Can hemorrhoidectomy cause permanent urinary retention or altered bladder filling sensation?

Hemorrhoidectomy Does Not Cause Permanent Urinary Retention or Altered Bladder Sensation

Urinary retention after hemorrhoidectomy is a common but temporary complication that resolves completely in the vast majority of patients; permanent urinary dysfunction is exceptionally rare and typically occurs only when severe complications such as necrotizing pelvic sepsis or prolonged untreated retention lead to secondary bladder or renal injury. 1, 2

Incidence and Natural History of Post-Hemorrhoidectomy Urinary Retention

• Acute urinary retention occurs in 2–36% of patients after hemorrhoidectomy, making it one of the most common early postoperative complications 3, 4
• The wide incidence range reflects differences in surgical technique, anesthesia type, fluid management, and pain control strategies 1, 5
• This retention is almost always transient, resolving within 24–48 hours with catheterization and appropriate management 1
• The ambulatory surgical setting combined with fluid restriction reduces urinary retention rates to as low as 0.53% 6

Primary Mechanisms of Temporary Retention

The urinary retention that occurs after hemorrhoidectomy is driven by reversible factors:

• Reflex inhibition of detrusor muscle contraction caused by anal-region pain and internal sphincter spasm is the primary mechanism 3
• Excessive retraction or dilation of the anal canal during surgery can injure the internal sphincter, further contributing to temporary voiding dysfunction 1
• Narcotic analgesics impair bladder sensation and detrusor contractility, but these effects resolve when opioids are discontinued 1
• Spinal or epidural anesthesia significantly increases retention risk compared to general anesthesia (odds ratio 2.43 for general anesthesia as protective) 5, 7, 4

The Single Case of Long-Term Retention: A Cautionary Exception

• One case report describes a female patient who developed long-lasting urinary retention progressing to renal failure after hemorrhoidectomy and internal sphincterotomy 2
• The precipitating cause was a non-healing anal ulcer with excruciating anal pain at evacuation, creating a vicious cycle of pain-induced retention 2
• This represents a preventable complication resulting from inadequate wound healing, inappropriate low-fiber diet, and uncontrolled pain—not an inherent risk of the procedure itself 2
• This case underscores that permanent retention occurs only when acute retention is inadequately managed or when severe complications develop, not as a direct consequence of properly performed hemorrhoidectomy 2

Prevention Strategies That Eliminate Long-Term Risk

Limiting incision size and avoiding excessive anal canal dilation minimizes sphincter trauma and reduces both acute and any theoretical long-term voiding dysfunction 1

Adequate pain control with multimodal non-opioid analgesia (acetaminophen 1000mg every 6 hours plus NSAIDs 400-600mg every 6-8 hours) reduces reflex bladder inhibition 1

Perioperative fluid restriction (limiting intravenous fluids to <1000ml) significantly decreases urinary retention incidence from 16.7% to 7.9% 4

Prophylactic analgesic treatment further reduces retention rates from 25.6% to 7.9% 4

Early catheter removal within 24-48 hours prevents urinary tract infection and allows normal voiding to resume 1, 3

Risk Factors for Acute (Not Permanent) Retention

Clinicians should monitor patients with these characteristics more closely in the immediate postoperative period:

• Female sex (independent risk factor in multiple studies) 7, 4
• Preoperative urinary symptoms or diabetes mellitus 4
• Spinal or epidural anesthesia rather than general anesthesia 5, 7, 4
• Resection of more than three hemorrhoid columns 4
• Third- or fourth-degree hemorrhoid severity 7
• Intravenous fluid administration >1000ml 4

Altered Bladder Filling Sensation: No Evidence of Permanence

• The evidence does not support any mechanism by which hemorrhoidectomy would cause permanent altered bladder filling sensation 1, 3
• Temporary changes in bladder sensation occur due to pain, opioid use, and anesthesia effects—all of which resolve 1, 3
• Biofeedback does not correct measurable physiological defects in rectal sensation after hemorrhoidectomy, and any symptom improvement stems from psychological support rather than true sensory retraining 8
• The therapeutic relationship and simple relaxation techniques provide equivalent benefit to formal biofeedback, confirming that sensory changes are not structural or permanent 8

Critical Pitfalls to Avoid

Never attribute prolonged urinary retention (>72 hours) to "normal postoperative recovery"—this requires immediate evaluation for complications such as unhealed anal wounds, severe pain, or early signs of necrotizing infection 1, 2

The clinical triad of severe pain, high fever, and urinary retention suggests necrotizing pelvic sepsis, a rare but life-threatening complication requiring emergency examination under anesthesia with radical debridement 1

Immunocompromised patients (uncontrolled AIDS, neutropenia, severe diabetes) have increased risk of necrotizing infection and require heightened vigilance 1

Stop or dramatically reduce opioid analgesics immediately if urinary retention develops, as opioid-induced constipation exacerbates both constipation and retention through increased pelvic floor tension 1

Management Algorithm for Acute Retention

When urinary retention occurs postoperatively:

1. Insert a Foley catheter immediately to measure residual volume and provide relief 1
2. Plan for early catheter removal within 24-48 hours to prevent urinary tract infection 1, 3
3. Switch to multimodal non-opioid analgesia (acetaminophen plus NSAIDs if not contraindicated) 1
4. Ensure adequate bowel regimen with osmotic laxatives and stool softeners to reduce pelvic floor tension 1
5. Reassess if unable to void within 6-8 hours after catheter removal 3

Pelvic Floor Physical Therapy for Persistent Symptoms

If urinary symptoms persist beyond the acute postoperative period (which is exceedingly rare):

• Pelvic floor muscle training is the first-line therapeutic option for overactive bladder and urinary symptoms, emphasizing functional retraining over isolated strengthening 8
• Integrating cognitive-behavioral therapy with pelvic floor exercises can help reduce anxiety, discomfort, and lower urinary tract symptoms 8
• These recommendations are based on expert consensus for the rare patient with persistent symptoms, not because permanent dysfunction is expected 8