Post-Surgery Complications: Managing Pain, Bleeding, and Swelling After Circumferential Resection

Q: Post-Surgery Complications: Managing Pain, Bleeding, and Swelling After Circumferential Resection

Hello： In response to your question, complications arising from circumferential resection can often be quite troublesome and difficult to manage. <br>Postoperative pain may be related to insufficient depth of the circumferential resection, which can lead to subsequent swelling an

Post-operative hematoma and swelling after circumferential resection?

Hello Dr.
Ke,
I underwent a circumferential resection surgery at Renai Hospital in Taipei on December 12, 2006.
Since the surgery, I have been experiencing severe pain on the left side of my anus.
On the tenth day post-surgery, December 22, 2006, I experienced bleeding and was unable to have a bowel movement.
There are several growths located around the left side of my anus.
Initially, I went to the emergency department at Renai Hospital, but the physician there was not a colorectal surgeon.
They insisted on administering a rectal suppository, which caused me excruciating pain, and they told me that the swelling would subside in half an hour.

Two days later, the surgeon who performed my operation finally had an outpatient appointment.
Upon examination, he advised against using the suppository, as it could cause the wound to reopen.
He explained that the bleeding was due to the dislodgment of the sutures securing the wound, which caused the rectal mucosa to protrude outside the anus, and that it would take three months for the swelling to subside.
Regarding bowel movements, he suggested that I could try to pass stool slowly in water.

In the weeks following the bleeding, I visited the doctor weekly for check-ups.
This past Monday, January 25, 2007, during my latest examination, the doctor mentioned that the swelling was reducing slowly.
Currently, I am troubled by the fact that the bleeding has persisted for over a month, the lump has reduced by about one-third, but I still notice blood streaks during bowel movements, along with a few drops of blood, and I continue to experience pain.

Is it possible that the swelling caused by post-surgical bleeding may not completely resolve? If so, how can I prevent this? The medications prescribed by my doctor include oral pain relievers and stool softeners (the doctor has advised that I can stop taking them unless I have difficulty with bowel movements, and I have currently stopped the medication).
The topical medication I am using is "Power Proctol Cream." Are there any better options available?
Additionally, are there any specific lifestyle or dietary considerations I should be aware of? I would greatly appreciate your guidance, as I have already taken over a month off work, which has severely impacted my life.
Thank you for your assistance.

aero, 30~39 year old female. Ask Date: 2007/01/24

Dr. Ke Fangxu reply Surgery

Hello: In response to your question, complications arising from circumferential resection can often be quite troublesome and difficult to manage.
Postoperative pain may be related to insufficient depth of the circumferential resection, which can lead to subsequent swelling and bleeding.
Traditional surgeries typically use absorbable sutures, which can help alleviate pain, whereas circumferential resection employs non-absorbable metal staples, so unless the staples fall out, improvement may be limited.
For postoperative bleeding, reoperation may be considered to suture the bleeding site for hemostasis.
If surgical intervention is not an option, then current treatment should be maintained.
In daily life, it is advisable to avoid spicy and irritating foods and to maintain a regular routine.
Constipation should be strictly avoided.

Reply Date: 2007/01/24

More Info

Post-surgery complications can be quite challenging, especially after a circumferential resection. Your experience with persistent pain, bleeding, and swelling is not uncommon, but it does require careful management and monitoring.
Firstly, it is essential to understand that after any surgical procedure, especially one involving the rectal area, patients may experience a range of symptoms as the body heals. Pain is often a significant concern, and it can be exacerbated by factors such as inflammation, infection, or even the healing process itself. In your case, the pain on the left side of the anus and the presence of growths (which you referred to as "肉瘤") could indicate a few possibilities, including scar tissue formation or even a potential complication related to the surgical site.

The bleeding you experienced on the tenth day post-surgery is also concerning. While some bleeding can be expected after such procedures, especially if there are issues with sutures or staples, persistent bleeding is not normal and should be evaluated by your surgeon. The fact that your doctor mentioned that the sutures may have come loose and that the rectal mucosa is protruding suggests that there may be a need for further intervention or at least close monitoring to prevent further complications.

Regarding your question about whether the swelling will completely resolve, it is possible that some residual swelling may persist, especially if there has been significant trauma to the area or if there are ongoing issues with healing. The body often takes time to reabsorb any hematomas or fluid collections, and this process can vary from person to person. To aid in recovery, it is crucial to follow your doctor's advice regarding activity levels, bowel movements, and any prescribed medications.

In terms of medication, while "強力保士德痔膏" may provide some relief, it is essential to discuss with your physician if there are alternative treatments that might be more effective for your specific situation. Sometimes, topical treatments may not be sufficient if there is significant underlying inflammation or if there are other complications at play.

For lifestyle and dietary considerations, it is advisable to focus on a high-fiber diet to promote regular bowel movements and prevent straining, which can exacerbate pain and bleeding. Staying well-hydrated is also crucial. If you are experiencing pain during bowel movements, consider using a stool softener or a gentle laxative as recommended by your doctor to ease the process.

Additionally, you should avoid any activities that could put strain on the surgical site, such as heavy lifting or vigorous exercise, until you have fully healed. Regular follow-up appointments with your surgeon are vital to monitor your recovery and address any concerns promptly.

In summary, while your symptoms are concerning, they are not uncommon after such a procedure. It is crucial to maintain open communication with your healthcare provider, adhere to their recommendations, and seek further evaluation if your symptoms do not improve or worsen. Your recovery is paramount, and addressing these issues early can help prevent more severe complications down the line.

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