Internal Hemorrhoidectomy Does Not Cause Chronic Fatigue
Internal hemorrhoidectomy is not associated with chronic fatigue as a recognized complication. The established complications of hemorrhoidectomy include postoperative pain, bleeding, urinary retention, anal stenosis, infection, and sphincter defects—but chronic fatigue is not documented in the medical literature as a sequela of this procedure 1, 2.
Recognized Complications of Hemorrhoidectomy
The well-documented complications following internal hemorrhoidectomy include:
- Urinary retention occurs in 2–36% of patients, primarily due to reflex inhibition of bladder function from anal pain and sphincter spasm 3, 4
- Postoperative bleeding affects 0.03–6% of patients, typically when the eschar sloughs 1–2 weeks after surgery 2, 4
- Anal stenosis develops in 0–6% of cases due to excessive tissue excision or scarring 2, 4
- Perianal infection/abscess occurs in 0.5–5.5% of patients 2, 4
- Sphincter defects are documented by ultrasonography in up to 12% of patients, particularly when excessive retraction or dilation is performed 2, 4
- Fecal incontinence ranges from 2–12% depending on surgical technique and patient factors 2, 4
Expected Recovery Timeline
The typical recovery course after hemorrhoidectomy is well-defined:
- Most patients return to work within 2–4 weeks after conventional hemorrhoidectomy 2
- Narcotic analgesics are generally required during the early postoperative period for pain management 2, 3
- Minimal spotting or small amounts of bleeding are normal and typically resolve within 7–14 days 3
Why Chronic Fatigue Is Not a Recognized Complication
The absence of chronic fatigue from the complication profile is notable because:
- Hemorrhoidectomy is a localized anorectal procedure that does not involve systemic metabolic changes or major organ systems that would predispose to chronic fatigue 1
- The procedure addresses vascular cushions in the anal canal, not structures involved in energy metabolism or systemic function 1
- Large-scale studies and comprehensive reviews of hemorrhoidectomy complications spanning decades do not report chronic fatigue as an outcome 2, 4, 5, 6
Alternative Explanations to Consider
If a patient reports persistent fatigue after hemorrhoidectomy, investigate:
- Anemia from preoperative hemorrhoidal bleeding that has not yet resolved—anemia due to hemorrhoidal disease is rare (0.5 per 100,000 population) but when present requires evaluation 1, 2
- Postoperative anemia from surgical blood loss, particularly if bleeding complications occurred 2, 3
- Narcotic analgesic use during recovery, which can cause sedation and fatigue 2, 3
- Unrelated medical conditions that coincidentally manifested around the time of surgery 1
- Depression or anxiety related to the surgical experience or chronic pain, rather than a direct physiologic effect of the procedure 4, 6
Critical Pitfall to Avoid
Never attribute chronic fatigue to hemorrhoidectomy without thorough evaluation for alternative causes, including complete blood count to assess for anemia, review of all medications (especially opioids), and assessment for systemic conditions unrelated to the anorectal surgery 1, 2, 3.