Post-Surgery Concerns: Managing Bleeding After Hemorrhoid Surgery

Post-hemorrhoid surgery

Hello Dr.
Ke,
Last month, I had difficulty passing a bowel movement, and instead of stool, a lot of blood came out.
I went to the hospital for an examination, and the doctor said I have a grade 3 mixed hemorrhoid that needs to be surgically removed.
I underwent traditional surgery on January 4th.
After the surgery, I found it very difficult to have bowel movements for several days, and I experienced dark red blood clots.
It wasn't until a week later that I was able to have a bowel movement with less pain.
Now, it has been over three weeks, and I have been continuously following up with the doctor, who said the wound is healing well.
However, during my appointment two days ago, the doctor performed a digital rectal massage and advised me to use an ointment to massage the inside of the anus to help the muscles contract.
The next day, after soaking in warm water in the toilet, I suddenly felt the urge to have a bowel movement.
When I gently pushed, the toilet was filled with blood clots and fresh blood, and there was continuous dripping of blood.
After cleaning up, I lay down on my side to rest.
After a while, I felt the urge to go to the bathroom again, and once more, I experienced bleeding.
I quickly went to the emergency room, but the emergency doctor said I need to schedule a follow-up appointment for observation.
I am now unsure if my wound is healing properly or if there are other issues.
I don't know the cause of the sudden bleeding.
Before the doctor performed the rectal massage, I didn't have any abnormal sensations, but since the massage, the aforementioned symptoms have occurred.
I am uncertain about what to do next.
Thank you.
🙏

A Cheng, 40~49 year old female. Ask Date: 2024/01/21

Dr. Ke Fangxu reply Surgery

Traditional hemorrhoid surgery has a small incidence of delayed bleeding occurring ten days post-operation, usually caused by suture loosening.
If there is no ongoing bleeding, it is not a concern; otherwise, a reoperation for hemostasis may be necessary.
It is recommended to avoid massage for the time being, and warm sitz baths are sufficient.
If bleeding recurs, a follow-up with the physician is advised.

Reply Date: 2024/01/21

More Info

After undergoing hemorrhoid surgery, it is not uncommon to experience some bleeding, especially during bowel movements. However, the amount and nature of the bleeding you are describing raise some concerns that should be addressed promptly.
Firstly, it is essential to understand that after surgery for grade 3 hemorrhoids, the surgical site is still healing, and any strain during bowel movements can lead to bleeding. The fact that you experienced dark red blood and blood clots after straining suggests that there may be some irritation or trauma to the surgical site. This could be due to several factors, including constipation, excessive straining, or even the manipulation of the area during follow-up examinations.

The sudden onset of bleeding after the doctor performed a manual examination could indicate that the area was agitated, leading to the rupture of small blood vessels or irritation of the healing tissue. While it is normal to have some discomfort and minor bleeding post-surgery, significant bleeding, especially if it is bright red and accompanied by clots, should not be ignored.

Here are some steps you can take to manage your situation:
1. Contact Your Surgeon: Given the recent bleeding episodes, it is crucial to reach out to your surgeon or healthcare provider as soon as possible. They may want to examine you to ensure there are no complications, such as a hematoma (a localized collection of blood outside of blood vessels) or an infection.

2. Avoid Straining: To minimize the risk of further bleeding, it is essential to avoid straining during bowel movements. You can achieve this by maintaining a high-fiber diet, staying hydrated, and possibly using stool softeners as recommended by your doctor.

3. Sitz Baths: Continue to use sitz baths as they can help soothe the area and promote healing. Warm water can help relax the anal sphincter and reduce discomfort.

4. Follow-Up Appointments: Keep all follow-up appointments with your healthcare provider. They will monitor your healing process and can provide interventions if necessary.

5. Medication and Topical Treatments: If your doctor has prescribed any medications or topical treatments, such as ointments to help with healing and reduce discomfort, be sure to use them as directed.

6. Watch for Signs of Infection: Be vigilant for any signs of infection, such as increased redness, swelling, fever, or pus. If you notice any of these symptoms, seek medical attention immediately.

7. Rest and Recovery: Allow your body time to heal. Avoid heavy lifting or strenuous activities that could put pressure on the surgical site.

In terms of long-term recovery, most patients do well after hemorrhoid surgery, but it is essential to follow your doctor's advice closely. If bleeding persists or worsens, or if you experience severe pain, it is crucial to seek immediate medical attention.
In conclusion, while some bleeding can be expected after hemorrhoid surgery, significant or recurrent bleeding should be evaluated by a healthcare professional to rule out any complications. Your health and recovery are paramount, and open communication with your healthcare provider will help ensure the best possible outcome.

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