Anorectal Surgery Post-Op Instructions

Anorectal Surgery Post-Op Care Instructions

SOME ANORECTAL OPERATIONS ARE PAINFUL. In order to minimize your discomfort and maximize the rate at which you heal, the following instructions have been prepared. Please read it through as it will help answer many questions you might have. Any other instructions given to you at the facility should not override these instructions. If you have read these instructions pre-operatively and have questions, please call and get your answers before surgery.

MEDICATIONS:

  • * Local anesthesia is usually injected for postoperative pain relief; usually lasting for 4-6 hours.
  • * Resume all prescribed medications you were taking regularly before surgery unless otherwise instructed. Take prescribed postoperative medications as instructed.

PAIN CONTROL:  The goal is to relieve acute pain to a tolerable level. During healing, some pain is normal. Do not take pain medicines on an empty stomach.

  • * Begin taking oral pain medication when you get home after surgery, use the schedule below:
    • 1) Toradol (Ketorolac) or Advil (Ibuprofen): Take 10mg Ketorolac or two 200mg Ibuprofen tablets (400mg) every six hours, this reduces pain and swelling. If you suffer ulcers or stomach irritation, do not take. If bleeding is excessive, discontinue. If you are allergic to aspirin, do not take.
    • 2) Tylenol (acetaminophen): Two 500mg tablets (1,000mg) every six hours.
    • 3) Alternate Advil and Tylenol to take one or the other every three hours. You may substitute Vicodin for Tylenol. Tylenol dose should not exceed four grams (4,000mg) per day.
    • 4) Hydrocodone (Vicodin):  One every four hours or two every six hours. These contain acetaminophen (Tylenol). You may substitute for Tylenol. Do not add any more Tylenol.
    • 5) Muscle relaxers every 6 hrs.
  • * Fiber Supplements such as Konsyl, Metamucil, or Benefiber should be taken two times a day while the wound(s) are healing.
  • * Take Milk of Magnesia 1 tablespoon daily for the first seven days post-operatively.
  • * If you have not had a bowel movement within 48 hours after discharge, take 2 Ducolax tabs.
  • * If you have not moved your bowels by the morning of the 4th day following surgery call the office.

DISCHARGE/INFECTION: 

  • * Some bloody discharge, especially after bowel movements, is normal for at least two to four weeks after rectal surgery. If you have profuse, continuous bleeding with passage of clots, call your doctor immediately. There may be gelfoam packing which will slough and dissolve on its own. 
  • * Fever and chills in the first 24 hrs. after general anesthesia is normal.  Post-operative infection around the rectal opening is surprisingly uncommon despite the obvious contamination by stool. This is probably because of the excellent blood supply to the area.

WOUND CARE:

  • * After surgery, having an ice pack close to the area will help decrease the swelling. Use intermittently 30 minutes on and then 30 minutes off in an effort to reduce pain and swelling.
  • * Sit in a tub of water or Sitz bath with the water as warm as you can tolerate for approximately 30 minutes, at least 3 times a day, especially after a bowel movement. Start baths the evening of surgery and apply the prescribed cream after baths.  You may use a handheld shower at home if you have one. Its name comes from the German verb “sitzen,” meaning “to sit.”
  • * Apply a small amount of the moisture barrier ointment (Calmoseptine, Desitin, etc.) around the outside with a finger after each sitz bath or shower and after each bowel movement. Start the evening of surgery. These ointments will help protect the operative site skin and help with itching and burning from temporary seepage, which is a normal part of healing. You may also be given a prescription cream to apply the evening of surgery as well. Please take as directed. Kleenex Cottonelle wipes may be used after toilet paper as needed for anal comfort and hygiene. Do not try to wash or scrub off barrier protection ointment during showers or bathing. You may also use a 4×4 gauze dressing or cotton ball on open wounds to further prevent itching and irritation of perianal skin from any drainage. Use loose cotton underwear; not tape to hold cotton ball or gauze dressing in place. Large dressings or pads can be used to protect clothing or underwear but should not replace 4×4 gauze or cotton ball placed within an open perianal wound.
  • * Avoid any sitting “doughnuts” or any persistent pressure to the area. Use a soft fluffy pillow to sit and change positions frequently.
  • * It is not uncommon (20-30%) to have minor bowel leakage (soiling) after anorectal surgery. The leakage resolves after all the healing has finished in 6-8 weeks
  • * You make have a packing in the anal opening. This will fall out with your first bowel movement. If it falls out earlier, that is OK.

