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Old 11-29-2007, 01:05 AM   #2
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Hemorrhoidectomy Recovery Guide Page 2

First Bowel Movement

It’s recommended that you take stool softeners that contain fiber to help BM. Do whatever you can to prepare for a soft stool – but you do not want diarrhea.
Have a tub of hot water ready before you have your BM-very important.
Be sure you have taken your medications on time when your first BM occurs – pain prescriptions and relaxers (the Valium is to help your sphincter relax for the BM)
Do not strain or push at all - 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 worse.
Breathe through the entire BM - do not hold your breath - try the Lamaze technique of breathing.
Recognize that some bleeding is normal. It does not take much blood to turn toilet water red, so don’t be panicked. I most likely looks worse than it is. The amount of blood on the gauze you keep between your cheeks is a better indicator of how badly you are bleeding.
If it is too painful, you can climb into the tub of hot water to relieve yourself & clean up afterward. If you take this approach, do not let stool go down the drain – it will clog your tub. Use a strainer to capture the stool and transfer it to the toilet.
Otherwise, finish BM and optionally clean with aloe wipes and get into hot bath for relief – some people showered, but most bathed.
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.
I had my first BM the day after surgery. I did not try to have my first BM on the toilet at all since more posts indicated having it in a tub of water was less painful. I climbed into a tub or very warm water and focused on breathing the entire time and trying to relax my sphincter muscle. After your sphincter has be cut into, it will probably be difficult to get it to relax for the bowel movement. I did breathe through the whole thing and never pushed – that’s all I focused on. However my sphincter did not ever really relax; the pressure continued to build in my lower intestines which became more and more painful – but I continued to focus on relaxing throughout the pain. Eventually my abdomen went into spasms and pushed the stool out. This is very painful – but for me it was not as painful as the posts I’ve read. Personally I felt like I had passed something about the size of a tennis ball – and I felt quite a bit of pain in each incision. To me it felt like each incision was pulled apart. The pain is very significant, but the stool passed very quickly after it started – maybe 10 or 15 seconds. Just focus on breathing and relaxing your sphincter, and it will pass. You can do this. Afterward there was intense burning for about 5 minutes –still intense but nothing like the first pain. Following this my sphincter went into spasms. This occurred for 2 hours. The spasms were not unbearable pain either, but the length of time I was in spasm was tough to manage and not knowing when they’ll end is the worst part. This will pass – give it time. Yes I sat in dirty water for over 2 hours, but trust me that you won’t care. After I was able to get to my feet, I used a strainer to transfer the stool to the toilet and emptied the tub & I showered to clean myself off. After the first BM, I had swelling and I was very uncomfortable for quite a while – I felt like my bowels were hanging out. I took ibuprofen to help with swelling.
Food

It is very important to have a high fiber diet so that your stool remains soft. Your diet should be high in fresh fruits, vegetables, greens, bran, juice, etc. Canned fruit is handy for convenience. Soups, jello, oatmeal, and puddings are also recommended. Eat nothing fried, spicy, 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 exiting the body later - also some doctors recommend holding off on the high fiber because of the bulk it adds but other want the bulk to prevent narrowing of the anus. The former recommend soft foods with softeners. One recommendation is 30 grams of 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 - stenosis.
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 diarrhea - 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.
I ate on schedule from the day of surgery. I had 7 paper lunch sacks each filled with pretty much the same thing so my meals would be consistent and I’d know exactly how many softeners to take each day to keep my stool regulated. I had baggies with my meds counted out and my softeners counted out. I began each morning with a glass of water mixed with Citrucel. Per another suggestion, I followed that with very watery, hot oatmeal for my breakfast-this caused a BM shortly afterward each time. For a week I stuck to canned soups for my lunches and dinners – usually 1 can halved for each meal. I had 2 graham crackers, 4 prunes, 1 pudding snack pack, ½ cup dehydrated fruit trail mix, 1 slice wheat bread, 1 fresh apple and 1 fresh pear, ½ can fruit, 1 fig newton type bar, and 1 trailmix bar. And constant water when I was up.
Pain Management

