Hemorrhoidectomy

[wjpjr]

Tammy,

I kept the appointment today with yet my fourth surgeon. He didn't offer any quick solution to my problem. After reading over my operative report he concluded the surgeon may of done a four quadrant hemorrhoidectomy. He thought this might be the reason why I now am dealing with fissures. He indicated maybe to much lining (skin) was removed therefore preventing total wound closure. He would never perform more than a two quadrant surgery for that reason. He thought my surgeon might be a little inexperience as a reason why I had four quadrant surgery -- finally a doctor willing to speak out against another.

He gave me a script for the nifedipne. It's now being compounded and I will have it in a few hours. His opinion of diltiazem was not to high. If I don't heal within 3-4 more months (6-7 months normal healing) I may be facing anal plastic surgery. Basically they would need to perform a skin graft to close the wound(s). The though of that is pretty damn scary. As is the prospect of 3-4 more months of healing in my current state. I'm hoping the nifedipne helps me heal. He offer some hope. He also thought I should be doing two warm sitz baths a day to promote blood circulation (healing). I'm kind of apprehensive about sitz baths. My feeling is they promote bleeding. Any thoughts?

[Tammynoska]

RCL, you are now in the world of hemorrhoidectomy recovery; that means you need a basic education. You will be stuck in this world for 4-9 months. It is in your best interest to read back about 10-15 pages and you will find all the details of what you need to do, and what is normal, far more than I can cover or take the time to type. It is really imperative that you take the time to educate yourself on reading these past posts, as you will see what you need to do, and what happens to those who only partially do these steps or overdo them, so you know exactly why you have to follow these things and for how long.

Briefly this is the kind of stools you should have during your recovery period (please note, this is a special time-frame you need stools like this and not for the rest of your life):

1. Take colace stool softener 100 mg pills. 1 pill at breakfast and 2 pills at your last meal. Take each dose with at least 8 ounces of water. Do not take on an empty stomach but after meals, or you will have an irritated stomach. These are not laxatives. I had this surgery twice and each surgeon told me to take colace. Colace is an over-the-counter stool softener---I tried the generic alternatives, but found they didn't work, so I can only recommend Colace brand.

2. Add at lunch 1/2 a metamucil wafer to your meal at the end. One adult dose is 2 wafers of apple cinnamon metamucil. Do NOT take that dose, or you will have bad diarrhea. Take only 1/2 of one; this is combined with the colace. Colace is the thing that will make your stools flow out on their own; metamucil with the colace helps in the softening of the stool. Too much of both together will give you misery. Some posters have gone overboard in their desperation and taken too much, and ended up with bad diarrhea; then they stopped all and ended up impacted. It is imperative you follow this carefully and be patient. It takes 3 days for all to work.

3. To your breakfast add a serving or 2 of instant plain oatmeal.

4. To your lunch add a serving of 1/4 cup of raisin bran.

5. To your dinner add 1/2 an apple with the skin. You must eat the skin. Add also 1 teaspoon of olive oil to your meals.

6. Throughout the day, drink around 1 cup of water per hour in-between meals. Yes, you will pee a lot, but the objective is to have soft and self-propelling stools.

7. Finally, just before the time that is normal for you to go, drink 8-10 ounces of steaming hot water, the kind of heat for hot coffee or hot cocoa. Hot water stimulates the intestines and also helps to penetrate the stool quickly. Do this every time that is normal for you to go. It is also a good aid when you feel like you have to go, but don't have the urge, to drink a steaming hot cup. I keep an electric pot in my bathroom that takes a couple of minutes to make hot water on demand, so I can drink right then when I need it.

At this stage of your recovery you should not push for any reason. The above steps give you the kind of stools that you do not have to push for. If you are now constipated, then you should take a dose of milk of magnesia, along with 1 spoon of mineral oil. This is a one-time dose to move your present constipation. Then start right away on the above regimen.

The mistakes some people make are:

A). not to take enough colace. It is safe to take up to 500 mg total per day, which is five 100 mg pills. If the 1 in the morning and 2 at night don't bring on the right kind of self-moving stools within 4 days of taking this dose regularly, add one more to your evening meal. If this proves to be too much, cut back on the one, but do NOT drop the three you were taking. But, instead increase your 1/2 metamucil wafer at lunch to 1 full one.

B). not space apart their dose of colace at breakfast, then dinner. It DOES make a difference when you take the colace, as you need to soften your breakfast and lunch meals, as well as your dinner, or you will get a partially hard stool.

C) not drink enough water. Forget about six glasses of 8 ounces of water; you have a special situation that requires above average water, and constantly throughout the day to hydrate your stools.

D) don't train their bowels to go each day by eating 3 regular meals, and queing it by drinking hot water at the time they wish to go regularly.