STITCHES/SWELLING:

  • * You may have some stitches after surgery. These will dissolve on their own. Do not be alarmed by the swelling of the skin tags you may have around the anus. These are not hemorrhoids, but simply a response of the skin to the stitches and/or surgery you have had. The swelling will decrease daily. Sitz baths will help speed this process. Stitches may break apart, do not become alarmed. Healing will still proceed normally. Swollen skin tags will get smaller in time. Skin tags are the price one pays to avoid an anal stricture from removing too much perianal skin during a conventional hemorrhoidectomy. This is rarely a problem with the THD. Any remaining bothersome skin tags can be easily removed at a later date once all healing is complete (approximately 6-12 months).

URINATION: 

  • * It is not uncommon to have difficulty completely emptying your bladder after surgery. If this happens after you get home, try to encourage urination by sitting in a warm tub or standing in a warm shower.
  • * If you are still unable to empty your bladder and become painfully distended, you will need a Foley catheter. In this case you will need to go to the closest Emergency Room to have them insert the catheter into your bladder. This Foley catheter will stay in 4 to 7 days. The ER will instruct you on how to remove the catheter at home. Have the ER call my office if they need orders for the foley catheter.

DIET:

  • * Feeling tired, sometimes with nausea, is common. Plan a light meal immediate after the surgery and continue to drink liquids, since many patients may be dehydrated.
  • * Once nausea resolves, A regular diet, including plenty of fresh fruit and vegetables, is recommended. Try to drink 6 to 8 glasses of water per day.

ACTIVITIES:   

  • * You may be out of bed as desired.  You may use the stairs.
  • * No heavy lifting or strenuous exercise for 2 weeks.
  • * You may drive when you are no longer taking narcotics for pain. 
  • * Return to work or full activity when able to do so without significant pain. Depending on the type of operation you had it may be 3 to 7 days (i.e. fissure surgery) or 3 to 6 weeks (i.e. standard hemorrhoidectomy, complex fistulotomy or sphincteroplasty).

CAUSE FOR CONCERN:  If any of the following occur, please call our office and speak with a nurse who will help you with your problem or ask the doctor to call you:

  • * Persistent fever over 101° F
  •  * Heavy or persistent bleeding from the rectum
  • * Pain that is not relieved by your medications
  • * Constipation
  • * Chills

BE SURE TO KEEP YOUR FOLLOW-UP APPOINTMENT IN OUR OFFICE. IF AN APPOINTMENT WAS NOT MADE FOR YOU, PLEASE CALL THE OFFICE THE NEXT BUSINESS DAY AND MAKE AN APPOINTMENT TO BE SEEN IN 2 TO 4 WEEKS OR SOONER IF INSTRUCTED IN POST-OP ORDER.

Some common potential complications following anorectal surgery are in order of most frequent to least:

  1. Urinary retention (10-30%)
  2. Swollen skin tags after conventional hemorrhoidectomy (6%), not with THD
  3. Fecal Impaction (avoidable- 1%)
  4. Anal stricture/stenosis (avoidable and may eventually need dilatation under anesthesia- 1%))
  5. Significant bleeding (less than 1%)
  6. Infection (rare and less than 1%)
  7. Pruritis Ani “Monkey Butt” (avoidable if barrier ointment is used 24/7 as instructed).
  8. Thrombosed external hemorrhoids after THD or LIS (less than 1%)

Finally, if you have any questions or concerns regarding your surgery or recuperation please DO NOT HESITATE to call our office –we are here to help in any way we can.