Post-Surgery Anal Changes: Concerns and Solutions

Q: Post-Surgery Anal Changes: Concerns and Solutions

Hello： We recommend that you consult with the Department of Colorectal Surgery at Changhua Hospital, Ministry of Health and Welfare, as they are concerned about your health.

After hemorrhoid surgery, the anus has become smaller, and this has persisted for 6 years, requiring long-term use of stool softeners?

In 2009, after undergoing hemorrhoid surgery in China, I started taking stool softeners, which allowed for smooth bowel movements.
However, a few months later, I noticed that my anus felt smaller.
Since the surgery, I have experienced a persistent sensation of heat and discomfort in the anal area, which has lasted nearly three years, and only recently has shown some improvement.
I have continued to take stool softeners to facilitate bowel movements, but if I take too much, I end up needing to have three to four bowel movements a day to feel completely empty.
Could this be the reason I often feel a heavy, warm sensation in my anus? It has become difficult to insert my finger into the anus, and due to the painful experience of the surgery, I have been afraid to see a doctor.
I have researched online and found that it might be scar tissue formation causing the narrowing of the anus.

1.
After six years, will the scar tissue continue to grow larger?
2.
Is there a possibility that the scar tissue might soften over the next few years?
3.
If surgery is performed to widen the anus, is there a significant risk? Could it potentially lead to an even smaller anus or incontinence?
4.
Will long-term use of stool softeners lead to tolerance?
5.
What treatment options would you recommend for my situation? I hope you don’t mind my many questions, as my quality of life has diminished significantly, and I have been suffering for these years.
6.
If surgery could allow me to have smooth bowel movements (safely and without side effects), I am willing to endure any pain for a cure.
7.
I apologize for my numerous questions, and I sincerely hope you can provide me with answers.
I would be extremely grateful.

Lilan, 50~59 year old female. Ask Date: 2015/09/16

Dr. Yu Mingchang reply Surgery

Hello: We recommend that you consult with the Department of Colorectal Surgery at Changhua Hospital, Ministry of Health and Welfare, as they are concerned about your health.

Reply Date: 2015/09/16

More Info

Post-surgery anal changes, especially after hemorrhoid surgery, can be quite distressing and may significantly impact your quality of life. Let's address your concerns systematically.

1. Scar Tissue Formation: After any surgical procedure, including hemorrhoid surgery, scar tissue can form as part of the healing process. Over time, this scar tissue can become more fibrous and may lead to a narrowing of the anal canal, which could explain the sensation of your anus feeling smaller. However, scar tissue does not typically continue to grow indefinitely. After several years, it may stabilize, but it can also become less pliable, which might contribute to discomfort.

2. Softening of Scar Tissue: In some cases, scar tissue can soften over time, especially with appropriate treatment such as physical therapy or certain medications. However, this process is highly individual and can depend on various factors, including the extent of the original surgery and your body's healing response.

3. Surgical Risks: If you are considering surgery to enlarge the anal canal, it is essential to discuss the potential risks with your healthcare provider. While surgery can relieve symptoms, there are risks involved, including the possibility of further narrowing, incontinence, or other complications. A thorough evaluation by a specialist is crucial to weigh the benefits against the risks.

4. Long-term Use of Laxatives: Prolonged use of laxatives can lead to dependence, where your bowel may not function properly without them. This can create a cycle of needing to take more laxatives to achieve a bowel movement, which can exacerbate your symptoms. It is advisable to consult with a healthcare provider about alternative treatments or dietary changes that can promote regular bowel movements without the need for laxatives.

5. Treatment Options: Given your situation, it would be beneficial to consult a gastroenterologist or a colorectal surgeon who specializes in post-surgical complications. They can perform a thorough evaluation, which may include a physical examination and possibly imaging studies, to assess the condition of your anal canal and surrounding tissues. Treatment options may include:
- Physical Therapy: Specialized pelvic floor therapy can help improve muscle function and alleviate discomfort.

- Medications: Topical treatments or other medications may help manage pain and discomfort.

- Surgical Options: If conservative measures fail, surgical intervention might be considered to address any strictures or scar tissue.

6. Quality of Life: It’s understandable that you are seeking relief from your symptoms, as they have significantly affected your quality of life. Open communication with your healthcare provider about your symptoms, fears, and treatment goals is essential. They can help guide you through the options available and develop a personalized treatment plan.

7. Seeking Help: It’s important to overcome the fear of seeking medical help, especially since your symptoms have persisted for several years. A healthcare professional can provide reassurance and support, helping you navigate your treatment options effectively.

In summary, while your concerns are valid and complex, there are pathways to address your symptoms and improve your quality of life. Engaging with a specialist who understands the nuances of post-hemorrhoid surgery complications will be crucial in finding a suitable solution for your situation.

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