Persistent Pain After Hemorrhoid Ligation: What to Expect and Remedies

Persistent pain after hemorrhoid ligation?

Hello Dr.
Ke, I underwent a rubber band ligation for internal hemorrhoids at Kaohsiung E-Da Hospital this morning.
The procedure was quite painful, and afterward, I felt a significant foreign body sensation, with ongoing mild pain.
The doctor who performed the ligation advised me to wait for it to fall off on its own and prescribed me a suppository called Yizhiping.
On my way home, the pain gradually subsided, leaving only the foreign body sensation.
However, shortly after returning home, the pain started to return.
When it became unbearable, I tried a warm sitz bath, which alleviated the pain significantly for about 10 minutes, but the pain returned as soon as I got out of the water.
Around 8 PM, I experienced mild cramping and needed to use the restroom, but I was constipated.
I went to the bathroom twice within about 10 minutes, both times struggling with constipation.
Shortly after using the restroom, I began to experience severe pain.
Initially, I thought it was due to the constipation possibly irritating the hemorrhoids, but the pain intensified as the evening progressed.
By around 10 PM, I inserted the Yizhiping suppository into my rectum, but just touching the anal area with my finger caused sharp pain.
Nevertheless, I felt compelled to insert the suppository, so I took a deep breath and pushed it in, which resulted in intense burning and pain in the anal area.
As of now, at 4 AM, the pain persists.
I took some acetaminophen, but it has not been effective, and I frequently experience sharp pain that prevents me from sleeping.
I considered going back for a follow-up, but that doctor only sees patients on Saturday mornings, and there is still a week until the next Saturday.
I feel like I can't endure this any longer, so I am reaching out for advice.
Please help me!

Bobo, 10~19 year old female. Ask Date: 2016/02/21

Dr. Ke Fangxu reply Surgery

Internal hemorrhoid ligation, as the name suggests, can only be performed on the internal hemorrhoids.
If the ligation is too close to the anal line, it can result in severe pain, which is the most common complication of internal hemorrhoid ligation.
This occurs because the ligation site may irritate the superficial nerves.
In such cases, the only option is to take oral pain medications and enhance warm sitz baths.
Personally, I do not recommend using topical ointments or suppositories, as applying these medications may exacerbate the irritation of the wound.
If the pain continues to worsen or if there is a fever, it is important to seek medical attention promptly to prevent wound infection.

Reply Date: 2016/02/21

More Info

After undergoing hemorrhoid ligation, it is not uncommon for patients to experience persistent pain and discomfort. This can be attributed to several factors, including the surgical procedure itself, the healing process, and the body's response to trauma. In your case, it seems that you are experiencing a combination of pain, an unusual sensation of a foreign body, and complications related to bowel movements, such as constipation.

Firstly, it’s important to understand that hemorrhoid ligation, while generally a safe and effective procedure, can lead to postoperative pain. This pain can vary in intensity and may be exacerbated by bowel movements, especially if you are experiencing constipation. The ligation process involves cutting off the blood supply to the hemorrhoids, which can lead to inflammation and discomfort as the tissue begins to heal and eventually slough off. The sensation of a foreign body is also common as the ligated hemorrhoids may take some time to fall off completely.

The pain you are experiencing, particularly the burning and sharp sensations, could be indicative of several issues. It may be a normal part of the healing process, but it could also suggest complications such as anal fissures or irritation from the medication you are using. The fact that you experienced significant pain after using the suppository may indicate that the area is still very sensitive or that there is some irritation present.

To manage your pain and discomfort, here are some recommendations:
1. Warm Sitz Baths: As you have already discovered, warm sitz baths can provide significant relief. Continue to use this method multiple times a day, especially after bowel movements. The warmth helps to relax the anal sphincter and can reduce pain and inflammation.

2. Pain Management: Over-the-counter pain relievers like acetaminophen (Tylenol) or ibuprofen (Advil) can help manage pain. If these are not effective, you may want to consult your doctor about stronger pain relief options.

3. Stool Softeners: Since you are experiencing constipation, consider using stool softeners or a gentle laxative to ease bowel movements. This can help prevent straining, which can exacerbate pain and discomfort.

4. Dietary Adjustments: Increase your fiber intake by consuming fruits, vegetables, and whole grains. Staying hydrated is also crucial, as it helps to soften stool and promote regular bowel movements.

5. Follow-Up Care: If your pain persists or worsens, it is essential to follow up with your healthcare provider. While you mentioned that your doctor is only available on Saturdays, consider reaching out to their office for advice or to see if there are alternative providers who can see you sooner.
6. Avoid Straining: When using the restroom, try to avoid straining. If you feel constipated, take your time and do not rush. If necessary, you can try to relax and breathe deeply to ease the process.

7. Monitor Symptoms: Keep track of your symptoms, including the intensity of your pain, any changes in bowel habits, and any new symptoms that may arise. This information will be helpful for your healthcare provider during your follow-up visit.

In conclusion, while postoperative pain after hemorrhoid ligation can be distressing, it is often manageable with appropriate care and attention. However, if your symptoms do not improve or if you experience severe pain, bleeding, or other concerning symptoms, it is crucial to seek medical attention promptly. Your comfort and health are paramount, and there are various strategies to help you cope with this challenging recovery phase.

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