Hemorrhoidectomy hope

[beachgal01]

Originally Posted by michelle13

ILOVEFROGS ~

Since I changed my diet to high fiber foods a week ago, I already have that sort of stuff. Am I over-thinking this????

Oh yeah ... Michelle - even though we haven't had our surgery yet, it doesn't sound like you can overthink anything related to this surgery!! I am so thankful for the tips!

[TacomaGuy]

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.

Things to Have Before Surgery

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.

***********

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PREPARATION FOR THE VISIT

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.


********
Day of Surgery

Surgery

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

Care Directly After Surgery

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.

First Bowel Movement

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.

Food

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.

Pain Management

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. ***** 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.

First Few Days

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.

First Week

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.

Next few weeks

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.

6 weeks

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

[beachgal01]

Wow!! You RULE! Thank you so very much for this amazing collection of information! I've got pages of tips that I've collected from reading through hundreds of pages of these boards, but yours is so organized! Thanks very much.

[RoadRunner0213]

Tacoma guy has some great tips.

I was told to take an enema 2 hours before surgery. Considering I had to be at the hospital for 6:20 a.m, that was NOT happening. I took it about 9pm the night before. What a nightmare! It hurt and the smell was absolutely FOUL. Think raw bowel stench.

The thing with this surgery is that all shame goes out the window. I've never had to plan my life around BMs like I've had to do.

Like Tacoma guy, I used the bag from a sitz bath and the little nozzle to hose off after a BM. Like a little mini car wash/bidet. I'm almost to the point where I can wipe, but not quite. It looks like stalactites of stitches are hanging out of me. I called the doc and she said this was normal and that they would dissolve or fall out on their own. The only thing is that during the night, the stitches mix with some discharge and dry onto my underwear. When I wake up in the morning to use the toilet, it's like ripping off a scab.

I'm also ashamed to admit, but my first BM after surgery was in the tub. I was having terrible gas pains and I thought I farted. I looked down and thought it was blood, but nooooooooo.......... Talk about disgusting. I actually screamed. My bf thought it was hysterical. He had quite a good laugh at my expense. It was just what I needed to shrug off such an embarassing moment. I was mortified, but he actually managed to make me laugh about it.

[TacomaGuy]

I want to point out that I make myself get out of bed an walk around some. I think that may be helping my recovery go better than some of the other posts I've read - and I'm not alone in believing this.

I've read multiple times and my Dr told me not to use the sitz contraption that sits on the toilet. He said that anything that causes your butt cheeks to be pulled apart is a no-no during recovery since it will pull on your stitches and put you at risk for fissures. The only exception is sitting on the toilet-and he said not to be on the toilet over 5 minutes. And when I sit on the toilet, I put my weight on one cheek or the other... if I put my weight evenly on both, it hurts more...not sure why, but don't really care why at this point - just trying to get through this.