E) do not add additional insoluble fiber like raisin bran and soluble fiber like oatmeal to their diet, just wanting the colace to do it alone.

F) do not moderately cut back if they find themselves getting too much diarrhea or do not moderately attempt to increase either their colace or metamucil if they find their stools still too hard. Lack of action will keep you stuck in the same problem. You must act one way or another if you find yourself not having the right kind of stools, but MODERATELY. Stopping cold turkey, or increasing your doses a lot will have terrible consequences.

G) take warm to hot sitz baths which increase bleeding. Heat pools blood to the area, and you don't want to increase blood to your wounds.

H) take prolonged sitz baths in water that inhibit wound healing.

I) sit on the toilet and read, hoping to spur a bowel movement, or sit on a suspended sitz bath on the toilet, or sit on a donut seat, 3 things that will increase bleeding.

J) take aspirin or ibuprofen or advil or vitamin e, which each cause increase bleeding. Tylenol or acetaminophen is an alternative that does not increase bleeding. Please note that any prescribed pain pills are known as major constipators; and if you are still taking prescription pain pills this can be the root of your current problem.

K) strain to go, or try to use their finger to work out stool, actions which can break a stitch or injure your surgical wounds

L) not pregrease their butt holes with vaseline right before they go each time.

M) not dab on prescribed HC Anusol cream after going to decrease itching and burning.

N) not keep off their butt holes and choose seats that have no firm foundations, like cushioned wheelchairs or recliners.

O) panic when they are not healed by 2 weeks. It takes an average of 10-12 weeks to get out of the first surgery red zone, and then 4-9 months to be in the near-normal butt hole zone.

There are a few more things, but you will get it by reading back, which you should do to learn what is good and bad. I advise you to print out these steps and refer to them frequently to learn what you have to do to get through this healing as quickly and painlessly as possible.

[Tammynoska]

Walt, first of all yay on the open-minded and honest surgeon! Finally!

As far as the sitz baths---for a person still recovering from their hemorrhiodectomy surgical wounds, I would absolutely tell that person to at no cost take any warm or hot sitz baths.

But, you are now fully healed from your surgical wounds. What you are experiencing are new cuts that are a complication to the raised scar tissues, so I don't think warm sitz baths would harm you. Only I would avoid hot hot ones, as you don't want to draw too much blood and maybe inspire a hemorrhoid (I don't know if that could happen, but I would be careful of that).

In your case, maybe even adding a bit of epson salts might help.

Just be sure to be religious on your application of the nifedipine, 3 times a day, about a bb size on the area, and to be careful not to stretch apart your fissures when you apply the cream.

About 2 hours after I apply the nifedipine, I then dab the vitamin A&D ointment to help keep things soft, just a bit, like bb pellet size.

Good luck, I hope this regimen helps. I, like you, have no stomach for another surgery.

[wjpjr]

Walt, first of all yay on the open-minded and honest surgeon! Finally!

Only I would avoid hot hot ones, as you don't want to draw too much blood and maybe inspire a hemorrhoid (I don't know if that could happen, but I would be careful of that).

In your case, maybe even adding a bit of epson salts might help.

Just be sure to be religious on your application of the nifedipine, 3 times a day, about a bb size on the area, and to be careful not to stretch apart your fissures when you apply the cream.

About 2 hours after I apply the nifedipine, I then dab the vitamin A&D ointment to help keep things soft, just a bit, like bb pellet size.

Tammy, exactly what I thought. I have the nifedipine now. I about to apply the first application. I follow up with one right be bedtime today. Tomorrow I'll do morning afternoon and night. The surgeon told me only twice daily though?

What was yours compounded with? Mine has 0.2% nifedipine together with a petroleum jelly base if I remember the script correctly.

I'm with you on those sitz baths. I'm still leery of the outcome. But I want to do all that I can at this point. I really want these damn cuts healed without constructive surgery. I know it's going to take time.

BTW, I'm not sure I have the right A&D. Mine says "A+D Original Ointment for Diaper Rash". It has 53.4% Petrolatum and 15.5% Lanolin.

I like your post on how to make soft and moving stools. You got the beginnings of a book .

[rcl]

Tammy:
Thank you. I am just so scared to use the bathroom right now. I went about 45 minutes ago and feel like I have to again. There was so much blood all over the place and I passed some wierd fleshy bloody thing too. I still have the impacted stool. Called the surgeon's office, nurse said to go when my body says to go, which is every half hour, take sitz baths and try my hardest to push out the impacted stool. She even suggested an enema. I think she's trying to kill me. I wish I'd read all this about 7 days ago. Now I'm just depressed and scared. I don't know what to do.
When I went in two days ago, they manually removed some stool. It hurt so bad. I just can't imagine going through that again. Isn't there a way they can anesthesize? It's killing me.
rcl