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[B][SIZE="5"]Hemorrhoidectomy Recovery Guide[/SIZE][/B]


I had a scalpel hemorrhoidectomy surgery on 2 hemorrhoids (one rather large) that were near my anal opening and a banding for an internal hemorrhoid. Although there are tips for any hemorrhoidectomy surgery, this guide focuses on scalpel surgeries and not the banding technique. I initially created this “Recovery Guide” to help prepare for my own surgery due to the lack of information provided by my surgeon’s office. Most of the information herein is borrowed from multiple postings of people who had the surgery before me. I have kept most of the information I originally gathered for my own surgery, but I have added my personal experiences of what I tried and what worked best for me throughout my recovery. I am not in the medical industry, so consult your surgeon on any suggestions provided. I’ve tried to organize everything in the order that the information is needed – and I tried to give a reasonable timeline of how the average person recovers from surgery from the posts I read. Even though I felt really bad on some of the first days after surgery, it gave me comfort to read over the list and see that I was on the expected recovery path. Recognize that everyone heals differently, but this should give you an indication if you are on track or not. My recovery was remarkably quicker than what seems to be the average in the postings – and I believe it is because of following the advice contained in this guide. For reference, I am a 36 year old male that is in fairly good health with about 20% body fat and worked out about 2 times a week. I did not document any remedies to complications to surgery. Contact your surgeon or go to the ER. I also did not include any herbal suggestions that I found on sites since it was too difficult to research possible side effects and the only one I wanted to try was too difficult to find.

[B]Things to Discuss With Your Surgeon before Surgery[/B]

Other options: This surgery has a very painful recovery. Post-surgery, many patients posted they wish they had discussed more alternatives with their surgeon. Some felt that the surgeon’s recommendation was biased due to financial gain of performing the surgery.
[INDENT]I personally have no regrets after having the surgery; although after going through recovery, I might had tried more options first. [/INDENT]

Time off work: Most people posted that their surgeons indicated they would need less time off work than they actually needed. 3 weeks seemed to be the average minimum time before going back into office and many started with half days for a week; although many worked from home in 2 weeks. 6 weeks seemed to be the long end of the spectrum unless there were complications. Jobs requiring manual labor seem to require 6 weeks or longer recovery.
[INDENT]I tried to work from home in 5 days which was mostly unsuccessful and returned to work at a desk job in 11 days, but I was not at 100% and I was fatigued during the day. [/INDENT]

Specifically what procedures will occur: There are multiple operations to remove hemorrhoids. Some involve banding and others involve cutting the tissue out. The surgery wounds may be left open, stitched, or stapled. It’s a good idea to know exactly where the hemorrhoids are being removed from and details of the surgery being done. There are multiple posts of patients going in for a banding which is less painful and to awaken after having the more painful scalpel surgery. This will result in a longer period away from work and you may not be prepared for the extra recovery. Be clear with your surgeon what you authorize him to do versus what you don’t.
[INDENT]I went into surgery to have 1 hemorrhoid cut out and another banded, and the surgeon decided to cut 2 out instead so I had an extra incision. I was okay with this result, but had he made 5 incisions I would not have been.[/INDENT]

Expectations of physical appearance: Some expect to have no noticeable scaring after surgery. If you are having surgery for appearance, discuss this openly with the surgeon before having surgery. You will possibly show signs of surgery afterward. If this is important to you, discuss it before hand – this is not a plastic surgery procedure.

Clearing upper and lower bowels before surgery: Your doctor will advise you when to stop eating the night before surgery. Most people feel like they had an easier time if they cleared their upper and lower bowels – via laxative – before surgery due to constipation from food that was in upper bowels during surgery.
[INDENT]I did not clear my upper bowels before surgery and I believe that is why the first part of stool to exit my body during the first BM was somewhat harder than the rest.[/INDENT]

Nausea: If you know that you are prone to nausea when you have surgery, see if the surgeon might recommend a patch or prescription to help counteract this.
[INDENT]I did not experience nausea.[/INDENT]

What Care Giver Assistance You Will Need/Have Available After Surgery: This is especially important if you are single and not located near family. What assistance you have available may influence what options are viable for you.
[INDENT]I am single and needed a ride home. I had the driver stay for about 3 hours until I was comfortable that I could take care of myself. I kept a cell phone close at all times.[/INDENT]

Risks and Possible Complications: Out of scope of this guide; but discuss with surgeon.

Put Things in Easy Reach: Reaching high and low will be very difficult after surgery. About 3 days before surgery, try to pay attention to anytime you bend or stretch to get something. Try to have everything out on countertops and in the center shelves of the fridge, etc.

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

Enemas (Fleet)
Panty liners
4x4 gauze
Flushable aloe vera baby wipes; i.e. "Kandoo"
Squeeze ketchup bottle – for makeshift bidet
Strainer with handle
Ointments - cocoa butter, diaper rash lotion, aloe plant, lidocaine, Desitin, A&D ointment, hydrocortisone, Prep H, Benadryl cream
Stool softener: milk of magnesia, Metamucil, Citrucel, Sennakot, delcolax, collace, mineral oil, fish oil
Magnesium pills
Pain pills: Tylenol, Advil, Motrin, etc.
Epsom salts
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, magazines, or mp3 player to pass time in tub and bed. Nothing corded to an outlet when in tub.

