Post-Surgery Care: Managing Bowel Issues After Hemorrhoid Surgery

Q: Post-Surgery Care: Managing Bowel Issues After Hemorrhoid Surgery

Hello： In response to your questions： <br>1. <br>It is generally recommended that if there is no longer any discharge from the anus, it indicates that the surgical wound has completely healed, and you can return to your pre-surgery lifestyle. <br>If there are no issues with const

Postoperative care

Hello, Doctor: I underwent a complete excision of internal and external hemorrhoids using an ultrasonic scalpel on May 12, 2010.
My recovery has been relatively good, and after two follow-up visits, the doctor said there were no issues with the wound and that I didn't need to return.
I have some questions regarding my post-operative condition:
1.
I am currently taking a stool softener (magnesium oxide) and Laxative, which has resulted in my stools being softer and not formed.
If my stools become slightly harder, I tend to experience bleeding.
It has been about 21 days since the surgery; when should I stop the medication to train my stools to form properly? Will consistently passing very soft stools lead to anal stenosis? (My attending physician said it would not.)
2.
My diet (including vegetables, fruits, and water) and daily routine (not staying up late) are normal.
I have a bowel movement every morning, which takes about five to ten minutes, and I do not read the news, hold in my urge, or feel incomplete after a bowel movement.
However, since my teenage years, I have often experienced hard stools, sometimes starting off hard but then becoming easier to pass, which has frequently resulted in blood in my stools.
Why is this the case (hard stools, sometimes very large) and related to hemorrhoids? My father and sister also have difficulty with bowel movements.
The doctor told me that if there is no family history of colorectal disease, the possibility of any lesions in my colon is low.
Two doctors advised me to eat more vegetables and drink more water.
During one examination, a doctor noted that my rectum contained a lot of hard stool, but I had already had a bowel movement that morning.
Is this due to poor gastrointestinal motility, or could there be any lesions in my colon or rectum?
3.
There are many types of constipation, such as "slow transit," "rectal," and "spastic." Based on your assessment, which type of constipation do you think I have?
4.
I am eager to understand my health status and seek a definitive solution, so I would like to undergo examinations once my wound has healed a bit more.
What type of examinations do you recommend? (Hospitals in Taipei City and County would be more convenient.) Thank you for your response!

fān, 30~39 year old female. Ask Date: 2010/06/03

Dr. Ke Fangxu reply Surgery

Hello: In response to your questions:
1.
It is generally recommended that if there is no longer any discharge from the anus, it indicates that the surgical wound has completely healed, and you can return to your pre-surgery lifestyle.
If there are no issues with constipation, softening agents can be discontinued, as excessively loose stools will not cause anal stenosis.
2.
In general, bowel issues in young people are often related to lifestyle habits.
Some may have insufficient fiber intake, while others may suffer from lack of sleep, both of which can lead to such problems.
3.
The term "slow transit" refers to slow intestinal motility, where individuals may go several days without passing stool.
"Rectal dysfunction" involves poor coordination of rectal contractions, making it difficult to expel even soft stools.
"Spastic" constipation is irregular in nature.
In fact, many cases of constipation cannot be classified and the exact type may not be important.
What matters is finding methods that can help you have a successful bowel movement.
4.
There are many methods for evaluating constipation in textbooks, such as measuring intestinal transit time or anal pressure testing, with colonoscopy being one of them.
However, aside from colonoscopy, few people undergo these tests because the treatment approaches do not differ significantly.
As long as colorectal cancer is ruled out, additional tests may not greatly assist in treatment.
It is recommended to cultivate good lifestyle habits and bowel habits as the most effective way to resolve constipation issues.

Reply Date: 2010/06/03

More Info

Post-surgery care, especially after hemorrhoid surgery, can be quite challenging, particularly when it comes to managing bowel issues. Your concerns are valid, and it's essential to address them comprehensively.

1. Bowel Movements and Medication: After hemorrhoid surgery, it's common to experience changes in bowel habits. The use of stool softeners like magnesium oxide and medications such as lactulose can help prevent straining during bowel movements, which is crucial for healing. However, you are right to be cautious about relying on these medications for an extended period. Generally, you can start tapering off the stool softeners once you notice that your bowel movements are becoming more regular and formed. This usually happens within a few weeks post-surgery, but it can vary based on individual recovery. If your stools remain too soft for an extended period, it may lead to issues like diarrhea, which can irritate the anal area. However, the risk of developing anal stenosis (narrowing of the anal canal) from consistently soft stools is low, especially if your doctor has indicated otherwise.

2. Diet and Lifestyle: It sounds like you are already following a healthy diet rich in fruits, vegetables, and adequate hydration, which is excellent for maintaining regular bowel movements. The fact that you have a consistent morning routine for bowel movements is a positive sign. However, if you have a history of hard stools and bleeding, it may indicate a tendency towards constipation or a structural issue in the bowel. Family history can play a role in gastrointestinal health, and it’s good that your doctors have ruled out significant concerns regarding colon pathology. If you continue to experience hard stools, it might be beneficial to keep a food diary to identify any specific triggers or patterns.

3. Types of Constipation: Based on your description, it seems you might be experiencing a combination of "slow transit" constipation and possibly "functional constipation." Slow transit constipation occurs when the movement of stool through the colon is slower than normal, leading to hard stools. Functional constipation can be influenced by dietary habits and lifestyle factors. Given your family history of similar issues, it may be worthwhile to explore this further with your healthcare provider.

4. Further Investigations: If you are keen on understanding your gastrointestinal health better, especially after your surgery, consider discussing the possibility of a colonoscopy with your doctor. This procedure can help visualize the colon and rectum, allowing for the assessment of any structural abnormalities or conditions that may contribute to your symptoms. Additionally, a consultation with a gastroenterologist may provide insights into your bowel habits and help tailor a management plan that suits your needs.

In summary, managing bowel issues post-hemorrhoid surgery requires a balanced approach involving diet, medication, and possibly further investigations. Regular follow-ups with your healthcare provider are crucial to ensure that your recovery is on track and to address any ongoing concerns. Always communicate openly with your doctor about your symptoms and any changes you experience, as they can provide personalized advice and adjustments to your treatment plan.

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