Perianal Discomfort After Hemorrhoid Surgery: Causes and Self-Assessment

Q: Perianal Discomfort After Hemorrhoid Surgery: Causes and Self-Assessment

Hello： The simplest way to identify an anal fistula is through visual inspection. <br>If you see an opening on the skin, it is highly likely that a fistula is present. <br>However, some fistulas may not have a visible skin opening, and in such cases, diagnosis relies on a physici

Discomfort around the anal area?

Hello Dr.
Ke, I would like to ask you a question.
Four months ago, I underwent traditional hemorrhoid surgery.
Two months post-operation, after stopping the use of Laxative, I experienced a mild anal fissure (without bleeding) which has since healed.
My bowel movements are normal now, with no abnormal discharge or pain.
However, for the past two months, I have been experiencing a dull pain at the junction of the left side of the anus and the thigh when sitting down.
There are no visible signs of redness or swelling.
Last week, I felt pain upon lightly touching the area, and I thought it might be muscle inflammation, so I gently massaged it with a topical ointment.
However, this made the pain worse.
After taking anti-inflammatory medication for two days, the pain has decreased significantly.
Yesterday, I consulted a rehabilitation physician who mentioned that the area above the anus and at the thigh junction could possibly be a fistula.
However, I visited a colorectal specialist a month ago who found no evidence of a fistula.
Is it possible that there is a sinus or a deeper fistula that was not detected? Is there a simple way to self-assess whether it is a fistula? Thank you, Dr.
Peter.

Peter, 30~39 year old female. Ask Date: 2014/01/10

Dr. Ke Fangxu reply Surgery

Hello: The simplest way to identify an anal fistula is through visual inspection.
If you see an opening on the skin, it is highly likely that a fistula is present.
However, some fistulas may not have a visible skin opening, and in such cases, diagnosis relies on a physician's examination.
If a hard, tubular structure extending toward the anus is palpated, a diagnosis can also be made.
However, it may be challenging for the average person to make this determination, especially for deeper fistulas, which may not even be detectable by all colorectal specialists.
It is advisable to consult a professional physician for an examination to avoid delaying treatment.

Reply Date: 2014/01/10

More Info

After undergoing hemorrhoid surgery, it is not uncommon for patients to experience various forms of discomfort, including perianal pain. In your case, you mentioned experiencing pain in the area where the anus meets the thigh, particularly on the left side, which has persisted for about two months. While you have ruled out visible signs of inflammation or infection, the discomfort you describe can be attributed to several potential causes.

Firstly, it is important to understand that after any surgical procedure, especially in the sensitive area of the anal region, it is common for patients to experience some degree of discomfort or altered sensation. This can be due to nerve irritation, muscle tension, or even scar tissue formation. The fact that you experienced a mild anal fissure two months post-surgery, although it has healed, suggests that your anal region may still be sensitive and could be contributing to the discomfort you feel when sitting.

The pain you describe, particularly when sitting, could also be related to muscle strain or tension in the pelvic floor muscles. These muscles can become tight or overworked, especially if you have been compensating for discomfort in other areas. The use of topical treatments like the one you mentioned (妥療瘀軟膏) may provide temporary relief, but if the pain worsens, it could indicate that the underlying issue is not being adequately addressed.

Regarding the possibility of a fistula or sinus, it is essential to note that these conditions can sometimes be challenging to diagnose. A fistula is an abnormal connection between the anal canal and the skin, while a sinus is a small channel or cavity that can also lead to discomfort. If your previous examination by a colorectal specialist did not reveal any signs of a fistula, it is less likely that one is present, but it is not impossible, especially if it is a deeper or more complex type that may not have been easily detectable.

To self-assess whether you might have a fistula or sinus, consider the following:
1. Pain Characteristics: Is the pain localized to a specific area, or does it radiate? Fistula-related pain is often more localized and can be associated with swelling or a palpable lump.

2. Changes in Symptoms: Have you noticed any changes in your symptoms after bowel movements, such as increased pain or discomfort? Fistulas can sometimes cause pain that correlates with bowel movements.

3. Discharge: While you mentioned no abnormal discharge, keep an eye out for any unusual drainage, especially if it has a foul odor, which could indicate an infection or a fistula.

4. Palpation: Gently palpating the area can help you identify any lumps or areas of tenderness that may warrant further investigation.

5. Response to Treatment: If the pain improves with anti-inflammatory medications but returns when you stop them, this could indicate an inflammatory process that needs to be addressed.

Given your symptoms and the complexity of the anal region, it would be wise to follow up with your healthcare provider for a thorough examination. They may consider imaging studies, such as an MRI or ultrasound, to evaluate for any hidden fistulas or sinus tracts that may not have been detected during your previous visits.

In conclusion, while it is possible that your discomfort is related to muscle tension or residual effects from surgery, it is essential to rule out any significant underlying conditions such as a fistula or sinus. Regular follow-ups with your healthcare provider and open communication about your symptoms will be crucial in managing your recovery and ensuring your long-term health.

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