Hemorrhoids Recurrence After Surgery: What You Need to Know

Hemorrhoids Recurrence After Surgery: What You Need to Know

Hemorrhoid surgery is often recommended for patients with severe or persistent hemorrhoids that do not respond to conservative treatments. However, many patients and even some practitioners assume that surgery provides a permanent solution. While surgical procedures can effectively remove existing hemorrhoids, they do not eliminate the underlying factors that contribute to their development.

Understanding the causes of hemorrhoids recurrence after surgery, recognizing early warning signs, and implementing preventative strategies are crucial for long-term relief. This article explores why hemorrhoids can return, what factors increase the risk, and what patients can do to prevent recurrence.

Why Do Hemorrhoids Recur After Surgery?

Surgical Limitations and Risks

Although surgical procedures remove existing hemorrhoids, they do not prevent new ones from forming. The recurrence rate depends largely on the type of surgery performed:

  • Excisional hemorrhoidectomy – This procedure removes hemorrhoidal tissue entirely and has the lowest recurrence rates. However, it comes with a longer and more painful recovery.

  • Stapled hemorrhoidopexy (PPH) – This method involves repositioning hemorrhoidal tissue rather than fully removing it. While it results in less pain, recurrence rates tend to be higher.

  • Rubber band ligation – Often used for smaller, less severe cases, this technique has a higher likelihood of recurrence compared to surgical removal.

Since none of these procedures address the root cause—chronic pressure and irritation of the rectal veins—hemorrhoids may return if risk factors persist.

Underlying Causes of Hemorrhoid Formation Persist

Even after successful surgery, many patients experience hemorrhoids recurrence due to persistent risk factors, including:

  • Chronic constipation or excessive straining – Hard stools require more effort to pass, putting excess pressure on rectal veins.

  • Chronic diarrhea – Frequent bowel movements irritate the rectal area, contributing to weakened tissues.

  • Lifestyle factors – Poor diet, obesity, and prolonged sitting increase the likelihood of recurrence.

How Common is Hemorrhoid Recurrence After Surgery?

Studies suggest that hemorrhoids recurrence after surgery occurs in 5% to 25% of patients, depending on the procedure performed and lifestyle choices. Patients who do not address contributing factors, such as poor bowel habits or a sedentary lifestyle, are at a much higher risk of experiencing a return of symptoms.

One of the most common reasons for recurrence is inadequate post-surgical care or failure to make long-term lifestyle changes. Patients who adopt healthier habits and follow their colorectal specialist’s recommendations can significantly reduce their risk.

Key Risk Factors for Hemorrhoid Recurrence

1. Bowel Movement Patterns

Irregular or strained bowel movements play a central role in hemorrhoid recurrence.

  • Chronic constipation leads to hard stools that require increased pushing and straining.

  • Frequent diarrhea causes irritation and inflammation of rectal tissues.

  • Straining during defecation places excessive pressure on the hemorrhoidal veins, potentially leading to new hemorrhoids.

2. Diet and Hydration

A poor diet can contribute to hemorrhoid recurrence, especially if it lacks sufficient fiber and hydration.

  • Low fiber intake leads to harder stools that are difficult to pass.

  • Inadequate hydration slows digestion and causes constipation.

  • Excess processed foods disrupt gut health, making bowel movements more difficult.

3. Lifestyle Factors

Certain lifestyle choices can increase the likelihood of hemorrhoid recurrence.

  • Prolonged sitting (e.g., office jobs, truck drivers) reduces circulation in the rectal area.

  • Lack of exercise leads to poor digestive health and increased venous pressure.

  • Frequent heavy lifting increases intra-abdominal pressure, worsening strain on rectal veins.

4. Obesity and Metabolic Factors

  • Excess weight puts continuous pressure on the pelvic floor and rectal veins.

  • Metabolic conditions such as diabetes can impair tissue healing, increasing the risk of hemorrhoid recurrence.

5. Incomplete Healing After Surgery

  • Improper wound care can lead to inflammation, increasing the risk of new hemorrhoid formation.

  • Persistent tissue damage or poor healing can weaken the area, making it susceptible to recurrence.

Signs That Hemorrhoids May Be Recurring

Early Symptoms

  • Mild discomfort or itching around the anus.

  • Small amounts of bright red blood after bowel movements.

  • A sensation of fullness in the rectum.

Advanced Symptoms

  • Persistent swelling or lump formation.

  • Prolapse of hemorrhoidal tissue during bowel movements.

  • Increased pain, especially with thrombosed hemorrhoids.

Patients who experience any of these symptoms should consult a colorectal specialist to determine the best course of action.

Best Practices for Preventing Hemorrhoid Recurrence

1. Optimizing Bowel Health

  • Increase fiber intake

    • Consume 25–30 grams of fiber daily from vegetables, fruits, and whole grains.

    • Use fiber supplements (psyllium husk, methylcellulose) if needed.

  • Hydration

    • Drink at least eight glasses of water daily to promote soft stools.

  • Avoid straining

    • Use a squat position (with a footstool) to ease bowel movements.

2. Long-Term Lifestyle Adjustments

  • Exercise regularly

    • Walking, swimming, and cycling improve circulation.

    • Core-strengthening exercises help reduce intra-abdominal pressure.

  • Maintain a healthy weight

    • Excess weight exacerbates rectal pressure.

  • Avoid prolonged sitting

    • Stand and move every 30–60 minutes.

3. Post-Surgical Care Recommendations

  • Follow wound care instructions carefully to prevent complications.

  • Avoid heavy lifting for several weeks post-surgery.

  • Monitor for signs of infection, swelling, or prolonged discomfort.

4. When to Seek Medical Attention

  • Persistent rectal pain or discomfort.

  • Heavy bleeding that does not subside.

  • Hemorrhoidal tissue prolapsing beyond what is manageable.

Conclusion

Hemorrhoid surgery can provide effective relief, but it is not a guaranteed permanent solution. Hemorrhoids recurrence after surgery is possible, particularly if underlying risk factors are not addressed.

Patients can significantly reduce their chances of recurrence by adopting a high-fiber diet, staying hydrated, maintaining an active lifestyle, and avoiding excessive straining during bowel movements.

For those experiencing recurring symptoms, consulting a colorectal specialist can help determine the best approach to long-term prevention and management.

Brian Chandler