Pain is easier to keep under control consistently than to get back under control if you go too long without your medications. Be sure to stay on schedule with your pain medications – especially at night. Don’t allow yourself to be woken up from pain. It will take a minimum of 30 minutes for the pain meds to kick in and your pain may increase quickly in 30 minutes. You should have medications for pain, relaxants, and swelling. You may also have something for nausea and infection. Understand your pain so you can try to treat it correctly:

1. The type of pain just after the surgery where the sphincter muscle has to expand for stool to pass. If you've ever pulled a muscle so that you can't extend your arm or something, imagine your butt having that problem while you are trying to have a bowel movement. The muscle will knot up and it won't relax enough to let stool pass, so the first few BMs you are forcing the stool through this muscle and at the same time there is pulling on the surgical site where the stitches are. The prescribed painkillers may decrease this but not by much - many claim to take pain pills early in morning before the BM to help with this (again always keep in mind that pain killers take 30 minutes to kick in), but a Valium (or other muscle relaxant) and warm or hot baths may be more helpful. If your surgeon prescribes both, switching out Percocet with Vicodine every 4 to 6 hrs was recommended. This is part of the pain that make most people shudder about. Making the sphincter expand while it's knotted up and pulling against the stitches hurt. If you started with your stool softeners and diet a week before surgery and ate light and bland the day before surgery (soups, etc) - chew all foods well before swallowing – you will have an easier time. Almost everyone reports that the first bowel movement was the most painful, but the next couple are still pretty painful. The first BM will most likely occur the day following surgery or the next. Expect a fairly noticeable decrease in pain around the 4th BM, and continual improvement each time thereafter. Do not sit on the toilet until you are about to actually go. Sitting on the toilet pulls against your stitches and causes blood to pool in your anus and slowly builds up pressure. It will cause a more painful experience and can make you bleed more during the BM. Do not push...your stool will eventually slide out on it on (because you have taken your fiber and softeners like you should) or your body will have a contraction and push it out. Recognize that some people have trouble having a BM until the pain meds wear off.

