After complete healing from a hemorrhoidectomy, can a patient perceive the scar tissue and distinguish it from normal hemorrhoidal tissue?

Medical Advisory BoardAll articles are reviewed for accuracy by our Medical Advisory Board
Educational purpose only • Exercise caution as content is pending human review
Article Review Status
Submitted
Under Review
Approved

Last updated: February 25, 2026 • View editorial policy

Personalize

Help us tailor your experience

Which best describes you? Your choice helps us use language that's most understandable for you.

Can Patients Perceive Scar Tissue After Hemorrhoidectomy?

No, patients typically cannot distinguish healed hemorrhoidectomy scars from normal tissue through conscious perception alone, though altered rectal sensation may occur in a subset of patients due to changes in the underlying sensory apparatus rather than scar tissue itself. 1

Understanding Post-Hemorrhoidectomy Tissue Changes

Normal Healing and Tissue Appearance

  • After complete healing (typically 9–14 days for most patients), the excision sites undergo secondary intention healing that leaves minimal visible scarring, and the healed tissue blends with surrounding anoderm and rectal mucosa. 2

  • Conventional excisional hemorrhoidectomy (both Milligan-Morgan open and Ferguson closed techniques) removes hemorrhoidal tissue and underlying vascular structures, with the Ferguson technique closing wounds primarily and potentially offering slightly improved wound healing compared to the open approach. 1

  • The recurrence rate of only 2–10% after conventional hemorrhoidectomy indicates that the surgical site heals with sufficient structural integrity to prevent reformation of pathologic hemorrhoidal tissue. 1, 2

Sensory Changes vs. Scar Perception

The key distinction is that patients do not "feel" scar tissue as a discrete structure, but some may experience altered rectal sensation due to changes in the sensory nerve network. 1

  • Up to 12% of patients develop sphincter defects documented by ultrasonography and manometry after hemorrhoidectomy, which can alter proprioception and rectal sensation, but these changes reflect neuromuscular injury rather than scar tissue perception. 1, 3

  • Biofeedback therapy for altered rectal sensation after hemorrhoidectomy does not correct measurable physiological defects in rectal sensation; any clinical improvement stems mainly from psychological support rather than true sensory retraining, confirming that the sensation changes are not due to patients "feeling" scar tissue. 1

  • Two small randomized trials using 8-week biofeedback programs showed global symptom improvement, but a placebo-controlled trial of 60 patients found no additional benefit of formal biofeedback over attention-placebo control, further supporting that altered sensation is not about perceiving scar tissue. 1

Clinical Implications

What Patients Actually Experience

  • Anal stenosis, which occurs in 0–6% of patients and represents excessive scarring that narrows the anal canal, is the only scenario where scar tissue creates a functionally perceptible problem—but patients experience this as difficulty with defecation rather than tactile awareness of scar tissue. 1, 3

  • Incontinence (affecting 2–12% of patients) results from sphincter injury during surgery, not from scar tissue formation, and manifests as functional impairment rather than conscious perception of altered tissue. 1, 3

Distinguishing Normal Hemorrhoidal Tissue from Healed Surgical Sites

Patients cannot reliably distinguish healed hemorrhoidectomy sites from normal hemorrhoidal tissue through self-examination or sensation. 1

  • Normal hemorrhoidal tissue consists of vascular cushions underlying the distal rectal mucosa and anoderm that contribute to anal continence (corpus cavernosum function), and after successful hemorrhoidectomy, the remaining tissue maintains this normal architecture. 4, 5

  • Internal hemorrhoids originate above the dentate line and are covered by insensate rectal mucosa, while external hemorrhoids arise below the dentate line in pain-sensitive anoderm; after healing, the dentate line anatomy is preserved, and patients cannot distinguish surgical sites from native tissue in either zone. 5, 2

Critical Pitfalls to Avoid

  • Do not attribute persistent anal pain to "scar tissue" without proper evaluation, as uncomplicated hemorrhoids and healed hemorrhoidectomy sites should not cause pain; persistent pain suggests other pathology such as anal fissure, abscess, or thrombosis. 1

  • Avoid assuming that altered rectal sensation represents scar tissue formation; formal biofeedback evaluation may be warranted, but clinicians should set realistic expectations that biofeedback is unlikely to "re-train" deep rectal sensation or correct any sensory alterations. 1

  • Never delay evaluation of anal stenosis symptoms (difficulty with defecation, straining, narrow stools) by attributing them to "normal scar tissue," as stenosis occurs in 0–6% of patients and may require intervention. 1, 3

References

1
Guideline

Management of Hemorrhoids

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

3
Guideline

Post-Hemorrhoidectomy Complications

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

4
Research

Hemorrhoidectomy: indications and risks.

European journal of medical research, 2004

5
Research

Hemorrhoids.

Clinics in colon and rectal surgery, 2007

Related Questions

In an adult undergoing internal hemorrhoidectomy who has mild urgency, occasional fecal leakage, and altered rectal sensation, how important is the amount of hemorrhoidal tissue removed for overall patient well‑being?
What is the best course of action for a patient with a history of hemorrhoids who is passing dark red blood clots, up to a quarter in size, with painful bowel movements?
In a 28-year-old woman with intermittent painless rectal bleeding, spontaneously resolving anal swelling, anoscopic internal hemorrhoids at 3, 7, and 11 o’clock with active bleeding and anemia, what is the most appropriate management?
Where do internal hemorrhoids anatomically start?
What is the diagnosis for a patient with large internal hemorrhoids (internal piles) and multiple episodes of rectal bleeding, with small dark purple thrombosis (blood clots) on the hemorrhoids?
What is the recommended management for degenerative (osteoarthritic) arthritis of the foot?
Is the levonorgestrel‑releasing intrauterine system (Mirena) safe for a healthy 16‑year‑old female without contraindications?
What first‑line antipsychotic medication and dosing should be used for a 14‑year‑old adolescent with schizophrenia?
Do angiotensin‑II receptor blockers (ARBs) effectively lower blood pressure in patients with hypertension secondary to Agent Orange exposure?
What are the surgical options for chronic lower‑leg elephantiasis due to lymphatic filariasis or severe secondary lymphedema?
A 14-year-old girl with schizophrenia started aripiprazole (Abilify) 2 mg and feels very tired; what should be done?

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.

Have a follow-up question?

Our Medical A.I. is used by practicing medical doctors at top research institutions around the world. Ask any follow up question and get world-class guideline-backed answers instantly.

Ask Question