Can hemorrhoidectomy or lateral internal sphincterotomy (LIS) affect bladder sensation?

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Can Hemorrhoidectomy or Lateral Internal Sphincterotomy Affect Bladder Sensation?

Yes, both hemorrhoidectomy and lateral internal sphincterotomy (LIS) can significantly affect bladder function, with urinary retention occurring in 2–36% of patients after hemorrhoidectomy. 1

Urinary Retention After Hemorrhoidectomy

Urinary retention is one of the most common complications following hemorrhoidectomy, with a wide reported incidence range reflecting variation in surgical technique, anesthesia type, and patient factors. 1

Mechanism of Bladder Dysfunction

  • The high incidence of urinary retention after anorectal surgery stems from reflex inhibition of bladder detrusor muscle contraction caused by pain and sphincter spasm in the anal region. 1
  • Excessive retraction and dilation of the anal canal during surgery can cause sphincter injury, which contributes to postoperative complications including urinary retention. 1
  • Narcotic analgesics required for postoperative pain management further impair bladder sensation and detrusor contractility. 1

Clinical Presentation

  • Patients typically develop inability to void within 6–8 hours postoperatively, often accompanied by suprapubic discomfort and bladder distension. 2
  • The condition is usually temporary, resolving within 24–48 hours with appropriate management. 2

Effect of Lateral Internal Sphincterotomy on Urinary Retention

Adding LIS to hemorrhoidectomy actually reduces the incidence of urinary retention compared to hemorrhoidectomy alone. 3, 4

Evidence from Comparative Studies

  • A 2021 randomized trial of 200 patients found significantly lower urinary retention rates when LIS was added to hemorrhoidectomy (p=0.01). 3
  • A 2016 systematic review of 2,180 patients reported that urinary retention ranged from 0–60% after LIS, but overall rates were lower than hemorrhoidectomy without sphincterotomy. 4
  • A 2000 prospective study demonstrated that patients who underwent LIS had better postoperative outcomes, including reduced urinary retention, compared to hemorrhoidectomy alone. 5

Mechanism of Benefit

  • LIS reduces internal anal sphincter spasm and resting anal pressure, which decreases the reflex inhibition of bladder function that causes urinary retention. 6, 5
  • By lowering postoperative pain intensity, LIS indirectly reduces the need for high-dose narcotics that impair bladder sensation. 3, 4

Management of Postoperative Urinary Retention

Prevention Strategies

  • Remove urinary catheters within 24 hours after surgery in most cases to reduce the risk of catheter-associated complications while balancing retention risk. 2
  • Use topical 0.3% nifedipine with 1.5% lidocaine ointment every 12 hours to reduce anal sphincter spasm and associated pain, which may prevent reflex bladder inhibition. 2
  • Administer scheduled NSAIDs and acetaminophen rather than relying primarily on opioids, minimizing narcotic-induced bladder dysfunction. 2

Treatment When Retention Occurs

  • Catheter reinsertion should be considered if the patient is unable to void within 6–8 hours postoperatively, particularly if bladder distension is present. 2
  • Warm sitz baths 3–4 times daily may help relax pelvic floor muscles and facilitate voiding. 2
  • Parasympathomimetic agents have been studied to avoid urinary retention, though results have been mixed. 1

Critical Pitfalls to Avoid

  • Never assume urinary retention is "normal" or self-limited without assessment—prolonged bladder overdistension can cause permanent detrusor damage. 2
  • Do not attribute all postoperative voiding difficulty to the surgery alone—evaluate for other causes including medications, fluid overload, or pre-existing bladder dysfunction. 1
  • Avoid excessive anal dilation during surgery, as this technique causes sphincter injuries and has a 52% incontinence rate at long-term follow-up, while also increasing urinary retention risk. 1
  • Do not routinely leave urinary catheters in place beyond 24 hours unless specific indications exist, as prolonged catheterization increases infection risk without proven benefit. 2

Comparative Risk: LIS Versus Hemorrhoidectomy Alone

The evidence consistently shows that adding LIS to hemorrhoidectomy reduces rather than increases urinary retention risk, contrary to what might be expected from adding an additional sphincter-disrupting procedure. 3, 4, 5 This paradoxical benefit occurs because the reduction in sphincter spasm and postoperative pain outweighs any direct effect of the sphincterotomy itself on bladder function. 6, 5

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

2
Guideline

Post-Operative Care After Hemorrhoidectomy

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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