Can a hemorrhoidectomy (hemorrhoid removal surgery) cause pain the day after surgery?

Post-Hemorrhoidectomy Pain: Expected and Manageable

Yes, pain is a common and expected occurrence the day after hemorrhoidectomy surgery, and is considered the major drawback of this procedure. 1 Excisional hemorrhoidectomy, while being the most effective treatment for hemorrhoids (especially third-degree hemorrhoids), is associated with significant postoperative pain that typically requires narcotic analgesics for management. 1

Pain Characteristics After Hemorrhoidectomy

• Postoperative pain is so significant that most patients do not return to work for 2-4 weeks following surgery. 1
• Pain typically begins immediately after surgery and continues through the recovery period, with the first few days often being the most intense. 1
• The severity of pain correlates with the number of hemorrhoidal cushions removed - more extensive surgery results in greater pain and increased need for opioid analgesics. 2

Why Pain Occurs After Hemorrhoidectomy

• The anal canal is richly innervated with sensory nerve fibers, making it highly sensitive to pain. 1
• Surgical excision creates wounds in this sensitive area that become exposed to stool, digestive enzymes, and friction during bowel movements. 1
• Anal sphincter spasm after surgery contributes significantly to postoperative pain. 1, 3
• The type of hemorrhoidectomy technique influences pain levels, though pain is common with all techniques. 1

Pain Management Approaches

• Multimodal analgesia is required, typically including:

  • Narcotic analgesics for the first few days 1
  • Non-steroidal anti-inflammatory drugs (NSAIDs) 4, 3
  • Acetaminophen/paracetamol as part of the regimen 3
  • Topical agents (lidocaine/lignocaine, glyceryl trinitrate) 3

• Surgical technique considerations:

  • Closed (Ferguson) hemorrhoidectomy may offer some pain reduction advantages compared to open techniques 4
  • Using vascular sealing devices or ultrasonic scalpels during surgery may reduce postoperative pain 4
  • Stapled hemorrhoidectomy typically results in less postoperative pain than conventional excisional techniques 1

• Adjunctive measures:

  • Oral metronidazole has shown benefit in reducing post-hemorrhoidectomy pain 4, 3
  • Stool softeners and laxatives help reduce pain during bowel movements 3
  • Sitz baths provide symptomatic relief 1

Potential Complications Related to Pain

• Urinary retention (2-36% of cases) can be exacerbated by pain and pain medications 1
• Constipation due to pain-related reluctance to have bowel movements 3
• Persistent pain beyond the expected recovery period may indicate complications such as:
  • Anal stenosis (0-6% of cases) 1
  • Infection (0.5-5.5% of cases) 1
  • Retained staples (in stapled hemorrhoidectomy) 5

Important Considerations

• Pain after hemorrhoidectomy is expected and does not necessarily indicate a complication unless it is severe, worsening, or accompanied by other concerning symptoms like fever or excessive bleeding. 1
• The intensity of pain typically diminishes gradually over days to weeks. 2, 3
• Patients should be counseled preoperatively about the expected pain to set appropriate expectations. 4, 6
• Despite advances in surgical techniques and pain management, post-hemorrhoidectomy pain remains a significant challenge in colorectal surgery. 2