Discussions that mention vicodin

Bowel Disorders board

[SIZE="5"]Hemorrhoidectomy Recovery Guide


I had a scalpel hemorrhoidectomy surgery on 2 hemorrhoids (one rather large) that were near my anal opening and a banding for an internal hemorrhoid. Although there are tips for any hemorrhoidectomy surgery, this guide focuses on scalpel surgeries and not the banding technique. I initially created this “Recovery Guide” to help prepare for my own surgery due to the lack of information provided by my surgeon’s office. Most of the information herein is borrowed from multiple postings of people who had the surgery before me. I have kept most of the information I originally gathered for my own surgery, but I have added my personal experiences of what I tried and what worked best for me throughout my recovery. I am not in the medical industry, so consult your surgeon on any suggestions provided. I’ve tried to organize everything in the order that the information is needed – and I tried to give a reasonable timeline of how the average person recovers from surgery from the posts I read. Even though I felt really bad on some of the first days after surgery, it gave me comfort to read over the list and see that I was on the expected recovery path. Recognize that everyone heals differently, but this should give you an indication if you are on track or not. My recovery was remarkably quicker than what seems to be the average in the postings – and I believe it is because of following the advice contained in this guide. For reference, I am a 36 year old male that is in fairly good health with about 20% body fat and worked out about 2 times a week. I did not document any remedies to complications to surgery. Contact your surgeon or go to the ER. I also did not include any herbal suggestions that I found on sites since it was too difficult to research possible side effects and the only one I wanted to try was too difficult to find.

Things to Discuss With Your Surgeon before Surgery

Other options: This surgery has a very painful recovery. Post-surgery, many patients posted they wish they had discussed more alternatives with their surgeon. Some felt that the surgeon’s recommendation was biased due to financial gain of performing the surgery.
[INDENT]I personally have no regrets after having the surgery; although after going through recovery, I might had tried more options first. [/INDENT]

Time off work: Most people posted that their surgeons indicated they would need less time off work than they actually needed. 3 weeks seemed to be the average minimum time before going back into office and many started with half days for a week; although many worked from home in 2 weeks. 6 weeks seemed to be the long end of the spectrum unless there were complications. Jobs requiring manual labor seem to require 6 weeks or longer recovery.
[INDENT]I tried to work from home in 5 days which was mostly unsuccessful and returned to work at a desk job in 11 days, but I was not at 100% and I was fatigued during the day. [/INDENT]

Specifically what procedures will occur: There are multiple operations to remove hemorrhoids. Some involve banding and others involve cutting the tissue out. The surgery wounds may be left open, stitched, or stapled. It’s a good idea to know exactly where the hemorrhoids are being removed from and details of the surgery being done. There are multiple posts of patients going in for a banding which is less painful and to awaken after having the more painful scalpel surgery. This will result in a longer period away from work and you may not be prepared for the extra recovery. Be clear with your surgeon what you authorize him to do versus what you don’t.
[INDENT]I went into surgery to have 1 hemorrhoid cut out and another banded, and the surgeon decided to cut 2 out instead so I had an extra incision. I was okay with this result, but had he made 5 incisions I would not have been.[/INDENT]

Expectations of physical appearance: Some expect to have no noticeable scaring after surgery. If you are having surgery for appearance, discuss this openly with the surgeon before having surgery. You will possibly show signs of surgery afterward. If this is important to you, discuss it before hand – this is not a plastic surgery procedure.

Clearing upper and lower bowels before surgery: Your doctor will advise you when to stop eating the night before surgery. Most people feel like they had an easier time if they cleared their upper and lower bowels – via laxative – before surgery due to constipation from food that was in upper bowels during surgery.
[INDENT]I did not clear my upper bowels before surgery and I believe that is why the first part of stool to exit my body during the first BM was somewhat harder than the rest.[/INDENT]

Nausea: If you know that you are prone to nausea when you have surgery, see if the surgeon might recommend a patch or prescription to help counteract this.
[INDENT]I did not experience nausea.[/INDENT]

What Care Giver Assistance You Will Need/Have Available After Surgery: This is especially important if you are single and not located near family. What assistance you have available may influence what options are viable for you.
[INDENT]I am single and needed a ride home. I had the driver stay for about 3 hours until I was comfortable that I could take care of myself. I kept a cell phone close at all times.[/INDENT]

Risks and Possible Complications: Out of scope of this guide; but discuss with surgeon.

Put Things in Easy Reach: Reaching high and low will be very difficult after surgery. About 3 days before surgery, try to pay attention to anytime you bend or stretch to get something. Try to have everything out on countertops and in the center shelves of the fridge, etc.

Things to Have Before Surgery

Enemas (Fleet)
Panty liners
4x4 gauze
Flushable aloe vera baby wipes; i.e. "Kandoo"
Squeeze ketchup bottle – for makeshift bidet
Strainer with handle
Ointments - cocoa butter, diaper rash lotion, aloe plant, lidocaine, Desitin, A&D ointment, hydrocortisone, Prep H, Benadryl cream
Stool softener: milk of magnesia, Metamucil, Citrucel, Sennakot, delcolax, collace, mineral oil, fish oil
Magnesium pills
Pain pills: Tylenol, Advil, Motrin, etc.
Epsom salts
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, magazines, or mp3 player to pass time in tub and bed. Nothing corded to an outlet when in tub.

