Post-Hemorrhoidectomy Complications

Complication Frequency Profile

The American Gastroenterological Association reports that urinary retention occurs in 2-36% of patients after hemorrhoidectomy, which is the most common complication, 1, 2, 3, 4
The American Gastroenterological Association notes that incontinence affects 2-12% of patients after hemorrhoidectomy, with sphincter defects documented by ultrasonography and manometry, 1, 2
Bleeding is a complication that occurs in 0.03-6% of patients after hemorrhoidectomy, according to the American Gastroenterological Association, 1, 2, 3, 4
Anal stenosis is reported in 0-6% of patients after hemorrhoidectomy, as stated by the American Gastroenterological Association, 1, 2, 3, 4
Infection occurs in 0.5-5.5% of patients after hemorrhoidectomy, according to the American Gastroenterological Association, 1, 2, 3, 4

The American Gastroenterological Association notes that postoperative pain is a major drawback of excisional hemorrhoidectomy, typically requiring narcotic analgesics, with most patients unable to return to work for 2-4 weeks, 4

Urinary retention occurs due to reflex inhibition from anal pain and sphincter spasm, as reported by the American Gastroenterological Association, 1
Excessive retraction with extensive dilation of the anal canal during surgery is a mechanism that contributes to urinary retention, according to the American Gastroenterological Association, 1, 2
The use of parasympathomimetics is sometimes needed to prevent urinary retention, as stated by the American Gastroenterological Association, 1, 3
Sphincter injury and incontinence result from excessive retraction with extensive dilation of the anal canal, as reported by the American Gastroenterological Association, 1, 2
Lateral internal sphincterotomy as an adjunct actually increases incontinence rates rather than reducing them, according to the American Gastroenterological Association, 1, 2

The American Gastroenterological Association advises against performing lateral internal sphincterotomy as an adjunct to hemorrhoidectomy, as it increases incontinence rates, 1, 2
Excessive retraction and dilation of the anal canal should be avoided, as it is the primary mechanism responsible for sphincter injury and subsequent incontinence, according to the American Gastroenterological Association, 1, 2

Stapled hemorrhoidectomy has comparable overall complication rates to conventional techniques but carries unique risks, including rectal perforation, retroperitoneal sepsis, and pelvic sepsis, as reported by the American Gastroenterological Association, 1, 5

Patients presenting within the first 24–48 hours after stapled hemorrhoidopexy with severe abdominal pain, peritoneal signs, fever, or hemodynamic instability should be considered at high risk for staple‑line failure and require urgent evaluation. 6

The American Gastroenterological Association states that life‑threatening complications such as rectal perforation, retroperitoneal sepsis, and pelvic sepsis arise when the procedure unintentionally excises the full‑thickness rectal wall rather than only mucosa and submucosa. 6

Broad‑spectrum antibiotic coverage is recommended for any patient with suspected full‑thickness rectal wall injury because of the elevated risk of pelvic sepsis. 6

Stapled hemorrhoidopexy should only be performed after direct intra‑operative inspection of the staple line to confirm that excision is limited to mucosa and submucosa; this precaution is the primary mechanism for preventing catastrophic complications. 6