Post-Surgery Concerns: Managing Bleeding After Anal Ulcer and Hemorrhoid Removal

Hello, doctor. I am a patient with anal ulcers and internal hemorrhoids, and I have some postoperative questions I would like to ask you. ^^

Hello Dr.
Ke,
On July 30th of this year, I underwent surgery for anal ulcer and hemorrhoidectomy.
I stayed in the hospital for two days post-surgery and have been resting at home in a side-lying position since then.
During the first week after the surgery, I took Lactulose (the stool softener prescribed by my doctor), and I was having bowel movements about 4 to 5 times a day.
The pain from the wound was quite severe, although I was doing sitz baths with warm water.

In the second week post-surgery, I stopped taking Lactulose, but my stool did not become hard or dry.
However, I started experiencing blood when passing gas (though it wasn't a continuous stream).
Sometimes, when I passed gas, blood clots would come out, but it wasn't a constant flow; it would happen before and after bowel movements, and I felt it was a bit excessive.
When I returned for a follow-up with my doctor on August 17th, he was somewhat alarmed by the photos of the blood clots I showed him.
He prescribed Tranexamic Acid 250 mg for me (this was the only medication he prescribed this time).

I have been taking the Tranexamic Acid (four tablets a day) for the past few days, and I haven't noticed much bleeding, but my stools have become thinner and harder to pass.
This morning, I passed gas again and noticed blood clots.
I have been taking the hemostatic medication (Tranexamic Acid) as prescribed! I am wondering if my bleeding could be due to lying flat instead of on my side, which might be putting pressure on the wound.
I noticed that whenever I sit for a while, I tend to have blood when I pass gas (which is a bit frightening).
Now, I only dare to lie on my side or stand; I completely avoid sitting.

The doctor did ask if I wanted to clean the wound, mentioning that examining the anal area would be painful since the wound hasn't healed yet.
So far, I feel that the pain from the anal wound is not as severe as immediately post-surgery, but it still hurts.
I am very concerned about the bleeding issue! On the fifth day post-surgery (August 5th), I was sent to the emergency room due to continuous bleeding after a bowel movement, and the next day, they cleaned the wound, which was extremely painful (but the nurse told me it looked clean and there wasn't much bleeding).
Dr.
Ke, I would like to ask you if the recovery from hemorrhoidectomy and anal ulcer surgery takes longer than regular hemorrhoid surgery? Is it normal to have fresh blood with every bowel movement? I really want to be able to sit comfortably.
Will the bleeding eventually stop after some time as the wound heals? Should I continue taking Tranexamic Acid (the hemostatic medication)? Is bathing in warm water about twice a day sufficient? Will I be able to sit comfortably by early September? How long does it typically take for complete healing? Thank you very much for your response, Dr.
Ke.

A Nai, 20~29 year old female. Ask Date: 2015/08/22

Dr. Ke Fangxu reply Surgery

Mild bleeding from the surgical site after hemorrhoid surgery is a normal occurrence.
However, if there is significant bleeding, it is important to take hemostatic medication (tranexamic acid).
If taking Laxatives leads to increased bowel movements, the dosage should be reduced from twice a day to once a day or halved to prevent excessive bowel movements that could cause bleeding from the wound.
Warm sitz baths are generally recommended four times a day; if attending school makes this inconvenient, at least three baths should be taken in the morning, after returning home, and before bedtime.
Typically, bleeding will stop about a week after surgery, and pain should subside within two weeks.
Complete healing of the wound takes about a month.
During this period, it is important to avoid constipation, prolonged sitting, and spicy foods.
Recovery should occur soon.

Reply Date: 2015/08/22

More Info

After undergoing surgery for anal ulcers and hemorrhoids, it is understandable to have concerns about post-operative bleeding and recovery. Your experience of bleeding after passing gas or having a bowel movement is not uncommon, especially following such procedures. However, it is essential to differentiate between normal post-operative symptoms and those that may indicate complications.

Firstly, the bleeding you are experiencing could be attributed to several factors. After surgery, the tissues in the anal region are healing, and any strain—whether from bowel movements or even passing gas—can cause minor bleeding. This is particularly true if there are still areas of inflammation or if the surgical site is not fully healed. The fact that you are experiencing blood clots or bleeding when passing gas suggests that there may still be some irritation or trauma to the surgical site.

Regarding your question about whether recovery from anal ulcer and hemorrhoid removal takes longer than standard hemorrhoid surgery, it can vary from person to person. Generally, recovery times depend on the extent of the surgery, the individual’s overall health, and how well they follow post-operative care instructions. In your case, since you had both an anal ulcer and hemorrhoid removal, it may take a bit longer for complete healing compared to a standard hemorrhoidectomy.

As for the use of tranexamic acid, it is a medication that helps reduce bleeding. If you are still experiencing bleeding despite taking this medication, it is crucial to communicate this to your doctor. They may need to reassess your condition and determine if further intervention is necessary. It is also important to continue monitoring your symptoms and report any significant changes, such as increased bleeding or pain.

In terms of your post-operative care, sitting for prolonged periods can indeed put pressure on the surgical site and exacerbate bleeding. It is advisable to avoid sitting for long periods until you feel more comfortable. Side-lying positions can help alleviate pressure on the area and may reduce the likelihood of bleeding. Additionally, maintaining a regular routine of warm sitz baths can help soothe the area and promote healing. If you are currently taking two sitz baths a day, that is generally a good practice, but you may want to increase it if it provides relief.

Regarding your bowel movements, it is crucial to maintain soft stools to avoid straining, which can lead to further bleeding. If you find that your stools are becoming harder or more difficult to pass, consider discussing with your doctor the possibility of reintroducing a stool softener or adjusting your diet to include more fiber and hydration.

As for your concern about being able to sit comfortably by early September, it is difficult to predict an exact timeline for recovery. Healing can take several weeks to months, depending on individual circumstances. It is essential to follow your doctor's advice, attend follow-up appointments, and communicate any ongoing issues.

In summary, while some bleeding after anal surgery can be normal, persistent or significant bleeding should be evaluated by your healthcare provider. Continue to practice good post-operative care, including warm sitz baths and avoiding pressure on the surgical site. Keep an open line of communication with your doctor regarding your symptoms and recovery progress. With proper care and attention, you should see improvement over time.

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