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  • Post-Operative Instructions Hemorrhoidectomy: Comfort Measures

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    Kath Reign
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    The document provides post-operative instructions for patients who have undergone a hemorrhoidectomy. It discusses comfort measures like ice packs and warm baths. It recommends dressings, sitz baths for comfort and healing, and notes patients may have difficulty urinating initially. It also discusses managing bowel movements, medications, diet and fiber to prevent constipation, possible skin tags or tenesmus, expected bleeding, and follow up care.

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    Hemorrhoidectomy (1)

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    The document provides post-operative instructions for patients who have undergone a hemorrhoidectomy. It discusses comfort measures like ice packs and warm baths. It recommends dressings, sitz baths for comfort and healing, and notes patients may have difficulty urinating initially. It also discusses managing bowel movements, medications, diet and fiber to prevent constipation, possible skin tags or tenesmus, expected bleeding, and follow up care.

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    53 views3 pages

    Post-Operative Instructions Hemorrhoidectomy: Comfort Measures

    Uploaded by

    Kath Reign
    The document provides post-operative instructions for patients who have undergone a hemorrhoidectomy. It discusses comfort measures like ice packs and warm baths. It recommends dressings, sitz baths for comfort and healing, and notes patients may have difficulty urinating initially. It also discusses managing bowel movements, medications, diet and fiber to prevent constipation, possible skin tags or tenesmus, expected bleeding, and follow up care.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    of 3

    Post-Operative Instructions

    Hemorrhoidectomy
    Comfort Measures
    During the first 24 hours after your surgery you can place an icepack over the surgical site. This can
    help reduce swelling and pain. A warm pack can also be helpful during the recovery period.
    Hemorrhoid surgery is predictably painful.

    Dressings
    You will leave the hospital with a cotton gauze dressing (also called a 3×3 or 4×4). This can stay
    until the morning after your procedure and can be removed while sitting in the sitz bath. It is OK if
    it comes out any time before the morning or if you need to remove it to go to the bathroom. You
    will probably want to keep some kind of cotton or other absorbent dressing in this area as you will
    have some bloody drainage for several days. It is probably easiest to remove any dressing after it is
    wet (see below…sitz baths).

    Sitz Baths
    You should plan on taking sitz baths for the first few days following your surgery. A sitz bath is
    simply immersing your bottom in water. This can either be in the bathtub, shower or in a portable
    sitz bath (looks like a plastic hat upside down). The nurses will give you a sitz bath before you leave.
    Plain, warm water (no soaps or salts) is recommended. Ten to fifteen minutes 2-3 times a day is
    minimum. More frequently is also acceptable. Dressings and baths can be stopped when desired.
    They are primarily for comfort and convenience; and are not crucial for healing.

    Urination
    Some people may have difficulty urinating initially. This is usually because it is difficult to relax when
    your bottom hurts, and not because your bladder is empty. If you feel the need to void, there is
    usually enough fluid in your bladder. While drinking fluid after surgery is ok, do it because you are
    thirsty and not because you think it will help to urinate. Filling your bladder beyond a volume that
    gives you urgency will not help you relax. If you get the urge but are unable to urinate, sit in a warm
    bathtub of water and try to relax. Occasionally patients who cannot void must go to the Emergency
    room to get a bladder catheter for a few days. While annoying, this relieves the urgency and distress.
    If unable to void by 6-8 hours after surgery, or 6:00PM, going to the ER should be considered.

    Bowel Movements
    Constipation can be a problem after hemorrhoid surgery. Though the first few bowel movements
    can be difficult, it is better to move your bowels regularly than to become constipated. If after two
    days you haven’t had a good, relieving bowel movement you can take 1-2 ounces of milk of
    magnesia, or another mild laxative you know will work for you. If that is not successful then on the
    third day after surgery start a colonoscopy prep. This consists of 4 Dulcolax tablets followed 1-2
    hours later by 238 gram bottle of Miralax mixed in 1/2 gallon Gatorade, consumed over 3-4 hours.
    This will work with near certainty. If you have a good BM before finishing, it is not necessary to
    complete.

    10 Andover Rd • Portland, ME 04102 • Phone: (207) 761-6642 • Fax: (207) 773-2603


    www.mainemedicalpartners.org
    While it is ok to strain to initiate, achieving a BM is more a function of relaxation when rectal
    volume is sufficient for the rectum to contract and the pelvic floor to relax. Straining when one
    cannot relax or when there is insufficient volume may not be effective.

    Medication
    You may resume your usual medications unless instructed to do otherwise.

    Pain Medication
    See separate sheet

    Diet
    To have regular bowel function, you must eat regularly. To help prevent constipation you must
    deliver volume to the rectum. This is best accomplished with fiber. Stool softeners may keep stools
    softer but do not change the volume delivered to the rectum and are not as helpful for bowel
    movements, though it is acceptable to take them in addition to fiber.

    The best way to actually consume sufficient fiber is with a high fiber cereal (12-14 grams of fiber per
    1/2 cup of cereal). FiberOne, All Bran, 100%Bran, Bran Buds are examples. 1/2 to 1 cup per day is
    sufficient. Supplements (Psyllium, Metamucil, and Citrucel) are also good, though there is less fiber
    than a high fiber cereal and one must take 2-4 doses to get the equivalent of a high fiber cereal.

    You should also drink plenty of fluid, though should be cautious until after urinating.

    If one consumes enough fiber in these forms then one can make food decisions without worrying
    about fiber. You can eat essentially what you desire.

    Tags after hemorrhoid surgery


    If you have had hemorrhoid surgery you may still notice that you have skin tags around the anal area
    which feel like hemorrhoids. Some of this is due to post-op swelling which will reduce with time
    after surgery. Some can be due to residual tissue that is not excised at surgery. Though the idea of a
    completely smooth bottom is attractive, the reality sometimes is that there is so much external
    redundancy that eliminating all the redundancy could cause a problem such as a stenosis, which can
    be difficult to fix. The relaxation of tissue during anesthesia makes the interpretation of redundancy
    difficult. If after the swelling of surgery has resolved there are still some floppy tags, these can often
    be excised in the office under local anesthesia without much pain or recovery.

    Tenesmus
    This is a medical term for the feeling that you have to have a bowel movement without any stool
    actually being present in your rectum. This feeling frequently follows hemorrhoidectomy and may
    last for up to a month. You will be able to figure out when it is actually time to have a bowel
    movement.

    Bleeding
    Nearly every patient has bloody drainage or even a small amount of actual bleeding following an
    operation in this area. This may last for several weeks following the procedure. Worrisome bleeding
    is when you pass a bowel movement and mostly blood comes and the bleeding continues. If this
    happens please call immediately or go to the emergency room.

    Office Follow-Up
    Most patients visit us in the office 4-6 weeks after the procedure. We are available 24 hours a day for

    10 Andover Rd • Portland, ME 04102 • Phone: (207) 761-6642 • Fax: (207) 773-2603


    www.mainemedicalpartners.org
    emergencies. You may call the office during working hours for questions that are not emergencies,
    and are not covered by this handout. Our office number is (207) 761-6642.

    Last updated 7/1/13 rc

    10 Andover Rd • Portland, ME 04102 • Phone: (207) 761-6642 • Fax: (207) 773-2603


    www.mainemedicalpartners.org

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