Challenges in Healing After Hemorrhoid Surgery: A Patient's Experience

Difficult wound healing after hemorrhoid surgery?

Hello Doctor: I developed a grade 3-4 mixed hemorrhoid last year, with part of it prolapsing outside the anus.
Therefore, on March 8 of this year, I underwent laser hemorrhoid ablation combined with partial excision.
It has been nearly two months since the procedure, and the wound has not completely healed.
Every morning during bowel movements, I experience pain as the anus stretches over the wound.
After wiping, I notice that the toilet paper is damp, appearing to have tissue fluid mixed with a little light pink blood.
Neither the application of topical ointments nor hemorrhoid creams has improved the situation.
I consulted the surgeon who performed the operation, and he stated that the wound is clean and there is no infection, but the tissue is not regenerating.
Although I take warm sitz baths for five minutes after each bowel movement, I begin to feel a swollen, itchy, and prickly sensation in the anus due to excessive stretching, which lasts for about the entire morning.
Additionally, I have noticed a discharge resembling pus, which decreases over time until it gradually stops by the evening, but this situation recurs every time I have a bowel movement the next day.

Another issue is that the area below the anal dentate line feels very tight; it even feels like the tissue is being pulled tightly when I touch it, causing a sensation of tightness at the anal opening each time I sit on the toilet, which was not present before the surgery.
Immediately after the surgery, I could feel stitches in this area.
Is it possible that excessive skin excision or the stitches could have caused anal stenosis? Although I have tried massaging around the anal opening, applying even slight pressure can cause a small amount of light pink blood to emerge.
My mixed hemorrhoid is located on the right side of the anus, and post-surgery, there is a portion on the left side that feels like excess tissue, which does not hurt and normally presses against the wound.
Could this potentially affect the healing of the wound? Thank you.

Miss Lin, 30~39 year old female. Ask Date: 2024/05/04

Dr. Zhang Shuhao reply Surgery

The recovery speed of hemorrhoid surgery wounds is related to the severity of the original hemorrhoids, the surgical method, the extent of the surgery, postoperative care, and individual constitution.
Occasionally, there are cases where complete recovery has not occurred even after two months.
Discharge resembling pus is generally tissue fluid; as long as there is no infection or abscess upon outpatient examination, it can be monitored.
If the surgical excision is extensive, a feeling of tightness may occur, but if the anal sphincter is not affected, it will not lead to anal stenosis.
Skin tags around the anus will not impact wound healing.
Postoperative care should be adjusted based on individual circumstances, and it is recommended to have regular follow-up visits to assess the wound and continue treatment as directed by the surgeon.

Reply Date: 2024/05/04

More Info

After undergoing hemorrhoid surgery, particularly a laser procedure for mixed hemorrhoids, patients can experience a range of challenges during the healing process. Your description of ongoing pain, discharge, and the sensation of tightness in the anal area is not uncommon, and it raises several important considerations regarding post-operative recovery.

Firstly, it is essential to understand that healing after hemorrhoid surgery can vary significantly from person to person. Factors such as the extent of the surgery, the individual's overall health, and adherence to post-operative care can all influence recovery time. In your case, the presence of pain during bowel movements and the discharge of serous fluid mixed with a slight pinkish hue may indicate that while the surgical site is not infected, it is still in the process of healing.

The sensation of tightness and discomfort you describe could be attributed to several factors. One possibility is that the surgical site has developed scar tissue, which can create a feeling of tightness or constriction. Additionally, if there was significant tissue removal during the procedure, it might lead to changes in the anatomy of the anal canal, potentially causing a sensation of narrowing or tightness. This can sometimes result in a condition known as anal stenosis, where the anal canal becomes narrower, leading to discomfort during bowel movements.

The fact that you are experiencing a discharge that appears to be a mix of tissue fluid and blood is also noteworthy. While it is good that your surgeon has confirmed there is no infection, the presence of ongoing discharge can be a sign that the tissue is still healing. It is crucial to continue monitoring this discharge; if it changes in color, consistency, or odor, or if you develop a fever, you should contact your healthcare provider immediately.

Regarding the use of sitz baths, they are generally recommended to promote healing and provide relief from discomfort. However, if you are noticing increased swelling and irritation after bathing, it may be beneficial to adjust the frequency or duration of these baths. Additionally, ensuring that you are maintaining a soft stool consistency through diet and hydration can help minimize pain during bowel movements, which is critical for healing.

The presence of what you describe as "excess skin" or a "tag" on the left side of the anus could potentially interfere with the healing process if it is causing friction or pressure on the surgical site. While these tags are often benign, if they are causing discomfort or affecting your recovery, it may be worth discussing with your surgeon whether any further intervention is necessary.

In terms of management, here are some recommendations:
1. Follow-Up Care: Regular follow-ups with your surgeon are essential. They can assess the healing process and determine if any additional treatments are necessary.

2. Pain Management: Continue to manage pain with prescribed medications or over-the-counter pain relievers as advised by your doctor. Avoiding constipation is crucial, as straining can exacerbate pain and hinder healing.

3. Diet and Hydration: Focus on a high-fiber diet and adequate hydration to ensure soft stools, which can help reduce pain during bowel movements.

4. Gentle Care: Be gentle when cleaning the area and avoid any harsh soaps or scrubs. Patting dry rather than wiping can help minimize irritation.

5. Physical Activity: Engage in light physical activity as tolerated, as this can promote circulation and aid in healing.

6. Avoid Straining: If you feel the urge to strain during bowel movements, consider using a stool softener or laxative as recommended by your healthcare provider.

7. Monitor Symptoms: Keep a close eye on your symptoms. If you notice any significant changes, such as increased pain, changes in discharge, or new symptoms, contact your healthcare provider promptly.

In conclusion, while the healing process after hemorrhoid surgery can be challenging, with appropriate care and monitoring, many patients do see improvement over time. It is essential to maintain open communication with your healthcare provider to address any concerns and ensure a smooth recovery.

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