Postoperative pain after haemorrhoidectomy: role of impaired evacuation

We hypothesized that obstructive defaecation is associated with more postoperative pain after haemorrhoidectomy.

Fifty patients with grade IV haemorrhoids were included in a prospective study. Impaired evacuation was defined as the inability to evacuate a rectal balloon. Perianal sensitivity was evaluated by means of an algometer, and anxiety and depression were assessed by the hospital anxiety and depression (HAD) scale. Over the first 10 days after a Milligan-Morgan haemorrhoidectomy, the following parameters were measured on daily questionnaires: pain (associated with and unrelated to defaecation by means of visual analogue scales), number of bowel movements, faecal consistency and analgesic requirement on demand (tramadol 50 mg p.o., number of doses). Results are expressed as median and interquartile range or mean ± SE.

Patients with impaired evacuation (14 women, eight men; age range 28-61 years) experienced more postoperative pain than patients with nonimpaired evacuation (eight women, 20 men; age range 24-70 years): 3.2 (2.1) vs 2.1 (1.8) defaecatory pain, respectively (P = 0.045), and 2.4 (2.3) vs 1.7 (2.3) nondefecatory pain, respectively (P = 0.048). There was no difference between the groups regarding stool consistency, number of bowel movements [12.5 (7.3) vs 15.5 (7.2), respectively; NS] and analgesic requirement [1.0 (6.1) vs 1.0 (5.2) extra doses on demand, respectively; NS] during the 10 postoperative days. No differences related to age, sex, HAD scores or perianal sensitivity were found.

Impaired anal evacuation is predictive of postoperative pain after haemorrhoidectomy.