Post-Surgery Concerns: Hemorrhoids vs. Skin Tags

Postoperative Issues After Minimally Invasive Hemorrhoid Surgery

Hello, Doctor: In September, I consulted a physician and was confirmed to have a grade IV condition, and I underwent minimally invasive surgery.
I understand that post-operative swelling is normal.
After two follow-up visits, the doctor advised to continue monitoring.
However, it has been three months since the surgery, and what I feel is not just swelling; it feels like a piece of tissue that has not resolved, lodged at the anal opening.
This has been very uncomfortable for the past three months.
The surgeon mentioned that there would be excess skin post-surgery (three were removed, and I can feel two small lumps that seem to be the excess skin referred to after the surgery, along with a piece of tissue).
However, it feels like a solid mass similar to what I felt before the surgery, and I do not believe it is excess skin.
I have returned for consultation and was advised to undergo another procedure, this time using electrosurgery.
Doctor, while I suspect whether it was not properly excised (I do not want to misunderstand the professional physician), could you please help clarify whether this is excess skin or hemorrhoids? Additionally, if it is excess skin, is electrosurgery the only option? I am concerned.

Syu, 40~49 year old female. Ask Date: 2023/12/13

Dr. Ke Fangxu reply Surgery

Grade IV hemorrhoids indicate that the external hemorrhoids are larger, and minimally invasive surgery is generally not recommended because the external hemorrhoidal tissue may not be completely removed.
Your situation seems to resemble this condition.
If there is no pain or discomfort, a repeat surgery may not be necessary.
However, if the goal is to eliminate the excess tissue, another surgical procedure may be unavoidable.
For small tags, electrosurgery can be effective, but if the size exceeds 0.5 centimeters, excision may yield better results.

Reply Date: 2023/12/13

More Info

After undergoing surgery for grade IV hemorrhoids, it is understandable to have concerns about the healing process and the presence of any residual tissue. Based on your description, it seems you are experiencing discomfort and the sensation of a mass at the anal area three months post-surgery. It is important to differentiate between skin tags and hemorrhoids, as they have different implications for treatment and management.

Understanding Hemorrhoids vs. Skin Tags:
Hemorrhoids are swollen veins in the lower rectum or anus that can cause pain, discomfort, and bleeding. They can be classified as internal or external, with grade IV hemorrhoids being the most severe, often requiring surgical intervention. Post-surgery, it is common to experience some swelling and discomfort as the area heals. However, if you are feeling a firm mass that resembles the hemorrhoids you had prior to surgery, it is essential to consider the possibility of residual hemorrhoidal tissue or the formation of skin tags.

Skin tags, or acrochordons, are benign growths of skin that can occur in the anal area, especially after surgery. They are typically painless and may feel like a small piece of flesh hanging from the skin. It is not uncommon for skin tags to develop after hemorrhoid surgery due to the trauma and healing process in that area.
Differentiating Between the Two:
1. Texture and Sensation: Hemorrhoids may feel more vascular and can be tender or painful, especially if they are thrombosed (clotted). Skin tags, on the other hand, are usually soft and do not cause pain unless they become irritated.

2. Appearance: Hemorrhoids can appear swollen and may have a bluish hue if they are thrombosed. Skin tags are typically flesh-colored or slightly darker and have a smooth surface.

3. Location: Hemorrhoids are often located internally or at the anal verge, while skin tags are usually found externally.

Next Steps:
Given your ongoing discomfort and the presence of what you describe as a "piece of meat" at the anal area, it is advisable to follow up with your surgeon or a colorectal specialist. They can perform a thorough examination to determine whether you are dealing with residual hemorrhoidal tissue, skin tags, or another issue entirely.

If it is determined that you have skin tags, there are several treatment options available. While electrosurgery is one method, skin tags can also be removed through other techniques such as excision or cryotherapy. The choice of treatment will depend on the size, location, and your overall health.

Conclusion:
It is crucial to communicate your concerns clearly with your healthcare provider. They can provide you with the best course of action based on a physical examination and your medical history. Do not hesitate to seek a second opinion if you feel uncertain about the recommendations provided. Your comfort and health are paramount, and understanding the nature of your symptoms will help you make informed decisions regarding your treatment.

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