After an internal hemorrhoidectomy, how much will an adult patient with mild urgency, occasional leakage, and altered rectal sensation perceive the scar site once it has healed?

Post-Hemorrhoidectomy Scar Perception and Healing

After internal hemorrhoidectomy, the surgical site will be essentially imperceptible to the patient once healed—the anal canal mucosa and perianal skin regenerate with minimal visible scarring, and most patients report complete resolution of symptoms with normal sensation by 6 weeks. 1

Expected Healing Timeline and Scar Formation

• Median healing time is 6 weeks after conventional hemorrhoidectomy, at which point the surgical wounds are fully epithelialized and functional recovery is complete. 2

• Closed (Ferguson) hemorrhoidectomy achieves faster wound healing than open (Milligan-Morgan) technique, with 75% of closed-technique patients fully healed at 3 weeks compared to only 18% in the open group. 3

• The anal canal mucosa above the dentate line and the perianal skin below regenerate with minimal visible scarring because these tissues have excellent blood supply and rapid epithelial turnover. 1

What Patients Actually Perceive After Healing

Physical Sensation and Appearance

• Most patients report no abnormal sensation or visible scarring at the healed hemorrhoidectomy site during routine activities or defecation. 2

• Skin tags develop in only 2 out of 633 patients (0.3%) at 1-year follow-up, representing the most common visible residual finding. 2

• Anal stenosis occurs in 0–6% of cases, which would be perceived as narrowing or tightness during defecation rather than visible scarring. 1, 4

Functional Outcomes and Symptom Resolution

• Anal pain drops from a median of 5.5/10 preoperatively to 0.1/10 at 1 year, indicating near-complete resolution of discomfort at the surgical site. 2

• Anal discomfort similarly decreases from 5.5/10 to 0.1/10 at 1 year, confirming that patients do not perceive the healed site as problematic. 2

• 88% of patients report being satisfied or very satisfied at 1-year follow-up, suggesting the healed surgical site does not negatively impact quality of life. 2

Addressing Your Specific Concerns: Urgency, Leakage, and Altered Sensation

Impact on Continence and Sensation

• The median Wexner incontinence score remains unchanged (2/20) at 1 year, indicating that hemorrhoidectomy does not typically worsen baseline urgency or leakage. 2

• De-novo anal incontinence (Wexner score >5) affects 8.5% of patients at 1 year, but importantly, preoperative incontinence disappears in 16.7% of patients, suggesting the surgery may actually improve rather than worsen these symptoms. 2

• Up to 12% of patients may develop sphincter defects detectable by ultrasound or manometry, but these are usually subclinical and do not correlate with patient-perceived symptoms. 1, 5

Rectal Sensation After Healing

• Altered rectal sensation typically normalizes as the surgical site heals, because the sensory nerve endings in the anal canal regenerate during the 6-week healing period. 2

• Anal pain is generally not associated with uncomplicated healed hemorrhoidectomy sites; persistent pain suggests other pathology such as fissure or stenosis. 1

Critical Factors That Influence Scar Perception

Surgical Technique Matters

• Closed (Ferguson) technique produces less visible scarring and faster healing compared to open (Milligan-Morgan) technique, with significantly better wound appearance at 3 weeks. 3

• Avoiding circumferential excision and limiting tissue removal to only symptomatic hemorrhoidal tissue reduces the risk of stenosis and visible scarring. 4

• Emergency hemorrhoidectomy carries significantly higher rates of late anal stenosis (which would be perceived as tightness) compared to elective procedures, because more extensive tissue removal is required in acutely inflamed, thrombosed hemorrhoids. 4

Postoperative Interventions That Improve Healing

• Botulinum toxin injection into the internal anal sphincter at the time of hemorrhoidectomy significantly accelerates wound healing and reduces postoperative pain, potentially improving the final appearance and sensation of the healed site. 6

• Diosmin-hesperidin (flavonoid therapy) can be used as an adjunct to standard postoperative care (narcotic analgesics, stool softeners, sitz baths) to support healing, although symptom recurrence reaches 80% within 3–6 months after cessation. 7, 8

Common Pitfalls and What to Avoid

• Do not assume that mild urgency, occasional leakage, or altered sensation are caused by the hemorrhoidectomy scar itself—these symptoms may reflect pre-existing sphincter dysfunction, obstetric injury, or other comorbidities that were present before surgery. 5

• Anemia due to hemorrhoidal disease is rare (0.5 per 100,000 population), so if your patient has significant anemia, ensure colonoscopy has been performed to exclude inflammatory bowel disease or colorectal cancer. 1

• Persistent anal pain at the healed site is not normal—it suggests complications such as fissure, abscess, or stenosis that require further evaluation. 1

• Avoid attributing all anorectal symptoms to the healed hemorrhoidectomy site—up to 20% of patients with hemorrhoids have concurrent anal fissures, and other conditions may coexist. 1

Bottom Line for Your Patient

The healed hemorrhoidectomy site will not be visible or palpable to your patient during normal activities. 2 The anal canal mucosa and perianal skin regenerate completely by 6 weeks, leaving no significant scarring that the patient can perceive. 2, 3 The mild urgency, occasional leakage, and altered sensation you describe are more likely related to pre-existing sphincter dysfunction or other factors rather than the surgical scar itself. 5, 2 If these symptoms persist beyond 6 weeks, further evaluation with anorectal manometry and endoanal ultrasound is warranted to identify the underlying cause. 5