Recurrence of Hemorrhoids After Surgery: Causes and Solutions

Recurrence after hemorrhoid surgery?

Hello, doctor.
I have been experiencing chronic constipation and developed a hemorrhoid that became irreducible.
Last month, I underwent surgery to remove the external hemorrhoid.
Upon discharge, my attending physician prescribed a topical ointment and a stool softener (brown in color), instructing me to take two capsules at night, which would induce bowel movements in about four to six hours.
The pharmacist advised that if I experienced discomfort from the stool softener, I could discontinue its use.
However, shortly after taking it, I experienced intense urges to defecate and often had cramping pain, so I stopped the medication.
The consequence was constipation, with difficulty passing stool, and I experienced bleeding and swelling.
I quickly took the stool softener and used an enema, but the result was swelling and bleeding at the original hemorrhoid site.
During my follow-up appointment, the doctor prescribed a suppository and medication to see if the swelling would subside.
After a few days of observation, the swelling did not go down, and I developed another hemorrhoid that is also irreducible.
It appears that I now have two.
I would like to ask the doctor if this situation indicates that the surgery did not completely remove the hemorrhoid, or could it be that my constipation caused a tear in the wound, compounded by my late-night habits, which worsened the condition?

Hsu, 20~29 year old female. Ask Date: 2016/02/14

Dr. Yu Mingchang reply Surgery

Hello, please come back for a follow-up appointment.
The Department of Colorectal Surgery at Changhua Hospital, Ministry of Health and Welfare, is concerned about you.

Reply Date: 2016/02/14

More Info

The recurrence of hemorrhoids after surgery can be a frustrating and painful experience, especially for individuals with a history of constipation. Your situation highlights several important factors that can contribute to the recurrence of hemorrhoids, as well as potential solutions to manage and prevent further complications.

Firstly, it’s essential to understand that hemorrhoids can recur for various reasons, even after surgical intervention. One of the primary causes is the underlying condition of chronic constipation. When you experience constipation, the straining during bowel movements can put excessive pressure on the veins in the rectal area, leading to the formation of new hemorrhoids or the exacerbation of existing ones. This is particularly relevant in your case, where you mentioned having a long-standing issue with constipation.

The surgical removal of hemorrhoids, while effective, does not address the underlying causes of hemorrhoid formation. If the contributing factors, such as constipation, are not managed, there is a significant risk of recurrence. In your case, the aggressive bowel movements induced by the stool softeners may have led to discomfort and pain, prompting you to stop the medication. This decision, while understandable, likely resulted in a cycle of constipation and straining, which can aggravate the area where the hemorrhoids were previously removed.

Another factor to consider is the surgical technique used during your procedure. If the hemorrhoids were not entirely excised or if there was residual tissue left behind, this could lead to the formation of new hemorrhoids. Additionally, the healing process itself can sometimes result in scar tissue formation, which may cause discomfort or lead to new hemorrhoid development.

To address your current situation, it is crucial to focus on managing your constipation effectively. Here are some strategies that may help:
1. Dietary Changes: Increase your fiber intake by consuming more fruits, vegetables, whole grains, and legumes. Fiber helps to soften stool and promote regular bowel movements, reducing the need for straining.

2. Hydration: Drink plenty of water throughout the day. Staying hydrated is essential for maintaining soft stool and preventing constipation.

3. Regular Exercise: Engaging in regular physical activity can help stimulate bowel function and reduce the likelihood of constipation.

4. Medication Management: If stool softeners cause discomfort, discuss alternative options with your healthcare provider. There are various types of laxatives and stool softeners available, and your doctor can help find one that works for you without causing excessive urgency or pain.

5. Avoid Straining: When using the bathroom, try to relax and avoid straining. If you feel the urge to go, respond promptly to prevent stool from hardening.

6. Follow-Up Care: Regular follow-up appointments with your healthcare provider are essential to monitor your recovery and address any concerns. If you notice new growths or persistent symptoms, it’s important to seek medical advice promptly.

7. Consider Additional Treatments: If conservative measures fail and you continue to experience issues, your doctor may recommend additional treatments, such as rubber band ligation or other minimally invasive procedures to address recurrent hemorrhoids.

In summary, the recurrence of hemorrhoids after surgery can be influenced by several factors, including chronic constipation and the surgical technique used. By focusing on dietary changes, hydration, and regular follow-up care, you can help manage your symptoms and reduce the risk of further complications. Always consult with your healthcare provider for personalized advice and treatment options tailored to your specific situation.

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