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 some parts prolapsing outside the anus.
On March 8 of this year, I underwent laser hemorrhoidectomy 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 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 not infected, but the tissue is not regenerating.
Although I take warm sitz baths for five minutes after each bowel movement, I begin to feel a swelling, itching, and prickling sensation in the anus, likely due to excessive stretching, which lasts for most of the morning.
Additionally, I have noticed a discharge resembling pus that decreases over time until it gradually stops by the 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, 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 affect the healing of the wound? Thank you.

Miss Lin, 30~39 year old female. Ask Date: 2024/05/06

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 two months post-surgery.
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, anal stenosis will not result.
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: 2024/05/06

More Info

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

Firstly, it is important to understand that healing after such a procedure can vary significantly from person to person. Factors such as the extent of the surgery, individual healing capacity, and adherence to postoperative care can all influence recovery. The presence of pain during bowel movements, especially when the wound is still healing, is a common complaint. This discomfort can be exacerbated by the stretching of the anal tissues during defecation, which may lead to a fear of bowel movements, further complicating the healing process.

The discharge you are experiencing, which includes a mixture of tissue fluid and a small amount of blood, can be a normal part of the healing process, especially in the early stages. However, if the discharge is persistent or accompanied by increased pain, it could indicate issues such as inflammation or the formation of a seroma (a pocket of clear fluid) at the surgical site. It is reassuring to hear that your surgeon has assessed the wound and found no signs of infection, but continued monitoring is essential.

The tightness and discomfort you feel in the anal area could be attributed to several factors. One possibility is that the surgical site has resulted in some degree of scarring or fibrosis, which can lead to a sensation of tightness. 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 feeling of constriction. This tightness can also contribute to discomfort during bowel movements.

Regarding the potential for anal stenosis (narrowing of the anal canal), it is a possibility if excessive tissue was removed or if the sutures are causing tightness. If you suspect that the tightness is due to scarring or excessive skin removal, it is crucial to discuss this with your surgeon. They may recommend interventions such as anal dilation or, in some cases, further surgical evaluation.

The presence of what you describe as "excess skin" on the left side of the anus may also play a role in your healing. If this tissue is pressing against the surgical site, it could potentially interfere with the healing process. It is advisable to have this evaluated by your surgeon, who can determine if any intervention is necessary.

In terms of management, here are some recommendations that may help facilitate healing and alleviate discomfort:
1. Warm Sitz Baths: Continue with warm sitz baths after bowel movements to promote relaxation of the anal sphincter and improve blood flow to the area, which can aid in healing.

2. Dietary Adjustments: Ensure you are consuming a high-fiber diet and staying well-hydrated to prevent constipation and minimize straining during bowel movements.

3. Topical Treatments: While you have mentioned using ointments, consider discussing with your doctor the possibility of using a topical anesthetic or steroid cream to reduce inflammation and pain.

4. Gentle Massage: If you are comfortable, gentle massage around the anal area may help alleviate tightness, but be cautious to avoid causing additional bleeding.

5. Follow-Up Care: Regular follow-up appointments with your surgeon are crucial. They can monitor your healing progress and intervene if necessary.

6. Physical Therapy: In some cases, pelvic floor physical therapy may be beneficial to address tightness and improve function.

In conclusion, while postoperative challenges are common, persistent symptoms warrant thorough evaluation and management. Open communication with your healthcare provider is essential to ensure that your recovery proceeds as smoothly as possible. If you have any concerns about your healing process or if symptoms worsen, do not hesitate to seek further medical advice.

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