Most Common Complication After Hemorrhoidectomy
Urinary retention is the most common complication after hemorrhoidectomy, occurring in 2-36% of patients, followed closely by pain which affects 5-60% of patients depending on the specific technique used. 1
Complication Frequency Profile
The American Gastroenterological Association provides clear data on post-hemorrhoidectomy complication rates:
- Urinary retention: 2-36% - The widest range and highest upper limit of all complications 1
- Incontinence: 2-12% - Sphincter defects documented by ultrasonography and manometry in up to 12% of patients 1
- Bleeding: 0.03-6% 1
- Anal stenosis: 0-6% 1
- Infection: 0.5-5.5% 1
Pain as a Competing "Most Common" Complication
While urinary retention has the highest reported upper limit, pain deserves special mention as it is reported in 5-60% of patients after rubber band ligation and is the predominant complaint after conventional hemorrhoidectomy. 2 The American Gastroenterological Association notes that postoperative pain is the major drawback of excisional hemorrhoidectomy, typically requiring narcotic analgesics with most patients unable to return to work for 2-4 weeks. 1
Mechanism and Risk Factors
Urinary retention occurs due to:
- Reflex inhibition from anal pain and sphincter spasm 1
- Excessive retraction with extensive dilation of the anal canal during surgery 1
- Use of parasympathomimetics is sometimes needed to prevent this complication 1
Sphincter injury and incontinence result from:
- Excessive retraction with extensive dilation of the anal canal 1
- Lateral internal sphincterotomy as an adjunct actually increases incontinence rates rather than reducing them 1
Critical Pitfalls to Avoid
Never perform lateral internal sphincterotomy as an adjunct to hemorrhoidectomy - randomized studies show this increases incontinence rather than providing benefit. 1
Avoid excessive retraction and dilation of the anal canal - this is the primary mechanism responsible for sphincter injury and subsequent incontinence. 1
Be aware that complications occur with significant frequency even when the procedure is performed correctly - approximately 10% of patients may have a complicated follow-up including bleeding, fissure, fistula, abscess, stenosis, urinary retention, soiling, or incontinence. 3
Technique-Specific Complication Patterns
Stapled hemorrhoidectomy has comparable overall complication rates to conventional techniques but carries unique risks of rectal perforation, retroperitoneal sepsis, and pelvic sepsis when full-thickness rectal wall is inadvertently excised. 1, 4
Rubber band ligation complications include pain (5-60%), abscess, urinary retention, band slippage, and prolapse/thrombosis of adjacent hemorrhoids (approximately 5%). 2