Post-Surgery Anal Pain: Recovery After Hemorrhoid Surgery

Severe pain during bowel movements after hemorrhoid surgery?

Doctor, I apologize for the interruption; my statement is quite complex.
I underwent minimally invasive surgery at the clinic on December 27, 2023.
The next morning, I experienced tearing pain while having a bowel movement, and upon examination, I discovered a lump outside my anus.
When I contacted the surgical clinic, they only advised me to take a two-hour sitz bath and apply medication as prescribed, assuring me that the swelling would subside.
They instructed me to return for a follow-up in two weeks.
However, even after finishing the medication, the swelling persisted, and the pain remained severe.
On January 5, my family took me to another hospital, where the doctor immediately identified a severely damaged internal hemorrhoid.
They performed a hemorrhoid ligation procedure.
Since then, I have experienced excruciating pain during bowel movements, to the point where I cannot stand upright and break into a cold sweat.
I have been taking painkillers and finding some relief after bathing and cleaning the area.
My stools are soft, not hard, and I can pass them without difficulty.
However, outside of bowel movements, I can sit in a car and walk without significant pain.
On January 10, I returned to the surgical clinic for a follow-up.
However, when they attempted to insert instruments for an internal examination, the pain was unbearable, and they could not complete the internal exam.
The doctor mentioned that the wound might not have healed yet, which could explain the pain during bowel movements.
I would like to ask if the ligation procedure could have delayed the healing of my wound.
I am still following the two-hour sitz bath routine and applying medication, but I continue to experience severe pain during bowel movements.
I have developed a fear of having bowel movements, and my pre-existing postpartum depression, for which I require regular medication, has worsened.
Thank you, doctor, for taking the time to read my statement and questions.

Taipei Miss Chen, 30~39 year old female. Ask Date: 2024/01/11

Dr. Zhang Shuhao reply Surgery

Most minimally invasive surgeries available in the market primarily address internal hemorrhoids, but postoperative venous return obstruction can lead to swelling of external hemorrhoids.
Taking warm sitz baths and using anti-inflammatory medications can help alleviate symptoms.
Generally, hemorrhoid ligation is not performed immediately after hemorrhoid surgery, as most hemorrhoids have already been excised.
Ligation can easily involve muscle or rectal tissue, and if it is directly tied to the surgical wound, it may affect wound healing.
Currently, it is still recommended to follow the physician's instructions for warm sitz baths, use pain relievers, stay well-hydrated, and wait for the wound to heal.
If there is fever or unbearable pain, it is advisable to return for an earlier follow-up to adjust medication.
If there are no other complications, improvement can be expected in about a month, and there is no need for excessive concern.

Reply Date: 2024/01/11

More Info

Post-surgery anal pain, particularly after hemorrhoid surgery, can be a distressing experience, and it’s important to understand the recovery process and what to expect. Based on your description, it seems you have undergone a minimally invasive procedure for hemorrhoids, followed by a more invasive procedure for a severe internal hemorrhoid. The pain you are experiencing during bowel movements is not uncommon, especially after such surgeries.

Understanding Post-Surgery Pain
1. Surgical Trauma: Any surgical procedure, including hemorrhoid surgery, involves trauma to the tissues. This trauma can lead to inflammation and pain as the body begins to heal. The presence of a significant internal hemorrhoid, as noted by the second doctor, suggests that the area was already compromised, which could contribute to prolonged healing and discomfort.

2. Wound Healing: The healing process can vary significantly from person to person. Factors such as the extent of the surgery, your overall health, and adherence to post-operative care can influence recovery time. It’s not unusual for pain to persist for several weeks after surgery, particularly if there are complications or if the surgical site is still healing.

3. Bowel Movements and Pain: The act of having a bowel movement can be particularly painful post-surgery due to the pressure exerted on the surgical site. Even with soft stools, the sensation of passing stool can cause discomfort, especially if there are any fissures or if the surgical site is still inflamed.

Recommendations for Managing Pain and Promoting Healing
1. Warm Sitz Baths: Continuing with warm sitz baths can help soothe the area and promote blood flow, which is beneficial for healing. It can also provide temporary relief from pain and discomfort.

2. Pain Management: Over-the-counter pain medications, such as acetaminophen or ibuprofen, can help manage pain. If these are ineffective, discussing stronger pain relief options with your doctor may be necessary.

3. Dietary Adjustments: Maintaining a high-fiber diet and staying hydrated can help ensure that bowel movements remain soft, reducing strain during defecation. Consider incorporating fruits, vegetables, and whole grains into your diet.

4. Avoiding Strain: It’s crucial to avoid straining during bowel movements. If you feel the urge to go but are experiencing pain, it may be helpful to relax and try again later. Using a stool softener may also be beneficial.

5. Follow-Up Care: Since you mentioned that your follow-up appointment was painful and that the doctor indicated the wound may not be healed, it’s essential to keep your healthcare provider informed about your symptoms. If pain persists or worsens, or if you notice any signs of infection (such as increased swelling, redness, or discharge), seek medical attention promptly.

6. Mental Health Considerations: Given your mention of postpartum depression, it’s important to address any mental health concerns as well. Pain and discomfort can exacerbate feelings of anxiety or depression, so consider discussing these feelings with a healthcare professional who can provide support and resources.

Conclusion
In summary, while post-surgery pain after hemorrhoid surgery can be significant, it is often a part of the healing process. It’s essential to follow your doctor’s advice, manage pain effectively, and maintain a healthy diet to facilitate recovery. If your symptoms do not improve or worsen, do not hesitate to seek further medical evaluation. Your health and comfort are paramount, and addressing both physical and emotional aspects of recovery is crucial for your overall well-being.

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