Frequent Bowel Urgency After Hemorrhoid Surgery: Causes and Solutions

Frequent urges to defecate?

Hello Doctor: My mother, who is 71 years old, underwent surgery for hemorrhoids and has since experienced an increase in bowel movements.
Every time she urinates, she also feels the urge to defecate.
During her follow-up visit, the doctor adjusted her medication, but two days later, she began experiencing unusually frequent urges to defecate, approximately every ten minutes, with strong urges during the day and much less at night.
Each bowel movement only produces a small amount, and she feels a sense of incomplete evacuation, unable to relieve the urge.
She has visited the doctor multiple times, and the medication has had no effect.
Previous stool tests covered by health insurance were normal, and we are currently considering a colonoscopy.
Additionally, when I assist my mother with bathing, I notice that my finger can slightly reach the stool when inserted into the rectum, and she reports difficulty urinating immediately, needing to sit on the toilet for a while.
I wonder if this situation relates to the link provided, and which specialty would be most appropriate for her to consult? Thank you!

Otaru, 40~49 year old female. Ask Date: 2016/02/25

Dr. Ke Fangxu reply Surgery

After elderly patients undergo hemorrhoid surgery, they may sometimes experience difficulties with bowel movements.
This is often related to whether they had pre-existing bowel issues prior to the surgery.
If they had difficulty with bowel movements before the procedure, this condition may worsen postoperatively due to abnormal sensations.
If a colonoscopy has not been performed prior to surgery, it can still be done afterward; however, bowel irregularities may complicate the bowel preparation process.
It is recommended to first take stool softeners and enhance warm sitz baths.
If symptoms persist for more than a month after surgery, it is advisable to undergo a colonoscopy as soon as possible.

Reply Date: 2016/02/25

More Info

Frequent bowel urgency after hemorrhoid surgery can be a distressing and uncomfortable experience, particularly for elderly patients. In your mother's case, it seems she is experiencing an increase in bowel urgency and frequency, which can be attributed to several potential causes related to the surgical procedure and the healing process.

Firstly, hemorrhoid surgery, especially if it involves excision, can lead to changes in the anal sphincter function. The surgery may cause temporary swelling or irritation of the anal area, which can result in increased sensitivity and urgency to defecate. This is often a result of the body adjusting to the surgical changes and can improve over time as healing progresses.

Another possible cause of her symptoms could be related to the development of a condition known as "rectal hypersensitivity." After surgery, some patients may experience heightened sensitivity in the rectal area, leading to a feeling of urgency even when the bowel is not full. This can be exacerbated by anxiety or stress about bowel movements, which is common after surgery.

Additionally, the presence of residual stool or fecal impaction can lead to a sensation of incomplete evacuation, causing frequent urges to defecate. If your mother is feeling a "fullness" or pressure in the rectum, it may be due to stool that is not being expelled effectively. This can also lead to a cycle of urgency and discomfort.

Given that your mother has already undergone medication adjustments without relief, and considering her symptoms of frequent urges and the sensation of incomplete evacuation, it is indeed prudent to pursue further evaluation. A colonoscopy is a reasonable next step, as it can help rule out any underlying issues such as strictures, inflammation, or other abnormalities in the colon that may be contributing to her symptoms.

In terms of which specialty to consult, a gastroenterologist would be the most appropriate choice. They specialize in digestive system disorders and can perform the necessary diagnostic procedures, including a colonoscopy. Additionally, they can provide guidance on dietary modifications, medications, or other interventions that may help alleviate her symptoms.

In the meantime, there are several strategies that may help manage her symptoms. Encouraging a high-fiber diet can promote regular bowel movements and reduce straining. Adequate hydration is also essential to prevent constipation. If she is experiencing significant discomfort or urgency, it may be beneficial to explore medications that can help regulate bowel function, but these should be discussed with her healthcare provider.

Lastly, it is important to monitor her symptoms closely. If she experiences any new symptoms, such as severe pain, bleeding, or changes in bowel habits, she should seek medical attention promptly. Overall, while frequent bowel urgency after hemorrhoid surgery can be concerning, with appropriate evaluation and management, many patients find relief and return to a more normal bowel pattern.

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