Recurring Hemorrhoids and Post-Surgery Complications

Hemorrhoid issues

The patient has a long-term history of hemorrhoids, along with issues related to a fistula.
They have undergone rubber band ligation but continue to experience frequent recurrences.
Post-surgery, there is a small lump felt internally in the anal area.
Additionally, there is another lump that feels similar to the first one, which causes discomfort when pressed (this lump was confirmed to be absent before the ligation).
Is this lump a normal tissue response after the ligation? Occasionally, there is a sensation of discomfort radiating upwards, as if there is a muscle strain extending to the internal anal area.

Chen, 30~39 year old female. Ask Date: 2015/12/30

Dr. Ke Fangxu reply Surgery

Without a personal examination, I cannot provide you with a definitive answer.
However, generally, these are mild hemorrhoid symptoms and should not be related to rubber band ligation.
I recommend that you avoid self-exploration of the anal canal with your fingers, as this could cause injury to the anus or rectum, and may even lead to infection or contamination of the surrounding environment.

Reply Date: 2015/12/30

More Info

Recurring hemorrhoids can be a frustrating and painful condition, especially for those who have undergone surgical procedures like rubber band ligation. This technique is commonly used to treat hemorrhoids by cutting off blood supply to the hemorrhoidal tissue, causing it to shrink and eventually fall off. However, it is not uncommon for patients to experience recurrence of symptoms or complications after surgery.

In your case, the presence of a small "meatball" or lump inside the anal canal after the rubber band ligation could be a few different things. It might be a remnant of the hemorrhoidal tissue that was not fully treated during the procedure, or it could be a new hemorrhoid that has developed post-surgery. Sometimes, the tissue can become inflamed or engorged, leading to the formation of what feels like a lump. Additionally, if you have a fistula (an abnormal connection between the rectum and the skin), this could also contribute to discomfort and the sensation of pressure or pain.

The discomfort you describe, particularly the sensation of a "muscle" or "tendon" pulling up to the anus, could be related to several factors. It might be due to muscle tension in the pelvic floor area, which can occur as a response to pain or discomfort. Chronic pain in the anal region can lead to muscle spasms, which may cause a feeling of tightness or discomfort that radiates.

To address your concerns, it is essential to consult with a healthcare professional, preferably a colorectal surgeon or a gastroenterologist, who can perform a thorough examination. They may recommend a digital rectal exam or an anoscopy to visualize the area and determine the nature of the lump. Imaging studies may also be necessary if there is suspicion of a fistula or other complications.

In terms of management, if the lump is indeed a residual hemorrhoid or new hemorrhoidal tissue, treatment options may include additional rubber band ligation, sclerotherapy (injection of a solution to shrink the hemorrhoid), or surgical excision if conservative measures fail. If the lump is related to a fistula, surgical intervention may be required to correct the abnormal connection.

For ongoing management of hemorrhoids, lifestyle modifications can be beneficial. These include:
1. Dietary Changes: Increasing fiber intake through fruits, vegetables, and whole grains can help soften stools and reduce straining during bowel movements. Staying well-hydrated is also crucial.

2. Regular Exercise: Engaging in regular physical activity can promote healthy bowel function and reduce the risk of constipation.

3. Avoiding Straining: When using the bathroom, try to avoid prolonged sitting or straining, as this can exacerbate hemorrhoidal symptoms.

4. Warm Baths: Soaking in warm water can help relieve discomfort and promote healing.

5. Topical Treatments: Over-the-counter creams or ointments may provide temporary relief from itching and discomfort.

6. Follow-Up Care: Regular follow-ups with your healthcare provider can help monitor your condition and address any new symptoms promptly.

In conclusion, while the presence of a lump after hemorrhoid surgery can be concerning, it is essential to have it evaluated by a healthcare professional to determine the appropriate course of action. Early intervention can help prevent further complications and improve your quality of life.

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