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

Difficult wound healing after hemorrhoid surgery?

Hello, Doctor: I developed a grade 3-4 mixed hemorrhoid last year, with some parts prolapsing outside the anus.
Therefore, on March 8 of this year, I underwent laser hemorrhoid ablation combined with partial excision.
Nearly two months have passed since the procedure, and the wound has not fully 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 a mixture of tissue fluid and 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 indicated that the wound is clean and not infected, but the tissue is not regenerating.

Although I take warm sitz baths for five minutes after each bowel movement, I start to feel a swollen, itchy, and prickly sensation in the anus afterward, which lasts for most of the morning.
Additionally, I have noticed a discharge resembling pus that decreases over time until it gradually stops by evening, but this situation recurs with each 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, leading to a sensation of tightness at the anal opening each time I sit on the toilet, which was not present before the surgery.
Initially after the surgery, I could feel stitches in that 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 appear.
My mixed hemorrhoid is located on the right side of the anus, and post-surgery, there is a possibly excess tissue on the left side that does not hurt when touched.
It normally presses against the wound; could this affect the healing of the wound? Thank you.

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

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 according to 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: 2024/05/05

More Info

After undergoing hemorrhoid surgery, particularly a laser hemorrhoidectomy combined with partial excision, it is not uncommon for patients to experience a range of challenges during the healing process. Your description of ongoing pain, discharge, and the sensation of tightness around the anal area indicates that you are facing some typical post-operative complications, which can be frustrating and concerning.

Firstly, it is important to understand that healing from such surgeries can take time, and the recovery process can vary significantly from one individual to another. The pain you experience during bowel movements is likely due to the trauma inflicted on the tissues during surgery, especially if the area is still sensitive or inflamed. The presence of tissue fluid mixed with a slight pinkish discharge is not uncommon in the early stages of healing, but it should be monitored closely to ensure it does not develop into an infection.

The tightness and discomfort you feel, particularly if it is accompanied by a sensation of pulling or stretching, could be attributed to several factors. One possibility is that the surgical site has developed scar tissue, which can sometimes lead to a feeling of constriction. Additionally, if there was significant tissue removal during the procedure, it could result in changes to the anatomy of the anal canal, potentially leading to a condition known as anal stenosis, where the anal opening becomes narrowed. This can cause discomfort and pain during bowel movements.

Regarding the presence of what you describe as "excess skin" on the left side of the anus, it is possible that this could be a result of the surgical procedure. Sometimes, the healing process can lead to the formation of excess tissue, which might not be painful but could affect the overall healing of the surgical site. If this tissue is pressing against the area where the surgery was performed, it could potentially impede proper healing.

To address your concerns, here are some recommendations:
1. Follow-Up with Your Surgeon: It is crucial to maintain open communication with your surgeon. If you feel that your symptoms are not improving or are worsening, do not hesitate to seek a follow-up appointment. Your surgeon may want to examine the area to rule out any complications such as infection or improper healing.

2. Pain Management: Continue to manage your pain with over-the-counter pain relievers as recommended by your healthcare provider. If the pain is severe, your doctor may prescribe stronger medications.

3. Sitz Baths: You mentioned using sitz baths, which can be beneficial for soothing the area and promoting blood flow to aid healing. Ensure that the water is warm but not hot, and consider doing this several times a day, especially after bowel movements.

4. Dietary Adjustments: To ease bowel movements and reduce strain, maintain a high-fiber diet and stay well-hydrated. This can help prevent constipation, which can exacerbate pain during bowel movements.

5. Gentle Massage: While you have attempted to massage the area, be cautious. If it causes bleeding, it may be best to avoid this until you have further guidance from your healthcare provider.

6. Consider Physical Therapy: In some cases, pelvic floor physical therapy can help alleviate tightness and improve function in the anal area. A specialized therapist can provide exercises and techniques to help with relaxation and healing.

7. Monitor Symptoms: Keep a close eye on your symptoms. If you notice increased pain, significant changes in discharge, or any signs of infection (such as fever or increased redness), seek medical attention promptly.

In conclusion, while it is normal to experience some discomfort and challenges after hemorrhoid surgery, persistent issues warrant further evaluation. Your healthcare provider can offer tailored advice and interventions to help facilitate your recovery and address any complications you may be facing.

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