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Here is what I came up with for things to do when I was researching surgery. I also tried to organize things into a reasonable timeline of when things should be occurring. Hopefully this will be of use to someone else also. If anything is a bad idea, don't blame me - I borrowed it from other posts.

[B]Things to Have Before Surgery [/B]

Fleet enemas
Panty liners; 4x4 gauze
Flushable aloe vera baby wipes; ie "Kandoo"
Squeeze ketchup bottle for makeshift bidet
Ointments - cocoa butter, diaper rash lotion, aloe plant, lidocaine, Desitin, A&D ointment, hydrocortizone, Prep H, Benedryl cream
Stool softener: milk of magnesia, metamucil, citricel, Sennakot, delcolax, collace, mineral oil, fish oil
Multivitamin, Magnesium pills
Pain pills: Tylenol, Advil, Motrin
Epsom salt
Fruits (prunes also), vegetables, greens, bran, juice (prune juice), canned fruit, Soups, jello, puddings, fig newtons, wheat bread, yogurt
Bucket to carry around for nausea
Book or mp3 player to pass time in tub. Nothing corded to an outlet.



Take a stool softener such as Metamucil or Citrucel for a few days prior and after the procedure. Don't overdo it - use just need enough to keep the stool soft. Remember to drink plenty of water - this should make the first BM less painful.
It's a good idea to be eating a high fiber (low meat) diet a few days prior to surgery - plenty of vegetables and fruit and high fiber cereals and breads.

Prior to coming in, take one to two enemas an hour or two before the planned surgery - as directed by your doctor. Hold the enema for 5 to 10 minutes and then expel it. Fleets enemas or tap water enemas are fine.

[B]Day of Surgery[/B]

[U]Surgery [/U]

Local anesthetic should last 6 to 12 hours after surgery. You will leave only after the anesthesia wears off and you have urinated.

[U]Care Directly After Surgery [/U]

Take pain meds as prescribed and on time. Do not combine Percocet and Vicodin - you'll get ill. Percocet claimed to work best...start with it and switch off every 4 to 6 hrs. Use an alarm to keep on schedule through the night - Pain meds will take approximately 30 minutes to kick in - staying on schedule is important.
Some doctors may recommend that you take an antibiotic (such as metronidazole) to prevent infection and reduce pain.
Ice packs applied to the anal area may reduce swelling and pain.
Frequent soaks in warm or hot water (sitz baths) help relieve pain and muscle spasms. Recommended to add epsom salts to bath - roughly 1/3-1/2 cup of epsom salts either every or every other time. This may speed recovery.
Try to walk some - at least 3 trips to the end of the house. You won't feel like it, but it will make you feel better in the long run. Carry a small bucket in case of nausea.

[U]First Bowel Movement [/U]

Recommended that you take stool softeners that contain fiber to help bm.
Have a tub of hot water ready before you have your BM.
Do not strain - you will be risking getting fissures or another hernia.
You may apply numbing medicines before and after bm to relieve pain.
Do not, no matter how much you want to - hold it in. This will just hurt you worse. Breathe through the bm - do not hold your breath - try the Lamaze technique of breathing.
If it is too painful, you can climb into the tub of hot water to relieve yourself & clean up afterward.
Otherwise, finish BM and optionally clean with aloe wipes and get into hot bath for relief.

In addition to stool softeners and citrucel, One doctor recommended to take Sennakot - or any vegetable based laxative - if there is no BM after 2 days.

[U]Food [/U]

It is very important to have a high fiber diet so that your stool remains soft. Your diet should be high in fruits, vegetables, greens, bran, juice, etc. Canned fruit is handy for convenience. Soups, jello, oatmeal, and puddings are also recommended. Eat nothing fried, spicey, acetic (take heed with citric and tomato products) for many weeks. Be sure to chew well. Note that some complain that bran and cereals can cause pain due to being rough when expelling later - also some Dr's recommend holding off on the high fiber because of the bulk it adds but other want the bulk to prevent narrowing of the anus. They recommend so to stick with soft foods with softeners. One recommendation is 30 g fiber per day - fig newtons, wheat bread, bean soups (be aware that gas will cause pain) are ways to increase fiber. If you eat only liquids it will constipate you and might cause your rectum to narrow from not stretching from the bowel movements during your healing.
Recognize that fiber absorbs quite a bit of water. You need to increase your water intake - aim for at least 8 glasses of liquids per day.
Pain meds will cause constipation, so additional stool softener is important. Collace, citrucel (mixing with apple or grape juice helps it go down), delcolax, milk of magnesia, etc. with a couple of meals per day reported to help. Prune juice or organic dried prunes are good alternatives that are highly recommended. An additional 2 tsp of mineral oil or fish oil can help as well. Your goal is for soft stools not diahrrea - so don't take everything listed. Everyone's body is different so adjust as needed.
Again, in addition to stool softeners and citrucel, One doctor recommended to take Sennakot - or any vegetable based laxative - if there is no BM after 2 days.
A good multivitamin should be taken to help promote healing. Magnesium pills were recommended to help soften stools and for general healing.
Eating will result in a BM, so it's a good idea to take a pain killer while eating so that it kicks in at the same time as your BM.