Honestly, I didn't even try to poop on the toilet the first time due to all that I have read on here. From my research, having a BM in the tub is a lot easier on the body so I did my first BM that way so I could decide if I wanted to try to used the pot next time or not. I started practicing relaxing my rectum even before surgery since I've read much of the pain comes from trying to pass stool through the rectum which is so tight after being cut on. Just as everyone else, I was very concerned about the first BM and all I've read about it. Actually I was still debating on relieving myself in the toilet or in the tub for my first BM, but late in the evening the day after surgery I was sitting in my sitz bath reading a book and I had to pass gas (passing gas is much easier in the tub too.) Shortly after passing gas, I could tell something of more substance was coming down the pipe as well. At that point it was too late, I couldn't get myself out of the tub in time. And after it was all over, I'm glad I was in the tub because I think I might had fallen in the floor otherwise. If you've read the stuff I've read, then you've seen where someone described it as passing a watermelon wrapped with barbed wire dipped in acid or some other non sense. The part that kills me is that others are agreeing that it's an accurate description - hell they had me scared to death. I'm a little irritated that people are exaggerating to that extreme when they should have compassion to try to help each other through this. Don't let me fool you, it hurts, but I'd go through this pain any day over trying to poop barbed wire. I'm not sure how much cutting they did down there, but I have stitches on both sides of my rectum and it was the traditional scapel technique to give you a reference. I was only scheduled to remove one hem, but I'm assuming they removed 1 from each side. I feel compelled to give a more accurate description about the pain. The first BM hurt the most, but it was also harder than the rest. I think I had Pre-surgery stool in me still that hardened up a bit from being in my digestive tract so long. So there I am sitting in my tub of water thinking that I'm just passing gas & then I realize there is something more... And my butt is puckered up. I'm trying to relax my rectum and trying to concentrate on not pushing at all - never push or risk other complications. I sat there trying to relax for maybe a minute or 2 and I could feel my rectum starting to give way slowly then an uncontrollable (and unexpected) convulsion hit and it pushed everything out. It did hurt quite a bit, but it was quick too. It did feel larger than it was, but more like tennisball, not watermelon wrapped in barbed wire. I do think that because I was in a tub of warm water helped my rectum relax enough to pass the stool more easily, but that's a decision each person has to make. I could feel where the stool pushed against the incisions but it didnt feel like glass against the incisions. If you've ever scraped yourself badly and run water across it, well imagine that sort of pain but a bit worse-maybe rubbing a washcloth across it. Yes, it hurts but keep breathing and try to keep from pushing and it will pass. I think it helps with the pain if you are concentrating really hard not to push....and breath and breath and breath. The incisions were most likely bleeding some because they were burning and they continued to burn for a bit. And you might cry but you are tired too so you might just be glad it's over while you endure. Every time I've had a BM I still feel the urge to poop afterward. I try to just relax and I think this is a false sensation. The burning of the incisions reminds me of alcohol based ointment on a cut...where it's burning and you are blowing on it to make it feel better, but you just have to wait it out. That probably lasts 2 or 3 minutes then you get the part that I think is the worst - it's replaced by your rectum going into a spasm of sorts. I've heard it compared to what contractions feel like, but I'm a guy so I have no frame of reference. But the first one lasted for 2 hours for me (luckily they seem to get shorter each time I have a BM.) The remedy I've heard is the sitz bath, but I couldn't tell it helped for me. I tried to walk it off - that actually hurts more because you feel like your insides are falling out. It's not that it's unbearable pain, it's the fact that it last so long that I have trouble with. It's a throbbing that just won't stop and I don't know how to tell you to get through it, except to endure. I'm litereally worn out by the time it's done...I'm constantly moving my legs to a new position over and over again looking for one that offers some relief. I've read that really hot water helps, but I'm scared that hot water might increase bleeding. Anyway, I try to note what time it is & I know that it will be over in 2 hours so I just try to endure for 2 hours. If anyone knows of a way around this, I for own would love to know it. Your rectum will be sore after all this. My doctor recommended neosporin afterward, but I haven't really tried that yet.

Recognize that signals your rely on don't feel the same as before surgery. It is very hard to tell when you have gas versus a BM. I was climbing in the tub to relieve gas and it happened to be diahrrea that ran down my leg before I even got seated.

I've had a couple of other BMs since then. One in the tub and one on the toilet. They both hurt, but they werent as firm as the first and they didnt hurt as badly, but the one on the tub did bleed more, but nothing too badly. If you do have a BM in the tub, you cannot let poop run down the drain or it'll clog your pipes. I have multiple pails sitting next to my tub with my essentials for recovery. One contains magazines, a mp3 player, my cell phone, etc - things to do while I'm in the tub. Another is my vomit pail. Luckily I've only used it when I tried mineral oil, but I have felt nauseous a couple of times so I keep it handy. The third holds a strainer, paper plates, etc. to get poop out of the tub and over to the toilet. And I have another container that I keep towels in. My tub and toilet are next to each other so I keep a cup and epsom salts on the back of the tub so I can easily have my tub of water set up for my next BM. Cleaning poop out of the tub in this condition is no picnic, but trying to climb into the tub in a spasm wasn't the easiest thing I've ever done either.

I think I'm having a normal recovery so far, so this is probabably not accurate if you are having any complications. This is tough, don't get me wrong... but the descriptions I've read make this sound 5 times worse than what I think it actually is. Plus I've had a hernia repair at the same time. I do reserve the right to change my opinion at any time, but so far I think this is pretty accurate of what I'm going through.