2. The extreme burning as stool and stomach acids pass the surgical site. It is recommended to use aloe dampened baby wipes (Kandoos found in the baby aisle) and a squirt bottle bidet (something like those ketchup bottles you see in restaurants) to make this pain pass quickly. Witch Hazel on gauze is an alternative to the wipes. Touching the incision sites directly after surgery is painful so you may be unable to wipe until a week has passed. Quite a few people seem to have trouble having a BM until the meds wear off a bit. This pain is quite a bit less than pain # 1 and may last about 5 minutes. This should be pain you can endure – it’s similar to running water or alcohol over a fresh cut. You should be in your tub of water soon after this starts, which should help it pass as well. Again, you don’t want to be filling your tub after the pain has already started. Having your tub prepared when you need it is very important. Another important note: there is a contraption that sits on your toilet that is labeled a sitz bath as well. It has an IV bag attached where water streams into a basin that you sit in and it overflows into the toilet out an opening in the side of the basin. Many patients were advised by their doctors not to use this because it caused blood pooling and pressure build up at the surgical site and caused more harm than good; but you have to make your own decision if you want to try it. The time this pain lasts should decrease as the surgical site heals. It is also documented that applying ointments helped decrease this pain as well, but to be sure and clean the ointments off afterward. Be aware that oil based products delay healing, so discuss this with your doctor. Vaseline has been documented as a big no-no for that reason. There are also precautions that some ointments may thin the anal skin and lead to other complications such as fissures, etc. Many diaper rash ointments have zinc oxide in them and there are claims that these promotes quicker healing of the wounds - again discuss with your doctor.
For me this pain immediately followed the pain # 1 each BM for about a week. It lasted about 3 or 4 minutes each time without any real improvement. My plan was to have a squirt bottle to clean my butt over the toilet and then climb in the tub. After one very awkward and uncomfortable squirt, I changed my mind and climbed in the tub dirty each time for about 5 days. Again, although MANY claim that the hotter the water, the quicker the pain relief, it was also documented several times that doctors don't want increase of blood to the site caused by extremely hot water. I personally kept my water warm, but slightly on the hot side - mostly because lukewarm water gets cold quicker than I wanted to get out of the tub. On about day 7 after surgery, I applied A&D ointment (lanoline based) on my incisions for itching and this pain stopped. Ever since then, I no longer have this burning but I do not know if it was cured by the ointment or healing time. After a couple of days I did not use the ointment and I did not experience burning, but itching returned. I tried a zinc oxide based ointment later, but it was very thick and painful to apply so I went back to the ointment.
3. Spasms from your sphincter muscle. Many people experienced these throughout the healing process with no rhyme or reason when they occur. Some have them directly after surgery, if they sit too long, etc. These can last for hours – everyone seems to have a different experience. Women compare the spasms to the contractions they have during labor but worse because of where they are occurring. The sphincter is really sore during all this and it uncontrollably flexes and relaxes and flexes and relaxes. These aren’t usually described as unbearable pain, but if they last a long time they will wear you out and your butt will be very sore afterward. Pain killers are reported not to be effective for this and to try relaxants (Valium). Sitz baths, heating pads, and a massager in the small of the back are suggestions for relief. One person suggested making a heating pad by placing a damp towel in a freezer bag and microwaving it. Others recommended trying ice and heat, one may work sometimes and the other at other times.
For me, these only occurred directly after pain # 2 after BMs. My first one lasted for 2 hours - and that's no exaggeration, it was 2 hours straight. Each of my spasms were about a second apart. I agree that pain killers didn't seem to help at all but I couldn't tell Vallium helped either. I relied on warm baths to help ease these spasms. My second spasm lasted about 90 minutes, then the third about 45 and then about 5 minutes so these tapered off very quickly.
4. Similar to the burning pain # 2, but less intense; acid irritant ache from seepage from the spincter across the wounds and your raw rectum. Use cocoa butter or diaper rash oinments on affected area 2 or 3 times a day to help numb the area and help with rubbing when you walk as well. Cuttting off a chunk from an Aloe Vera plant , peeling it and placing it between the butt cheeks was claimed to provide more relief than ointments. Baths will help with this as well. Again, Vaseline and oil based products are reported to slow the healing process.
I was in the bath tub probably 6 to 8 hours a day so I didn't experience much of this til around day 5 when I stopped spending so much time in the tub. My surgeon advised that I was only allowed to use Neosporin on the site and I could not tell that it offered any relief. A&D lanoline ointment did provide relief. A&D zinc oxide was too thick to apply painlessly.
5. Constipation. Narcartics cause constipation. You should also know your own body well enough to know what foods you need to avoid during recovery. Most people adjust their diet and add extra bran to each meal. Polyethyline glycol may be directed to use as a laxative, but the most popular one listed was Collace. Most people use Citrucel or Metimucel first thing in the morning and last thing at night as well. Milk of magnesia (careful - you don't want diarrhea) or magnesium pills are also recommended. Refer to pain # 1 if you allow yourself to get constipated. Severe constipation is not only very painful, but can rip your stitches so take this seriously.

6. Extreme itching. This can be the incisions or the whole anal area itching from a diaper rash type of condition. I’m not sure if the condition is a result of the seepage described in pain # 4. It may also be caused by difficulty in cleansing the surgical site due to swelling. You can't really scratch and again oil based products slow healing, but diaper rash ointments have been prescribed.
On day 11 I started experiencing this and A&D ointments with lanoline and one with zinc oxide seem to help.
7. The surgical site begins to stretch back to its normal size and shape. Keep bulk to your stool and this will be easier. Your goal is to have soft but bulked stools each time. Some people ignore their doctor warnings and don't eat enough or they use laxatives to keep diarrhea while they heal. If you do this, you will develop stenosis (where your sphincter closes shut) and you'll have to go through a second operation to correct it. Recovery for corrective surgery is unbearable from everything I've read. The only reason you should ever have diarrhea is if you haven't had a BM in 3 days - in which case you need to do whatever it takes to have one. If you ever consider taking more laxatives when you know you don't need them, do a search on the corrective surgery for stenosis...that's sure to scare you back on track.

Last edited by TacomaGuy; 11-29-2007 at 01:14 AM.

 
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