[U]Pain Management [/U]

Understand your pain:
The first type of pain is just after the surgery where muscle spasms pull on the surgical site. The percocet may or may not help for this - many claim to take pain pills early in morning before bm to help with this, but a Valium (or other muscle relaxant) and warm or hot baths may be more helpful. Switching out percocet with vicodine every 4 to 6 hrs was recommended; however, stopping the spasm as the source may be more effective than covering the pain with pain killers. Some reported good results with heating pads and a massager in the small of the back. Try ice and heat, one may work sometimes and the other at other times. This may only last about a week or so.
The second is the extreme pain as stomach acids in the BM pass the surgical site. Aloe dampened baby wipes and a squirt bottle bidet make those pass quickly. Witch Hazel on gauze is an alternative. Pain meds seem to hinder the bm so the meds may wear off before you are done. Try to walk until time to really go. Lamaze breathing helps to get you through. A hot bath may help for this as well.
The third is a similar, but less intense, acid irritant ache from seepage from the spincter. Use cocoa butter or diaper rash oinments (see list above) on affected area 2 or 3 times a day to help numb the area and help with rubbing as well. Cuttting off a chunk from an Aloe Vera plant , peeling it (very gooey) and placing between the cheeks (the low down ones) may provide more relief.
A forth type is due to constipation. Polyethyline glycol may be prescribed as a laxative, but more natural alternatives have been listed above.
The last one occurs as the surgical site begins to stretch back to its normal size and shape. Think of it as exercise: no pain, no gain.

[B]First Few Days [/B]

Your body needs food to heal. Review the Food section above. Your body needs plenty of rest to heal - sleep as often as the body will allow.
Keep on schedule with meds.
Frequent hot sitz baths (especially salty baths - roughly 1/3-1/2 cup of epsom salts in the bath every time) will help the most for discomfort--just sit in a hot bath for 20-30 minutes 3-4 times per day (or more) and after BM. Some prefer to use a wand showerhead over the bath.
BM will be painful. Do not hold it in, remember not to strain and refer to the Pain Management above. Try to take pain pills when you first wake up and with meals so they'll kick in when you have your BM.
You should have a BM every 2 days. Contact Dr. and increase laxatives if this does not occur. One Dr suggested - If you don't go at all one day, take one Tbs of Metamucil and one Tbs of Milk of Magnesia. If you go 1-2 times, take one Tbs of Metamucil. If you go 3 or more times, don't take anything. For severe constipation, an enema may be needed.
You need to be moving around some. Your body will be very tired after surgery, but you must force yourself to walk. Take a bucket even if you don't feel nausea still. Walking will help regulate BMs. Around day 3, you should be able to take a short walk outside. The sooner people started walking seems to be the sooner they feel better. Don't roam too far from home.
Try not to sit too much right now. Standing and lying are optimal.

[B]First Week [/B]

Try to stretch the time between pain pills by using using 600 mg advil. If you are having trouble urinating when taking Loritab, mix with Motrin and it should help. By the end of this week to 10 days, you should be almost off all prescription pain killers except for occasional use. Replace with Motrin or a mix of Motrin and Tylenol. You may go through 100 Motrin for the first 2 weeks. 2 weeks seems to be when most experience a noticeable decrease in pain & it tends to occur overnight. When nothing seems to help, try to remember you just need to make it to 2 weeks.
Continue with high fiber diet and softeners. You risk a setback if you stop softeners right now. If gas becomes an issue, Beeno may help.
Weeping of the wound (blood and mucus) is normal for several weeks. Wear depends, panty liners, gauze between your butt cheeks as needed. Recognize infection of the wound is possible so inform your Dr. of anything unusual.
If you aren't walking yet, you should be.
Try to do things that take your mind off your body. Have a plan to do something while you are in bed - a new book, movies, etc.
Follow-up exams are usually done 1 week and 3 weeks after surgery, but don't feel shy about asking to reschedule if you need to.

[B]Next few weeks [/B]

After 2 weeks, you can expect a noticeable decrease in pain. BM will still be an issue. You will need to plan around them.
10 days to 3 weeks seems to be the earliest for going back to work - don't be surprised if it takes 4 to 6 weeks.
Check with Dr, but with itching try mixing hydrocortisone & prep H with a little lidocaine. It should provide immediate relief to get thru the day.
There will still be weeping and spotting for 4 to 5 weeks (2 months for some). Around 10 to 14 days, some experience an increase in bleeding due to a scab falling off. This is normal.
10 days is too soon to stop laxatives, but everyone is different. The suggestion is to keep Metamucil or similar in the diet for months following the surgery. At 2 weeks (or sooner if you can), you need to be decreasing laxatives if your stool is not firm at all (you still want soft stool though) to help prevent narrowing of anus. In the next few weeks, slowly work toward a more normal BM. DO NOT STRAIN. You are progressing too fast if you are straining at all.
Continue with HOT water baths to promote healing and 2 motrins at bed time to be preventative for pain. Try to take with Tylenol to see if it helps more. At week 3, some are taking 3 to 6 Motrin daily. At 3 weeks, some are no longer doing hot baths, but replacing with a wand showerhead. At 3 weeks, some are adding meat back into diet but do this slowly and on a day when you can spend at home in case it causes discomfort.

[B]6 weeks [/B]

Most of swelling should go down and you should have a good idea how you healed up. You will not be completely healed - that takes months, but you should be noticeably better.
You may be still taking stool softeners, but no laxatives. This is the soonest to consider weaning off fiber drink if you choose to do so. Again, do it gradually - every 2 days for a week, then every 3 days

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