Preparation for the Surgery

Adjust diet at least a week before surgery. See food suggestions below.
Start taking a stool softener such as Metamucil or Citrucel for a few days prior to surgery. Don't overdo it - use just need enough to keep the stool soft. Stool softeners require plenty of water to work - this should make the first BM less painful and it’s helpful to have an idea before surgery how to get your stool to the consistency you need to have a bowel movement without having to push.
It's a good idea to be eating a high fiber and low meat diet a few days prior to surgery - plenty of vegetables and fruit and high fiber cereals and breads.
See if you can get your prescriptions filled the day before surgery. Some hospitals have a service to fill the prescription while you are in surgery.
It’s a good idea to try to clear your upper and lower bowels before surgery – possibly by taking a laxative the night before. Your surgeon will give you a cutoff time for any water or food prior to surgery – usually 8 hours. You may want to adjust this some to give your body time to get more stool out of your digestive tract. Prior to going to the hospital, your surgeon will advise to take one to two enemas an hour or two before the planned surgery. Hold the enema for 5 to 10 minutes and then expel it; repeat. Fleets enemas or tap water enemas are usually fine.
Directly before surgery, do not eat anything that might be “scratchy” while exiting the body.

Day of Surgery


Dress in very loose fitting clothes that you can get up and down easily. You will have to get dressed in these after leaving. Jogging suits and sweats seem to be very popular.
From the time you arrive at the hospital until you are in surgery will probably be about an hour to prep you. Surgery will probably last about another hour. Waking for anesthesia will probably be 30 to 45 minutes. Within another 30 to 45 minutes your vitals will expect to be normal, and you’ll be getting up to urinate. Depending on how long that takes, you’ll be going home shortly after that.
Local anesthetic should last 6 to 12 hours after surgery. You will leave only after the anesthesia wears off and you have urinated. You may feel nauseated.
Getting out of bed the first time was very difficult for me. They had me get to a wheelchair to go to the restroom. Use your arms as much as possible to get up and down into the wheelchair. I did not have urination issues, but I could not push to get a strong steady stream.
You will need someone to drive you home. Be sure he/she is aware to slow down far in advance of stops and to take bumps in the road with care. He/she may not be aware of how painful that will be for you.

Care Directly After Surgery

Take pain meds as prescribed and on time. Do not combine Percocet and Vicodin - you'll get ill. If prescribed both, it’s claimed to work best by beginning with Percocet and switching off every 4 to 6 hrs. Use an alarm to keep on schedule through the rest of the day and the night - Pain meds will take approximately 30 minutes to kick in - staying on schedule is important for a less painful recovery.
[INDENT]I was only prescribed Vicodin and Valium and was very careful to stay on schedule and did not experience pain until my first BM.
Some doctors may recommend that you take an antibiotic (such as metronidazole) to prevent infection and reduce pain.
Mine did not and I had no issues with infection.
Ice packs applied to the anal area may reduce swelling and pain.
I never needed this.[/INDENT]
Frequent soaks in warm or hot water (sitz baths) help relieve pain and muscle spasms. Some people could not urinate outside the tub for the first few days of recovery. Urine in the water will not cause any harm to your wounds. If passing gas is painful for you, it is less painful in a tub of water. Recommended to add epsom salts to bath - roughly 1/3-1/2 cup of Epsom salts either every or every other time. Fill the tub to just cover the hips. These baths may speed recovery.
[INDENT]I spent hours at a time in a tub of warm water and Epsom salt (probably 6 to 8 hours daily for the first week) and I believe this helped my recovery quite a bit. Although most posts indicate the hotter the water, the more the relief; I only soaked in very warm water. Some felt very hot water increased bleeding at the wounds and I did not want to risk it. Early in recovery, sitting in the tub was the only time I felt complete relief from pain.[/INDENT]
If at all possible, try to walk some - at least 3 trips to the end of the house. You won't feel like it, but it will probably make you feel better in the long run. Carry a small bucket in case of nausea.
You will not be able to sit directly up directly after surgery. Soft recliners seem to be popular, however I spent most of my time in bed. Some felt most comfortable on their side, but some were more comfortable on their backs – also try a pillow between your legs and under your knees depending how you are lying. Most opinions were that lying on the stomach did not offer enough support. You will have to experiment.
[INDENT]I was not in pain most of the first day so I made more than 3 trips to the kitchen and to the bedroom. Getting in and out of bed was a very slow process. I heated my own food and ate it standing up.[/INDENT]
You may or may not sleep most of this first day, but you will likely take a few naps and you will feel tired and exhausted. Try sleeping on the sofa, in a recliner and in bed to see which is most comfortable for you.
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.
[INDENT]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.[/INDENT]


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.
[INDENT]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.[/INDENT]

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.
[INDENT]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.[/INDENT]

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.
[INDENT]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. [/INDENT]

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.
[INDENT]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.[/INDENT]

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.
[INDENT]On day 11 I started experiencing this and A&D ointments with lanoline and one with zinc oxide seem to help.[/INDENT]

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.