Recurring Hemorrhoids: When Surgery is Necessary

Q: Recurring Hemorrhoids: When Surgery is Necessary

Hello Qianqian：<br>In response to your questions：<br>1. <br>After hemorrhoid surgery, there is a possibility of recurrence in 10 to 20 years. <br>As long as the first surgery did not cause damage to the sphincter muscle, a second surgery is unlikely to result in anal sphincter dy

Hemorrhoid issues

Hello, Dr.
Ko: Thank you for your response.
I have some additional questions to ask.
My situation is that I had hemorrhoid surgery 10 years ago, and in mid-March, the hemorrhoids recurred.
I applied topical medication and used suppositories for a while, but there was no improvement.
I experienced swelling and pain for more than half a day each time I had a bowel movement.
When I visited the clinic, the doctor mentioned that my anal canal could only accommodate one finger's width, suggesting that my anal canal is too narrow and recommended that I undergo surgery at a larger hospital, providing me with a referral.
Last Thursday, after an internal examination at the larger hospital, the doctor indicated that I have anal stenosis and external hemorrhoids, necessitating surgery.
However, I was in significant pain at the time and did not ask for detailed information.
The next day after returning home, I found that I did not experience much pain during my bowel movement, and after 3-4 days, it was not too painful and healed quickly.

1.
Given that I had hemorrhoid surgery 10 years ago, will undergoing another surgery now lead to issues with anal stenosis?
2.
If I can recover with topical medication as I am currently doing, is surgery still necessary?
3.
If I choose not to have surgery now, will I likely need surgery again as I age due to recurrent issues?
4.
The clinic doctor mentioned that anal stenosis and chronic inflammation of hemorrhoids could increase the risk of colorectal cancer.
Is this true?

Qianqian, 50~59 year old female. Ask Date: 2010/05/17

Dr. Ke Fangxu reply Surgery

Hello Qianqian:
In response to your questions:
1.
After hemorrhoid surgery, there is a possibility of recurrence in 10 to 20 years.
As long as the first surgery did not cause damage to the sphincter muscle, a second surgery is unlikely to result in anal sphincter dysfunction.
2.
I generally do not recommend surgery for asymptomatic hemorrhoids.
If topical medications are effective, it may be worthwhile to observe for a while.
If symptoms recur, then considering surgery would not be too late.
3.
There is indeed a possibility, but it depends on your personal choices and the extent of your symptoms.
4.
This claim does not have medical evidence to support it.
While it may sound reasonable at first glance, it does not mean it will occur.
Generally, there is no correlation between colorectal cancer and inflamed hemorrhoids, unless it is caused by specific types of autoimmune diseases leading to ulcerative colitis.
Otherwise, with the saying "nine out of ten men have hemorrhoids," wouldn't that imply that 90% of men would also develop colorectal cancer?

Reply Date: 2010/05/17

More Info

Understanding recurring hemorrhoids and the necessity for surgery can be quite complex, especially for patients who have previously undergone surgical procedures. Your situation, having had hemorrhoid surgery a decade ago and now experiencing a recurrence, raises several important considerations.

1. Risk of Anal Stricture: After any surgical intervention, including hemorrhoidectomy, there is a potential risk of developing anal stricture, which is a narrowing of the anal canal. This can lead to difficulties in bowel movements and increased pain. However, the likelihood of this occurring depends on various factors, including the surgical technique used, the extent of tissue removal, and individual healing responses. If you have been advised that your anal canal is narrow, this could indeed be a contributing factor to your recurring symptoms. It’s essential to discuss this concern with your surgeon, who can provide insights based on your specific surgical history and current examination findings.

2. Current Management with Medications: If topical treatments and suppositories are providing relief and your symptoms have improved significantly, it may lead to the question of whether surgery is necessary at this moment. While conservative management can be effective for some patients, it’s important to recognize that this may only provide temporary relief. If the underlying issues, such as the presence of external hemorrhoids or anal stricture, are not addressed, symptoms may recur. If your quality of life is affected, or if you experience significant pain or complications, surgical intervention may still be warranted.

3. Future Considerations: If you choose not to undergo surgery now and your symptoms improve, it’s still possible that you may experience flare-ups in the future, especially as you age. Chronic inflammation and recurrent hemorrhoids can lead to complications, including the need for surgery later on. Regular follow-ups with your healthcare provider can help monitor your condition and determine the best course of action as your situation evolves.

4. Concerns about Cancer Risk: The concern regarding chronic inflammation from hemorrhoids leading to colorectal cancer is a valid one. While hemorrhoids themselves do not cause cancer, chronic irritation and inflammation in the anal region can lead to changes in the tissue that may increase cancer risk over time. It’s crucial to maintain regular screenings, especially if you have a history of significant symptoms or changes in bowel habits. Your healthcare provider may recommend a colonoscopy to rule out any serious conditions, particularly if you have persistent symptoms.

In conclusion, while your current improvement is encouraging, it’s essential to weigh the benefits of surgical intervention against the risks of ongoing conservative management. Engaging in a thorough discussion with your healthcare provider about your symptoms, treatment options, and potential risks will help you make an informed decision. Regular monitoring and follow-up care are vital to managing your condition effectively and ensuring that any potential complications are addressed promptly.

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