Post-Surgery Complications: Managing Wound Healing After Hemorrhoid Surgery

Postoperative wounds from hemorrhoid surgery?

Hello Doctor: Almost three months ago, I underwent laser surgery for hemorrhoids, as the hemorrhoids had prolapsed outside the anus, and the doctor also excised the prolapsed portion.
However, I feel that the wound has not fully healed, as I experience a light yellow tissue fluid leaking from my anus after each bowel movement.
I place a 3x3 gauze pad at the anal opening, and within about an hour, three-quarters of the gauze is saturated with this fluid.
After some time, I start to feel tightness and discomfort in the anal area, and during contractions, there is even a slight irritation, at which point a purulent-like discharge appears at the anal opening.
It does not have an odor, so I believe it is not an infection; this purulent fluid tends to persist for about 3 to 4 hours before it diminishes.
When I insert a finger into the anus, I can feel a wound that resembles a fan shape, approximately 0.3 to 0.5 cm wide, and I am unsure if this is the excised wound.
After observing it for about two weeks, I feel that it has not closed up.
I consulted my attending physician, who also believes that the wound healing is too slow.
During the hemorrhoid surgery, I was also undergoing targeted cancer therapy every three weeks (which concluded in mid-April), and I am uncertain if this has affected the healing process.
Currently, my attending physician suspects that unhealthy skin may be causing the slow healing and has suggested two treatment options: 1.
Purchase a hydrocolloid dressing out of pocket, or 2.
Debridement to promote skin regeneration.
Since the wound is located at the anus, can hydrocolloid dressings be used on uneven skin? Or is direct debridement necessary? However, I am concerned about enduring more pain for another month.
I would appreciate your advice.
Thank you very much for taking the time to respond amidst your busy schedule.

Miss Yang, 30~39 year old female. Ask Date: 2024/05/29

Dr. Zhang Shuhao reply Surgery

If there is a fan-shaped wound, it indicates that the anally internal mucosal sutures have not healed and are in an open state.
This is a common postoperative condition; as long as the wound is kept clean and not overly stimulated, it will gradually heal over time.
The symptoms you described are related to the wound not yet healing, and in some cases, it may take four to six weeks for complete healing.
During this period, follow your physician's instructions for dressing changes and regular follow-up appointments.
It is unclear what type of targeted therapy is being referred to, but the impact of targeted therapy is not as significant as that of chemotherapy.
Self-paid dressings usually contain some antibacterial and growth-promoting components, which can be used.
Short-term reoperation may sometimes increase the risk of inadequate anal mucosa, excessive suturing, or sphincter injury, and should be carefully evaluated by a physician before proceeding.

Reply Date: 2024/05/29

More Info

Post-surgery complications, particularly after hemorrhoid surgery, can be quite challenging and may lead to prolonged discomfort and healing issues. In your case, it seems that you are experiencing a delayed healing process characterized by the discharge of serous fluid and some discomfort around the surgical site. Let's address your concerns systematically.

Firstly, the presence of a yellowish discharge after bowel movements is not uncommon following hemorrhoid surgery, especially if there was a significant amount of tissue removed. This discharge can be a combination of lymphatic fluid and some serous exudate from the healing tissue. The fact that it is not foul-smelling is a good sign, as it suggests that there is no active infection. However, persistent discharge and discomfort warrant further evaluation.

The sensation of tightness and discomfort during bowel movements can be attributed to the healing process of the anal sphincter and surrounding tissues. After surgery, the area can be sensitive, and the healing tissues may react to the pressure and movement associated with bowel movements. It is essential to maintain soft stools to minimize straining, which can exacerbate discomfort and delay healing.

Regarding the wound itself, the size and shape you describe (0.3-0.5 cm, fan-shaped) could indeed correspond to the surgical site where tissue was excised. If the wound appears to be open or not healing as expected, it may require intervention. Your surgeon's suggestion of using a water-based dressing is valid, as these dressings can provide a moist environment that promotes healing, especially in irregularly shaped wounds. They can also help protect the area from further irritation.

On the other hand, if your surgeon is recommending debridement (cleaning the wound), this might be necessary if there is necrotic tissue or if the wound is not healing properly. While this procedure may cause temporary discomfort, it can facilitate better healing by allowing healthy tissue to regenerate.
Given that you have undergone cancer-targeted therapy, it is essential to consider that such treatments can sometimes impact wound healing due to their effects on the immune system and tissue regeneration. Discussing this with your healthcare provider is crucial, as they can assess whether your healing issues are related to your recent treatments.

In terms of your options, here are some recommendations:
1. Water-based Dressings: If you choose to use water-based dressings, ensure they are applied correctly and changed regularly to maintain a clean environment. These dressings can be beneficial for irregular wounds and may help reduce discomfort.

2. Debridement: If your surgeon believes that debridement is necessary, it may be worth considering, especially if the wound is not showing signs of improvement. While it may be uncomfortable initially, it could lead to better healing in the long run.

3. Follow-Up Care: Regular follow-up appointments with your surgeon are essential to monitor the healing process. If you notice any changes, such as increased redness, swelling, or foul-smelling discharge, contact your healthcare provider immediately.

4. Pain Management: Discuss pain management strategies with your doctor, especially if you anticipate discomfort from any procedures. They may recommend medications or topical treatments to help alleviate pain.

5. Dietary Considerations: Maintain a high-fiber diet and stay hydrated to promote soft stools, which can help reduce strain during bowel movements.

In conclusion, while the healing process can be slow and frustrating, it is essential to work closely with your healthcare provider to determine the best course of action. Whether that involves using specialized dressings or considering debridement, your comfort and recovery should be the priority. Always feel free to ask questions and express your concerns during follow-up visits to ensure you receive the best care possible.

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