Post-Surgery Complications: Bleeding and Odor After Hemorrhoidectomy

Anal issues

Hello Doctor: I recently underwent hemorrhoidectomy due to a mixed hemorrhoid issue (between grade 3 and 4), using an ultrasonic scalpel.
I was discharged on the third day post-surgery and have been walking around since the fourth day.
Today marks the sixth day post-operation.
On the afternoon of the fifth day, I suddenly experienced intermittent heavy bleeding.
The bleeding was significant enough to completely saturate a gauze pad, and at times, it dripped onto my pants and turned the toilet water red, although it was not a continuous drip or spray.
However, during dressing changes, the bloodstains and discharge had a foul odor.
I have already visited the emergency department, where the doctor performed a digital rectal examination and found no signs of significant bleeding, advising me to observe for a few more days.
However, upon returning home around six o'clock, I experienced another episode of heavy bleeding, again saturating the gauze and coloring the toilet water.
After cleaning, the bleeding stopped.
Additionally, I often hear bowel sounds and feel intestinal peristalsis; whenever I experience these two symptoms, it seems to indicate that I am about to bleed again! I would like to ask the doctor: Is it normal for the discharge to have an odor? What could cause the discharge to smell? What might be the reasons for intermittent (non-continuous) heavy bleeding? Why is the pain on the fourth and fifth days post-surgery more pronounced than on the second and third days while I was in the hospital?

Fan Fan, 20~29 year old female. Ask Date: 2014/06/16

Dr. Ke Fangxu reply Surgery

1.
It is normal to have discharge after hemorrhoid surgery, as it may be mixed with feces, which can also cause an unpleasant odor.
However, if there is a bloody smell, it may indicate bleeding.
In the case of infection, in addition to the characteristic odor of bacterial infection, there may also be signs of redness, swelling, heat, and pain at the wound site.

2.
Ultrasonic scalpel surgery utilizes high-frequency sound waves to coagulate tissue and achieve hemostasis.
It is possible for wound rupture and bleeding to occur around seven days post-surgery, which can also happen occasionally with traditional surgery.
If constipation occurs after the procedure, it may increase the likelihood of this complication.
3.
Theoretically, the ultrasonic scalpel causes less thermal damage to the tissue, resulting in milder pain (this is what the manufacturers claim, but I am skeptical).
However, any surgical procedure involves some degree of tissue damage, which will inevitably lead to pain, especially in hemorrhoid surgeries where the wound is in a non-sterile environment.
Some level of bacterial infection is expected, and it typically takes about 3-5 days for the body's white blood cells to respond to bacterial growth.
Many patients experience this, so there is no need to overly worry about significant bleeding.
If it occurs again, it is important to seek medical attention promptly, as reoperation for suturing may be necessary.

Reply Date: 2014/06/16

More Info

After undergoing a hemorrhoidectomy, particularly with the use of ultrasound technology, it is not uncommon for patients to experience complications such as bleeding and unusual odors from the surgical site. Your situation, characterized by intermittent heavy bleeding and foul-smelling discharge, raises several important considerations.

First, let’s address the issue of the foul odor associated with the discharge. It is essential to understand that any surgical site, especially in the perianal area, can be susceptible to infection. The presence of a foul smell often indicates that there may be an infection, possibly due to bacteria that thrive in the moist environment of the surgical site. This can occur even if there are no visible signs of infection, such as redness or swelling. The odor is typically a result of necrotic tissue or pus, which can develop if the wound is not healing properly or if there is a collection of fluid (abscess) forming.

Regarding the intermittent heavy bleeding you are experiencing, this can be attributed to several factors. Post-surgical bleeding can occur due to the following reasons:
1. Surgical Technique: If the blood vessels were not adequately ligated during the procedure, they may bleed intermittently as the healing progresses. This is particularly true in the case of hemorrhoid surgeries, where the vascular supply is significant.

2. Infection: As mentioned earlier, an infection can lead to increased inflammation and tissue breakdown, which may result in bleeding.

3. Tissue Healing: The healing process can sometimes cause blood vessels to become fragile, leading to intermittent bleeding. This is particularly common in the days following surgery when the tissues are still inflamed and healing.

4. Straining: If you are experiencing bowel movements that require straining, this can exacerbate bleeding, especially in the early post-operative period.

The pain you are experiencing on the fourth and fifth days post-surgery being more pronounced than on the second and third days can also be explained by the healing process. Pain levels can fluctuate based on several factors, including:
- Inflammation: As the body begins to heal, inflammation can peak, leading to increased pain.

- Activity Level: Increased movement or activity can also lead to more discomfort as the surgical site is still sensitive.

- Bowel Movements: If you are experiencing bowel movements that are difficult or painful, this can lead to increased pain levels.

In terms of management, it is crucial to maintain good hygiene around the surgical site to prevent infection. Regularly changing dressings and keeping the area clean can help minimize the risk of infection and odor. If the bleeding continues or worsens, or if you notice any signs of systemic infection (such as fever, chills, or increased pain), it is vital to seek medical attention promptly.

Additionally, it may be beneficial to consult with your surgeon or a gastroenterologist about your symptoms. They may recommend imaging studies or further evaluations to rule out any underlying issues, such as a hematoma or abscess formation.

In conclusion, while some bleeding and discomfort can be expected after a hemorrhoidectomy, the severity and characteristics of your symptoms warrant close monitoring. The foul odor suggests a possible infection, and the intermittent bleeding could be due to several factors related to the surgical procedure and healing process. It is essential to maintain communication with your healthcare provider to ensure proper management and recovery.

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