Post-Operative Concerns After Thrombosed External Hemorrhoid Surgery

What are the issues after outpatient surgery for thrombosed external hemorrhoids?

Hello, doctor.
I would like to ask: Yesterday, I visited a colorectal specialist at a certain hospital, and the doctor diagnosed me with a thrombosed external hemorrhoid, suggesting that it could be treated with an outpatient procedure.
I believe the doctor would first incise it and then drain it.
However, the doctor mentioned that since it is quite large (I estimate it to be nearly 2 centimeters), it might recur after draining the external hemorrhoid.
Indeed, after the outpatient procedure yesterday morning, it reappeared in the afternoon.
This morning, I went to have it drained again, and it reappeared in the afternoon! Why is this happening? I would like to ask:
1.
After the outpatient procedure to drain the thrombosed external hemorrhoid, I had gauze packed for hemostasis.
Should I be standing or sitting at this time? Is it possible that sitting after the procedure caused it to reappear?
2.
Should I go for another drainage?
3.
Can this procedure be done under local anesthesia? Because the incision and drainage are quite painful.

4.
After the procedure, I experienced slight bleeding throughout the day.
How many days of slight bleeding is considered excessive, and when should I see a doctor again?
5.
If I choose to leave it alone and wait for it to resolve on its own, will there be any lasting effects since it is quite large?
6.
Since the wound has gauze packed for hemostasis, should I try to sit as little as possible or stand as much as possible?
7.
Are over-the-counter hemorrhoid cushions effective? If I buy one, should I only use it after the surgery, or can I use it regularly?
8.
Are there any other methods available? I appreciate your time in answering my questions.
Thank you.

Niming, 40~49 year old female. Ask Date: 2024/07/23

Dr. Zhang Shuhao reply Surgery

1.
If a thrombosed external hemorrhoid is only incised to evacuate the clot, the hemorrhoidal tissue will still become inflamed and swollen.
Gauze can be used to apply pressure to prevent further bleeding, but it does not help reduce swelling.
Whether standing or sitting has little impact.

2.
If symptoms persist after the incision, it indicates that the discomfort is not solely due to the thrombosis, and additional treatment methods may be necessary.

3.
Local anesthesia can be used, but after evacuation, the wound is usually left open to allow for drainage of blood and fluid, and there is no need for re-incision in the short term.

4.
Typically, bleeding will not occur after about three days.
If there are concerns, a follow-up examination is necessary.

5.
Continuing sitz baths and medication may help reduce swelling; however, the remaining issue is the hemorrhoidal tissue, which requires surgical intervention for resolution.

6.
The wound may be packed with gauze to control bleeding, and avoiding vigorous activities is sufficient; normal daily activities should not be affected.

7.
Over-the-counter hemorrhoid cushions can alleviate irritation to the hemorrhoids but do not provide therapeutic effects.

8.
If hemorrhoids frequently recur and affect quality of life, surgical treatment should be considered.

Reply Date: 2024/07/23

More Info

Post-operative concerns after thrombosed external hemorrhoid surgery can be quite common, and it’s important to address them thoroughly to ensure proper healing and minimize complications. Here are the answers to your questions based on medical knowledge and practices:
1. Positioning After Surgery: After the procedure, it is generally recommended to avoid prolonged sitting, as this can increase pressure on the surgical site and potentially lead to further complications, such as the recurrence of the thrombosed hemorrhoid. Standing or lying down may be more comfortable and can help reduce swelling and discomfort. If you must sit, consider using a cushion or a specialized hemorrhoid pillow to alleviate pressure on the area.

2. Recurrent Thrombosis: It is not uncommon for a thrombosed external hemorrhoid to recur, especially if the initial thrombosis was significant. If you find that the hemorrhoid continues to reappear after multiple attempts to relieve it, it may be beneficial to consult your doctor again. They may suggest a more definitive surgical approach or other treatments to prevent recurrence.

3. Anesthesia Options: Yes, local anesthesia is typically used for this type of procedure. If you experienced significant pain during the initial procedure, it’s important to communicate this to your healthcare provider. They can ensure that adequate anesthesia is administered for any future procedures.

4. Post-operative Bleeding: A small amount of bleeding can be normal after surgery, especially if there is a dressing in place. However, if you experience bleeding that is more than a few drops or lasts longer than a few days, you should contact your doctor. Continuous bleeding may indicate that the site is not healing properly or that there is a complication.

5. Choosing Not to Treat: If you decide to leave the thrombosed hemorrhoid untreated, it may eventually resolve on its own, but there is a risk of it becoming more painful or leading to other complications, such as infection or chronic discomfort. Large hemorrhoids can also lead to skin tags or other issues if not addressed.

6. Activity Level: After surgery, it is advisable to limit activities that put pressure on the surgical site. While standing is generally better than sitting, you should also avoid heavy lifting or strenuous activities until you have fully healed. Follow your doctor’s advice regarding activity levels.

7. Use of Cushions: Hemorrhoid cushions can be beneficial both post-operatively and for general comfort if you suffer from hemorrhoids. They help to relieve pressure on the affected area and can be used during recovery as well as in everyday life to prevent discomfort.

8. Additional Methods: Other methods to manage discomfort and promote healing include taking warm sitz baths, using topical treatments prescribed by your doctor, and maintaining a high-fiber diet to prevent constipation. Staying hydrated and avoiding straining during bowel movements can also help reduce the risk of future hemorrhoids.

In summary, it’s crucial to monitor your symptoms closely after surgery. If you have concerns about bleeding, pain, or recurrence of the hemorrhoid, do not hesitate to reach out to your healthcare provider for further evaluation and management. Proper follow-up care is essential for a successful recovery and to prevent complications.

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