[B]Preparation for the Surgery [/B]

Adjust diet at least a week before surgery. See food suggestions below.
Start taking a stool softener such as Metamucil or Citrucel for a few days prior to surgery. Don't overdo it - use just need enough to keep the stool soft. Stool softeners require plenty of water to work - this should make the first BM less painful and it’s helpful to have an idea before surgery how to get your stool to the consistency you need to have a bowel movement without having to push.
It's a good idea to be eating a high fiber and low meat diet a few days prior to surgery - plenty of vegetables and fruit and high fiber cereals and breads.
See if you can get your prescriptions filled the day before surgery. Some hospitals have a service to fill the prescription while you are in surgery.
It’s a good idea to try to clear your upper and lower bowels before surgery – possibly by taking a laxative the night before. Your surgeon will give you a cutoff time for any water or food prior to surgery – usually 8 hours. You may want to adjust this some to give your body time to get more stool out of your digestive tract. Prior to going to the hospital, your surgeon will advise to take one to two enemas an hour or two before the planned surgery. Hold the enema for 5 to 10 minutes and then expel it; repeat. Fleets enemas or tap water enemas are usually fine.
Directly before surgery, do not eat anything that might be “scratchy” while exiting the body.

[B]Day of Surgery [/B]


Dress in very loose fitting clothes that you can get up and down easily. You will have to get dressed in these after leaving. Jogging suits and sweats seem to be very popular.
From the time you arrive at the hospital until you are in surgery will probably be about an hour to prep you. Surgery will probably last about another hour. Waking for anesthesia will probably be 30 to 45 minutes. Within another 30 to 45 minutes your vitals will expect to be normal, and you’ll be getting up to urinate. Depending on how long that takes, you’ll be going home shortly after that.
Local anesthetic should last 6 to 12 hours after surgery. You will leave only after the anesthesia wears off and you have urinated. You may feel nauseated.
Getting out of bed the first time was very difficult for me. They had me get to a wheelchair to go to the restroom. Use your arms as much as possible to get up and down into the wheelchair. I did not have urination issues, but I could not push to get a strong steady stream.
You will need someone to drive you home. Be sure he/she is aware to slow down far in advance of stops and to take bumps in the road with care. He/she may not be aware of how painful that will be for you.

[U]Care Directly After Surgery [/U]

Take pain meds as prescribed and on time. Do not combine Percocet and Vicodin - you'll get ill. If prescribed both, it’s claimed to work best by beginning with Percocet and switching off every 4 to 6 hrs. Use an alarm to keep on schedule through the rest of the day and the night - Pain meds will take approximately 30 minutes to kick in - staying on schedule is important for a less painful recovery.
[INDENT]I was only prescribed Vicodin and Valium and was very careful to stay on schedule and did not experience pain until my first BM.
Some doctors may recommend that you take an antibiotic (such as metronidazole) to prevent infection and reduce pain.
Mine did not and I had no issues with infection.
Ice packs applied to the anal area may reduce swelling and pain.
I never needed this.[/INDENT]
Frequent soaks in warm or hot water (sitz baths) help relieve pain and muscle spasms. Some people could not urinate outside the tub for the first few days of recovery. Urine in the water will not cause any harm to your wounds. If passing gas is painful for you, it is less painful in a tub of water. Recommended to add epsom salts to bath - roughly 1/3-1/2 cup of Epsom salts either every or every other time. Fill the tub to just cover the hips. These baths may speed recovery.
[INDENT]I spent hours at a time in a tub of warm water and Epsom salt (probably 6 to 8 hours daily for the first week) and I believe this helped my recovery quite a bit. Although most posts indicate the hotter the water, the more the relief; I only soaked in very warm water. Some felt very hot water increased bleeding at the wounds and I did not want to risk it. Early in recovery, sitting in the tub was the only time I felt complete relief from pain.[/INDENT]
If at all possible, try to walk some - at least 3 trips to the end of the house. You won't feel like it, but it will probably make you feel better in the long run. Carry a small bucket in case of nausea.
You will not be able to sit directly up directly after surgery. Soft recliners seem to be popular, however I spent most of my time in bed. Some felt most comfortable on their side, but some were more comfortable on their backs – also try a pillow between your legs and under your knees depending how you are lying. Most opinions were that lying on the stomach did not offer enough support. You will have to experiment.
[INDENT]I was not in pain most of the first day so I made more than 3 trips to the kitchen and to the bedroom. Getting in and out of bed was a very slow process. I heated my own food and ate it standing up.[/INDENT]
You may or may not sleep most of this first day, but you will likely take a few naps and you will feel tired and exhausted. Try sleeping on the sofa, in a recliner and in bed to see which is most comfortable for you.

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