Why Some Hemorrhoidectomy Patients Feel Less Pain Than Others

I remember being very frustrated after reading hundreds of patient posts on post-hemorrhoidectomy recovery. About 80% are between horror stories and pain-saturated narratives, yet 20% or less of posts talked about how easy an recovery it is and would do it again. The frustration is we don’t know which train we are going to get on. Maybe you didn’t, but I seriously did and have not stopped wondering why there is the difference. How could we be more informed about what our recovery would be like? Are there factors we could use to predict what type of recovery we are going to have? After a few months of obsession of my own recovery,  I have at least one hypothesis about why and want to hear what you think. 

I emphasize this is purely my hypothesis and I have no formal medical training. I could be totally wrong. But prove me if you could. My purpose is simple – I want to do my part to help us understand how this procedure affects our body, so the next fellow patient and many future patients (could very well include our loved ones – hopefully not ourselves again 🙂 don’t have to go through what we have, or at least their sufferings can be somewhat alleviated.

Aside from some obvious reasons, such as how many incisions and the size of the incision, I believe the location of the incision matters tremendously. The most severe pain, according to most of our fellow patients, comes from BMs. Some of us experienced repeated tear-open of the incision, thus prolonging the pain and recovery. In my own case, I had two incisions, both at the back of the anus opening (6 o’clock position). In my opinion, this is the worst spot to have the incision. Here’s why.

Image Credit to Wisegeek.com

Start by looking at this illustration of our rectum. The end of our rectum is curved backwards, which forces stool to make a turn before heading out. Without this curve, the passage is a straight pipe – image how straight forward that is! Well, that’s not how our body is built. According to Wikipedia, this curved section is called rectal ampulla. It’s where feces are stored before release via anal canal. (So I guess we need the storage and gate control. Otherwise things just run and that’s not good! ) However, this change of direction forces stool to push onto the back wall of anal canal and opening before existing.

An incision on the back wall of the anal canal or opening therefore gets more impact during a BM, compared to an incision that’s on the front. So this explains my hypothesis that incisions on the back are more painful and take longer to recover. According to a NIH report, majority of anal fissure occurs at the 6 o’clock position.

In addition to the position of incision, as I’ve learned, post op infection, such as abscess, fissure, could also cause pain. If you are not sure about the source of your pain, please have those conditions checked.