatment plan is not effective, do not hesitate to seek a second opinion or ask for a referral to a specialist in pelvic floor disorders or colorectal surgery.

In conclusion, while the journey post-hemorrhoid surgery can be challenging, there are avenues for improvement. Engaging with specialists, considering physical therapy, and implementing lifestyle changes can help manage your symptoms. Remember, you are not alone in this, and seeking support from healthcare professionals can lead to better outcomes.

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