Post-Hemorrhoid Surgery: Bowel Movement Challenges

Postoperative bowel issues after hemorrhoid surgery?

I underwent hemorrhoid surgery on January 8 of this year, during which four internal hemorrhoids were removed.
However, I am currently experiencing the following issues: 1.
I feel the urge to have a bowel movement, but it requires significant effort to pass stool; 2.
I rely on medication to have bowel movements (currently taking Senna-coated tablets, approximately every two days, two tablets at a time); 3.
When the stool is relatively hard, I experience pain at the anal opening, accompanied by a small amount of bleeding, and there is a tingling sensation at the anal area.
Is this a normal condition? Thank you for your response.

Cheng, 40~49 year old female. Ask Date: 2016/02/26

Dr. Ke Fangxu reply Surgery

After hemorrhoid surgery, it is common to experience abnormal sensations during bowel movements within 2 to 4 weeks, similar to what you described.
However, these symptoms will gradually improve as the wounds heal.
It is recommended to increase your intake of dietary fiber and fluids, enhance sitz baths, and avoid prolonged sitting.
The symptoms should slowly resolve.
If there is no improvement after two months post-surgery, you should consult your physician for further evaluation.

Reply Date: 2016/02/26

More Info

Post-hemorrhoid surgery, particularly after the excision of internal hemorrhoids, can lead to several challenges regarding bowel movements. It is not uncommon for patients to experience difficulties in this area following surgery, and your symptoms are indicative of the healing process and potential complications that can arise.

1. Straining During Bowel Movements: The need to exert significant effort to have a bowel movement is a common complaint after hemorrhoid surgery. This can be attributed to several factors, including postoperative pain, swelling, and changes in bowel habits. After surgery, the anal region may be sensitive, and the fear of pain can lead to a psychological barrier that makes it harder to relax during bowel movements. It is crucial to avoid straining, as this can exacerbate pain and lead to complications such as anal fissures or the recurrence of hemorrhoids.

2. Dependence on Laxatives: Relying on medications like Senna (仙塞落) to facilitate bowel movements is also common. After surgery, the bowel may take time to return to its normal function, and stool softeners or mild laxatives can help ease the process. However, it is essential to use these medications judiciously and under the guidance of your healthcare provider. Over-reliance on laxatives can lead to a condition known as "laxative dependency," where the bowel becomes less responsive to natural stimuli.

3. Pain and Bleeding with Hard Stools: Experiencing pain and minor bleeding when passing hard stools is a sign that the anal area is still healing. The presence of pain can indicate that the surgical site is still sensitive or that there may be a fissure (a small tear in the lining of the anus). It is vital to maintain soft stools to minimize discomfort. This can be achieved through dietary changes, such as increasing fiber intake (fruits, vegetables, whole grains) and ensuring adequate hydration.

4. Numbness or Tingling Sensation: The "numb" feeling around the anal area can be attributed to nerve irritation or inflammation following surgery. This sensation may resolve as healing progresses, but if it persists or worsens, it is essential to discuss this with your surgeon.

Recommendations for Management:
- Dietary Adjustments: Focus on a high-fiber diet to promote softer stools. Consider incorporating foods like oats, beans, fruits, and vegetables. Additionally, drinking plenty of water can help keep stools soft and prevent constipation.

- Stool Softeners: Continue using stool softeners as needed, but consult your healthcare provider for the appropriate duration and dosage.

- Warm Sitz Baths: Taking warm sitz baths can help soothe the anal area, reduce discomfort, and promote healing.

- Avoid Straining: When you feel the urge to have a bowel movement, try to relax and avoid straining. If you find it difficult, consider waiting a bit and trying again later.

- Follow-Up Care: Regular follow-up with your surgeon or healthcare provider is crucial. They can assess your healing progress and address any complications that may arise.

In conclusion, while your symptoms are not uncommon after hemorrhoid surgery, they should be monitored closely. If you experience worsening pain, significant bleeding, or any new symptoms, it is essential to seek medical advice promptly. Your healthcare provider can offer tailored recommendations and interventions to facilitate your recovery and improve your bowel function.

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