Post-Surgery Concerns: Managing Hemorrhoid Thrombosis and Recovery

Q: Post-Surgery Concerns: Managing Hemorrhoid Thrombosis and Recovery

Hello, Adu： Hemorrhoids are caused by the dilation of the venous plexus within the anal canal due to lifestyle habits and gravity, leading to the formation of protrusions from the surrounding connective tissue hyperplasia. <br>When blood accumulates in these normally dilated vess

Hemorrhoids

Hello Dr.
Wang, I had a thrombosed hemorrhoid removed yesterday, July 14th.
That evening, I took two sitz baths, and this morning, July 15th, I took one more.
However, I still feel a lump that is about the same hardness as before the removal, and the size of the lump seems slightly larger than it was prior to the procedure.
There is still a small amount of bleeding.
I’m unsure if this is normal because I went out shopping with friends the day after the surgery, and since the gauze I was using to stop the bleeding kept falling out, I didn’t replace it until I got home that evening to take a sitz bath.
I’m worried that this might have caused a new thrombosis.
Additionally, I would like to ask how many days it typically takes for the lump to resolve before I should come back for a follow-up appointment.
Since you have clinic hours on Sunday, I’m wondering if I should take a day off work to come in for a check-up if the lump is still present by Thursday.

A Du, 20~29 year old female. Ask Date: 2009/07/15

Dr. Wang Zhitang reply Surgery

Hello, Adu: Hemorrhoids are caused by the dilation of the venous plexus within the anal canal due to lifestyle habits and gravity, leading to the formation of protrusions from the surrounding connective tissue hyperplasia.
When blood accumulates in these normally dilated vessels, it can cause the hemorrhoids to enlarge (thus, staying up late, prolonged sitting, standing, or straining during bowel movements can exacerbate hemorrhoids).
Poor blood flow in the abnormal vessels within the hemorrhoids can lead to the formation of a thrombosis.
Once a thrombosis forms, the obstruction of blood flow in the vessel triggers an inflammatory response, causing swelling and pain in the affected area.

For acute management of thrombosed hemorrhoids, if there are no signs of necrosis (which typically occurs a few days after thrombosis), incision and drainage of the thrombosed hemorrhoid to remove the clot is recommended.
The incision is small, so suturing is not necessary; gentle pressure with gauze can help control bleeding, which usually does not continue, although some bleeding may occur during bowel movements.
Post-operative care for the anal area includes warm sitz baths.
Sitz baths not only maintain cleanliness but also help reduce pain, promote blood circulation around the anus, and accelerate wound healing.
It is generally recommended to take sitz baths at least three times a day, and to increase the frequency after bowel movements.
In some cases, the underlying causes of thrombosed hemorrhoids may not be resolved (as mentioned earlier), leading to the potential for reformation of the thrombosis after removal.
If surgical intervention is not pursued, the body will gradually resolve the thrombosis on its own, which may take about 2-4 weeks (depending on the size of the clot).
The difference between surgical and non-surgical approaches is that surgery can slow the progression of hemorrhoid enlargement.
Regarding the issue you raised, it appears that you may have developed another thrombosis after the initial removal.
Therefore, it is advisable to consider another thrombectomy.
In addition to regular sitz baths for care, it is important to reduce late-night activities and constipation, and to rest more at home.
This should lead to complete improvement within 1-2 weeks.

Reply Date: 2009/07/15

More Info

Post-surgery concerns regarding hemorrhoid thrombosis and recovery are common, especially after a procedure like the removal of a thrombosed hemorrhoid. It’s essential to understand what to expect during the recovery process and when to seek further medical attention.

Firstly, it’s not unusual to experience some swelling or hardness at the site of the surgery after the removal of a hemorrhoid thrombosis. The area may still feel firm and may even appear larger than before the procedure, especially if there was significant tissue manipulation during the surgery. This swelling can be due to inflammation as the body heals, and it may take several days to weeks for the area to return to its normal state.
The presence of a small amount of bleeding post-surgery can also be expected, particularly in the first few days following the procedure. However, if the bleeding is persistent or increases in volume, it could indicate a complication, such as a new thrombosis or inadequate healing. It’s crucial to monitor the bleeding and report any significant changes to your healthcare provider.

Regarding your concern about the potential for a new thrombosis due to not using sanitary pads while out, it’s important to maintain proper hygiene and care for the surgical site. Walking and being active are generally encouraged, but if you notice increased discomfort, swelling, or bleeding after activity, it may be wise to limit strenuous activities and ensure you are adequately protecting the area.

As for the duration of the swelling or hardness, if the lump does not begin to decrease in size within a few days, or if you experience increased pain or bleeding, it would be prudent to schedule a follow-up appointment. Given that you mentioned your doctor is available on Sunday, if the lump persists through Thursday and you have concerns, it would be advisable to take a sick day and consult with your physician. They can assess the area, determine if there are any complications, and provide guidance on further management.

In the meantime, continue with sitz baths as they can help soothe the area and promote healing. Keeping the area clean and dry is essential, and using over-the-counter pain relief, if needed, can help manage discomfort. Additionally, maintaining a high-fiber diet and staying hydrated can prevent constipation, which is crucial as straining during bowel movements can exacerbate hemorrhoid issues.

In summary, while some swelling and minor bleeding can be normal after hemorrhoid thrombosis surgery, it’s essential to monitor your symptoms closely. If you have any concerns about the size of the lump or the amount of bleeding, do not hesitate to reach out to your healthcare provider for further evaluation. Your recovery is important, and ensuring that everything is healing properly will help prevent future complications.

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