Post-Hemorrhoid Surgery Leakage: Causes and Solutions

Postoperative leakage after hemorrhoid surgery?

Hello Doctor, I am #203132.
Two years after my hemorrhoid surgery, I experience leakage of intestinal fluid and feces after bowel movements.
I would like to ask you:
1.
I underwent anorectal manometry, and the results showed lower pressure than normal.
An ultrasound also indicated about a one-centimeter scar on the external anal sphincter.
Given these findings, does this mean my condition cannot be improved?
2.
Another doctor told me that the manometry results are just data, and the digital examination showed no significant issues, indicating that my function is adequate.
I want to know if my situation, where I need to wipe multiple times after bowel movements due to leakage, will worsen with age.

3.
I have consulted many doctors, and each has given different opinions.
One doctor suggested electrotherapy, but after the treatment, I experienced increased discomfort in the anal area.
Other doctors advised me to stop the electrotherapy, believing it was not beneficial.
I would like to know, in clinical practice, could electrotherapy be effective for my condition?

Niming, 30~39 year old female. Ask Date: 2023/12/06

Dr. Zhang Shuhao reply Surgery

1.
Rectal pressure measurement should show a resting pressure lower than that of normal individuals.
Ultrasound may reveal scarring of the external anal sphincter, but it is not completely torn.
If digital examination does not indicate complete relaxation, most physicians would not recommend surgical repair of the sphincter.

2.
After cleaning post-defecation, there may be leakage after some time, but when consciously holding it in, there is no leakage.
This indicates that although the external anal sphincter has scarring, it still retains some function.
It does not necessarily worsen with age.
3.
The function of the pelvic floor muscles can be improved through physical therapy, primarily using biofeedback or electrical stimulation.
However, the response varies for each individual and should be adjusted based on personal circumstances.
It is advisable to monitor the improvement of incontinence after a period of electrical therapy and discuss with a rehabilitation physician whether to continue with the treatment.

Reply Date: 2023/12/06

More Info

Post-hemorrhoid surgery leakage, particularly the leakage of fecal matter and intestinal fluid, can be a distressing condition for patients. It is essential to understand the underlying causes and potential solutions to manage this issue effectively.
1. Understanding the Causes: After hemorrhoid surgery, some patients may experience changes in anal sphincter function due to scarring or damage to the anal muscles. The results from your rectal pressure measurement indicating lower than normal pressure suggest that the anal sphincter may not be functioning optimally. The presence of a scar in the external anal sphincter, as noted in your ultrasound, could contribute to this dysfunction. Scarring can lead to decreased muscle elasticity and strength, which may result in difficulties in controlling bowel movements, leading to leakage.

2. Prognosis and Management: Unfortunately, if the anal sphincter has been significantly compromised due to scarring, it may be challenging to restore normal function completely. However, this does not mean that management options are unavailable. Many patients find that lifestyle modifications, such as dietary changes to ensure softer stools, pelvic floor exercises, and biofeedback therapy, can help improve symptoms. It is also crucial to maintain good hygiene to prevent skin irritation and infections due to leakage.

3. Age and Incontinence: As you age, the risk of fecal incontinence can increase due to natural changes in muscle tone and elasticity, as well as potential comorbidities that may affect bowel control. However, the degree of worsening can vary significantly among individuals. Regular follow-ups with your healthcare provider can help monitor your condition and adjust treatment plans as necessary.

4. Electrotherapy: Regarding the use of electrotherapy, it is a treatment modality that some practitioners recommend for strengthening the pelvic floor muscles and improving sphincter function. However, responses to electrotherapy can vary widely among patients. If you experienced increased discomfort after electrotherapy, it may not be suitable for your specific situation. It is essential to communicate openly with your healthcare provider about your experiences and concerns regarding any treatment. They may suggest alternative therapies, such as pelvic floor rehabilitation or other forms of physical therapy, which might be more beneficial for you.

5. Consultation with Specialists: Given the complexity of your condition and the varying opinions from different healthcare providers, it may be beneficial to seek a consultation with a colorectal specialist or a pelvic floor therapist. These specialists can provide a more comprehensive evaluation and tailored treatment options based on your specific needs.

In summary, while the presence of leakage post-hemorrhoid surgery can be concerning, understanding the underlying causes and exploring various management strategies can help improve your quality of life. Regular follow-ups and open communication with your healthcare team are vital in navigating this condition effectively.

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