Difficult wound healing after hemorrhoid surgery?
Hello Doctor: I developed a grade 3-4 mixed hemorrhoid last year, with some parts protruding 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 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 start to feel a swollen, itchy, and prickly sensation in the anus due to excessive stretching, which lasts for most of the morning.
Additionally, I notice 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, and 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 felt 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 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 of my anus 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: 2024/05/07
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 postoperative complications, which can be distressing and uncomfortable.
Firstly, the pain you experience during bowel movements is likely due to the trauma inflicted on the tissues during surgery. Even though the surgeon has confirmed that the wound is clean and free from infection, pain can persist for several reasons. The surgical site may still be inflamed, and the nerves in the area can be hypersensitive as they heal. The presence of tissue fluid and light pink blood on the toilet paper suggests that there may still be some healing occurring, and this can be exacerbated by the mechanical stress of passing stool.
The sensation of tightness and discomfort you describe, especially if it feels like the skin is being pulled, could be related to a few factors. One possibility is that the surgical site has resulted in scar tissue formation, which can lead to a feeling of tightness or constriction. Additionally, if there was significant tissue removal, it could lead to changes in the anatomy of the anal canal, potentially causing a degree of narrowing or tightness, which may contribute to your discomfort.
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 removal of hemorrhoids can lead to changes in the surrounding tissue, and what you are feeling may be a normal part of the healing process. However, if this tissue is pressing against the surgical site and causing discomfort, it could potentially impede healing.
To address your concerns, here are several recommendations:
1. Follow-Up with Your Surgeon: It is crucial to maintain communication with your surgeon or healthcare provider. If you feel that your symptoms are worsening or not improving, a follow-up appointment may be necessary to reassess the surgical site and ensure that there are no complications such as strictures or excessive scar tissue.
2. Pain Management: If you are experiencing significant pain, discuss pain management options with your healthcare provider. They may recommend over-the-counter pain relievers or prescribe medications to help manage your discomfort.
3. Dietary Adjustments: To ease bowel movements and reduce strain, consider increasing your fiber intake and ensuring adequate hydration. This can help soften stools and make bowel movements less painful.
4. Sitz Baths: Continuing with warm sitz baths can help soothe the area and promote blood flow, which may aid in healing. However, if you notice increased discomfort after these baths, it may be worth discussing this with your doctor.
5. Gentle Massage: While you mentioned trying to massage the area, be cautious with this approach. If it causes bleeding or significant discomfort, it may be best to avoid it until you have consulted with your healthcare provider.
6. Physical Therapy: In some cases, pelvic floor physical therapy can be beneficial for patients experiencing tightness or discomfort in the anal region. A specialized therapist can provide techniques to help relax the muscles and improve healing.
7. Monitoring for Infection: Keep an eye on any signs of infection, such as increased redness, swelling, or discharge that changes in color or odor. If you notice any of these symptoms, contact your healthcare provider immediately.
In conclusion, while healing after hemorrhoid surgery can be challenging, it is important to stay proactive about your recovery. Regular follow-ups with your healthcare provider, along with appropriate pain management and dietary adjustments, can significantly improve your healing experience. If symptoms persist or worsen, do not hesitate to seek further evaluation to ensure that you are on the right path to recovery.
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