Anorectal

Resources

Background

It is important to refer to a reputable source when seeking information on anorectal surgery. Virginia Surgery Associates (VSA) is a top surgery practice in the Northern Virginia area. VSA offers fellowship trained colorectal surgeons who perform advanced minimally invasive and robotic anorectal procedures to treat minor to complex anorectal conditions.

Anorectal surgery requires a lot of preparation and care before and after the surgery. Refer to our other resources as well as your surgeon/physician in order to remain fully educated on the subject.

After Surgery Care

Because of the discomfort you will experience following your surgery, initially you will not feel up to resuming your normal activities. However, it is important that you be active because mild daily exercise such as moving about the house promotes normal circulation and bowel activity. Do not overexert yourself, and avoid vigorous physical activity for two to three weeks. Avoid straining on the toilet, prolonged sitting (including on the toilet), squatting, or standing, because doing so can contribute to a recurrence of hemorrhoids or other anorectal problems.

Caring For The Incision

You may go home with packing in your anus and a gauze dressing over it, which you should leave in place until your first sitz bath. Begin taking sitz baths during the first evening after or the morning following your surgery. You should take three to five sitz baths a day by soaking in a tub of warm, plain water for 15-20 minutes for the first week to two weeks after surgery. Commercial sitz baths can be purchased from most pharmacies, or you can use a pan or bathtub. Before your first sitz bath, remove the gauze dressing; then, while you are soaking in the tub, gently pull the packing out. After the sitz bath, apply a gauze dressing (several layers of 4X4” gauze) or a perineal pad to the site to protect your clothing from any drainage. Change the dressing or pad after each bowel movement and sitz bath, or more often if the drainage makes it necessary. Wash gently after each bowel movement- you may wish to use a moist perineal wipe (such as baby wipes) after each bowel movement to keep the area clean. You may find that an ice pack placed closely to your anus intermittently for 15-20 minutes at a time for the first 24 hours reduces pain and swelling. You may be more comfortable if you use a thick foam pillow or pad to sit on (do not use air or rubber doughnut because they spread the buttocks apart and may cause more discomfort).

Diet

You may eat whatever you want after your surgery. It is important, however, to eat a diet high in fiber (bran, fruits, vegetables) to promote regular bowel movements and soft stools. Be sure to drink plenty of fluids (not including tea, coffee, or alcohol) – up to 8 – 10 twelve ounce glasses each day. It is critical not to become constipated after the surgery. We recommend using a bulk fiber agent (such as Metamucil, Benefiber or other) daily, along with Miralax, Milk of Magnesia or prune juice daily until you are having easy bowel movements more than once a day.

What to Look For

It is normal to have a slight to moderate amount of drainage from your incision site. The drainage will be red at first and will gradually turn pink and then clear. You will also have some swelling and bruising which will slowly decrease over several weeks. You may notice some bleeding for as long as ten days to two weeks after surgery- this is normal too, and is the result of the sutures dissolving. It is very important to encourage bowel activity after your hemorrhoidectomy/anorectal surgery. The first few bowel movements after surgery will be painful and may make you dizzy. Using bulk agents (fiber supplements), miralax and stool softeners, drink plenty of fluids, and getting regular, mild exercise will make bowel movements easier and less painful. Please call our office immediately if you notice any of the following after your surgery: Excessive bleeding or drainage (more than two saturated perineal pads in 8 hours); fever over 101F; pus draining from the anal area; redness, swelling, or warmth in the anal area; difficulty urinating; or constipation (no bowel movement within 3 days after surgery).

Medication

You will be given a prescription for pain medication. Prescription pain medications are there to help you recover comfortably, but stop them as soon as you are able. Side effects of nausea, vomiting, dizziness, fatigue, poor appetite, and above all constipation, are common. If you have these issues, try to use ibuprofen and Tylenol instead (see below). Do not use alcohol or drive if you are taking prescription pain medications. Unless you are told differently by your surgeon or primary doctor, you can take 400 mg ibuprofen every 4-6 hours, or 800 mg every 8 hours, for the first 3-5 days after surgery, for a maximum dose of about 2400 mg/day (refer to the label for specific dosing based on age and weight). It is best if you can take some food with this medication. Tylenol is also acceptable to help with the baseline pain after surgery. It can be taken in conjunction with ibuprofen, and with your prescription (unless your prescription already contains acetaminophen--which is Tylenol). Be very careful not to exceed the dosage on the bottle. Taking more than 3 grams/day is not advisable. You may be given a tube of dibucaine ointment when you leave the surgical facility. You can get more over the counter at a pharmacy under the name Nupercainal. This is a numbing cream which can be applied to the anal area 4-6 times daily, best after sitz baths or washing. Blood thinners should only be restarted after surgery according to the plan discussed with you by your surgeon or prescribing doctor before surgery. If this was not made clear to you, call our office.

All other medications should be resumed once you get home. Vitamins and supplements are not necessary to help you heal, unless you have a known deficiency. You may resume them after you get home if you wish. We would suggest sleep aids not be used while you are on narcotic pain medications.

Follow Up

We will see you in our office about two weeks after your surgery and often again several weeks later. There are no sutures to be removed. Prior to surgery, you should have made an appointment for your first post-operative visit. If for some reason that appointment was not scheduled, please call our office at (703) 359-8640 as soon as you return home to schedule your appointment.

Difficulties

Please call us if any problems or questions arise. We can be reached any time, including evenings and weekends, by calling our office number (703) 359-8640.