First 3 Days
Your body needs food to heal. Review the Food section above. Frequent meals throughout the day seems to have better results than one meal a day. You should be drinking plenty of water. Your body needs plenty of rest to heal - sleep as often as the body will allow.
Keep on schedule with meds – if you are having frequent pain, look at how well you are staying on schedule. Keep ahead of the pain.
If you are having trouble urinating when taking Loritab, mix with Motrin and it should help.
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.
BMs will be painful. Do not hold it in, remember not to strain. Refer to the Pain Management and BM sections 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; however I disagree. I would not risk not taking anything unless you are having severe diarrhea. 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 at first even if you don't feel nausea. 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 though and take a cell phone.
Try not to sit too much right now. Standing and lying are optimal.
Weeping of the wound (blood and mucus) is normal for several weeks. It is normal for the mucus to be smelly and yellow. If it has appearance of cottage cheese or you run fever over 101, recognize these as signs of infection and contact your surgeon. Wear depends, panty liners, gauze between your butt cheeks as needed; you may have considerable weeping initially.
On the day of surgery, I took a 2 hour bath and napped a few times during the evening. I began eating my diet as outlined above and I napped a few times during the evening.Day 4 through 7
On day 2, I took 2 long baths and slept on and off on the recliner. I stayed on my food schedule and had my first BM late in the evening. Afterward, I could no longer sit in the recliner. I slept quite a bit this day.
Day 3 was similar to day 2. I had a small BM followed by diarrhea very late at night. Due to diarrhea, the pain was noticeably less. Here is an idea of what I ate on day 3: Citrucel with water, 2 collace, 10 oz prune juice, 2 prunes, 2 sheets graham crackers, 1 c soup, 1 multigrain bar, 1/2 c raisin bran, 1/2 apple, 1/2 c fruit cocktail, 1 c apple juice, 1/2 sheet graham cracker. I would usually have the other cup of soup and the other half apple, but I slept much of the day as well.
Try to increase the time between pain pills by using 600 mg advil – but don’t let the pain get hold of you. Everyone has a different experience with pain, but if you are feeling very little pain it’s time to start decreasing meds. 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. Within 2 weeks most seem to experience a noticeable decrease in pain that occurs almost overnight. When nothing seems to help the pain, try to remember you just need to make it to 2 weeks.
Are you drinking enough water?
Continue with high fiber diet and softeners unless you have diarrhea. You risk a setback if you stop softeners right now, but decrease as needed to keep a consistently soft but formed stool. If gas becomes an issue, Beeno or Gas-x may help.
If you aren't walking yet, you should be unless your surgeon has specifically asked you not to.
Try to do things that take your mind off your body. Have a plan to do something while you are in bed and while you are in the bath - a new book, movies, music, 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.
Day 4 I did not have a BM all day. I was already decreasing meds at this point, but I woke up in pain so I increased meds pretty drastically to get back under control. I kept eating my diet and could tell I my digestive system was getting backed up. I took a sennokot around 4 PM to try to get things moving again. I had a fairly painful BM around midnight with a fair amount of spasm pain afterward – almost 2 hrs again. 4 pain pills, 6 ibuprofen, 3 valium, 1 collace, 1 sennokotNext few weeks
Day 5 I had BM just after noon and spasm that followed was just over an hour. Had a second BM at end of day with a very short spasm following. Most of pain was from incisions during BM. 3 pain pills, 4 ibuprofen, 2 valium, 2 collace, 1 milk of magnesium before bed. Tried to work from home, but was not productive at all – napped during day
Day 6 I started halving pain pills and started lowering dosage again. Spasms are short with BM. 2 pain pills, 5 ibuprofen, 3 valium, 5 collace, 2 tylenol; I used A&D ointment for weeping and burning after BMs did not occur. Worked from home this day as well. Attended conference calls, but was not productive.
Day 7 I had diarrhea. Pain from sitting on toilet was bad enough I had to pass stool in tub again. I only took 1 collace due to diarrhea. Down to 1 pain pill and 4 Ibuprofen and 1 valium. Using A&D before BMs still and no burning.
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 surgeon, 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.
You are most likely going to look at what the results of your surgery are during this time. Do not be alarmed if you see hanging skin or things that look like other hemorrhoids, etc. You are still swollen and you may have skin tags that may or may not reduce in size. Skin tags can often be removed in your surgeon’s office with a local anesthetic. The recovery for this is very short and relatively painless, but you need to wait a minimum of 6 weeks to get an idea how your surgical site will appear afterward.
3 weeks seems to be recommended the most to consider resuming sexual activities. Begin slowly and carefully so you know your limits.
Day 8, I was not going to go to my parents for Thanksgiving, but I felt exceptionally well this day and went. This is the first day I changed my diet, but I ate small portions and stuck to the no citrus and spicy rule. BM not overly painful. I did increase the amount of collace with the meal and I put Kellogg’s All-Bran on almost everything I ate. Mostly on ibuprofen at this point with a prescription pain pill every other day.6 weeks
Day 9, I replaced baths with showers. BM still not overly painful. Back on soup diet. Very small BM so took Milk of Magnesia at bedtime.
Day 10, Have gotten where my BM are happening on schedule in mornings and I can wipe lightly without too much pain although I have to shower afterward. I tried a burger without cheese for dinner without any bad consequences. I took 2 collace with the burger. I went to a bar and had a couple of beers and danced quite a bit without any issues. I did take valium, ibuprofen and pain pill before bed just in case but no issues the next morning besides extreme fatigue.
Day 11, I had pizza for dinner with 2 collace – no real issues.
Day 12 to 14, I went back at work. I am late to work multiple times due to increase of time for BM. I’ve been eating reasonably normal without any issues. I still take Citrucel in mornings and have collace with meals. I increase collace depending on what I eat. And I chew extremely well. I do feel exhausted sometimes, but otherwise doing well. Some BMs hurt just slightly when they first start, but no noticeable bleeding. I am still having to wear gauze, etc for weeping. But it’s not much at this point. I was extremely tired at beginning of week. I’m gaining stamina as the week progresses and I feel like I’m productive at work now. I am still not 100% but I can walk 2 blocks fairly easily. I do tire sometimes, but not too badly. I still need ibuprofen for occasional swelling. I will take a valium if I think I am constipated, just in case. I’ve had a couple of BM that were slightly painful for being a bit too hard but not enough to cause a spasm or blood.
Most of swelling should go down and you should have a good idea how you healed up.
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, etc.
You may be able to resume light running and exercise at this time. This is probably the earliest one can resume manual labor jobs. Don’t be surprised if it takes 8 weeks or longer. 8 weeks - Onward
You may be able to be on your old diet without any softeners by now.
You may be able to work your way up to heavier exercise by now. Squats are out of the question most likely still. 12 weeks is the earliest suggested to consider light squats. 4 to 6 months is the earliest suggested for heavy squats.
It is recommended to wait 2 to 3 months to resume any receptive anal intercourse. Scar tissue does not stretch as well or quickly as normal skin so start slowly as you are prone to developing tears and fissures.