Post-Operative Instructions: Anorectal Surgery

This is not a substitute for direct care by YOUR doctor. Confirm with your doctor before doing any of the following.

What to expect

• !!Pain is common after surgery on this part of your body. The skin around your anus is as sensitive as your fingertips!!

• Swelling may not COMPLETELY go away for 4-6 weeks. You can also use an ice pack in this area or elevate that part of your body to help reduce swelling.

• AVOID CONSTIPATION. Having a bowel movement can be painful after surgery but constipation is MUCH WORSE. 

•  A small amount of bleeding is common following rectal surgery. A sanitary napkin or gauze may be worn over the anal opening to keep underclothing clean. This small bleeding can last up to 4 weeks, although it typically goes away faster than this. If there is prolonged or profuse bleeding with passage of clots, call the office at once. If you had bleeding before surgery from hemorrhoids, this may continue for the first 1-2 weeks before it gets better. Some patients have bleeding that only starts 4-7 days after surgery. Do not worry if you have some bleeding, discharge, or itching during your recovery. This is normal. However, if you have prolonged or profuse bleeding with the passage of clots, call the office at once. If a stitch was placed during surgery, this may come out – that is not a cause for concern unless there is also bleeding.

• In some patients, a packing will have been placed in the anus at the end of the surgery. This should pass with the first bowel movement (or before).

• Difficulty urinating after surgery around the anus is usually due to spasm of the urinary sphincter resulting from pain due to the surgery. Getting the pain under control and relaxing the sphincter usually allows for the urine to pass. Take the pain medication you were prescribed and do warm sitz baths – either in a bathtub or sitz basin. While soaking, attempt to relax the bladder and urinate into the water.  If you are unable to urinate in the first eight hours after your surgery, notify the doctor’s office. After hours, go to the nearest emergency room or urgent care center. A bladder catheter will be placed and remain in place for 2 days, you may call the office to have the catheter removed. 

• You will be given a prescription for pain medication. Follow the directions given by your doctor for taking this medication. To avoid upset stomach, take your pain medication as prescribed with food in your stomach. Take these drugs exactly as directed. Never take more than the recommended dose, and do not take the drugs more often than directed. If the drugs do not seem to be working, call the office for advice. Do not share these or any other prescription drugs with others because the drug may have a completely different effect on the person for whom it was not prescribed. Some people experience drowsiness, dizziness, lightheadedness, or a false sense of well-being after taking these medicines.

• Sitz Baths: sit in 8 to 10 centimeters of warm water (sitz bath) for 15 to 20 minutes 3 times a day and / or after bowel movements. Then pat the area dry. Do this as long as you have pain in your anal area

• Avoid sitting on the toilet for long periods of time (greater than FIVE MINUTES) or straining during bowel movements. 

How to manage bowel movements and diet

• To avoid constipation, take a fiber supplement (Metamucil (orange bottle), Citrucel (orange bottle), Benefiber (green bottle), etc.). Start with one teaspoon once a day. You can increase this slowly to two teaspoons twice daily and the two teaspoons twice a day. Increasing fiber quickly can cause bloating and gas pains. Take a stool softener such as Colace or MiraLAX twice a day as well. You can also take MiraLAX AND a stool softener AND fiber. If you are not having bowel movements (or having bowel movements less than every 3 days), your bowel movements are hard, you have to strain with bowel movements, and / or your bowel movements are small pebbles - YOU ARE CONSTIPATED. 

 o Start with 200 mg Colace twice a day AND fiber. Make sure that you are drinking at least 64 ounces of non-caffeinated non-alcoholic liquids daily.

  - If that does not work, then ADD MiraLAX 1-3 times a day.

  - If that does not work, then ADD one dose of magnesium citrate or milk of magnesia.

• If you have not had a bowel movement by the morning of the fourth day following surgery, drink one bottle of citrate of magnesium, which can be purchased at any pharmacy. Following the first bowel movement, you should have a bowel movement at least every other day. If 2 days pass without a bowel movement, take an ounce of milk of magnesia. Repeat in 6 hours if no result.

• After a bowel movement, you can use toilet tissue, wet Kleenex, cotton, Tuck’s pads, or use a bidet to clean yourself. If possible, take a warm bath. After completing your cleaning, pat the area dry with dry tissue or use a hairdryer on a cool setting. Constant moisture in the area can cause itching and also delay healing.

• Eat a regular diet including plenty of fresh fruit and vegetables. 

Medications

Over the counter medications to use after surgery. I highly recommend taking all of these medications using the instructions below.

• Take BOTH Tylenol and Motrin (Advil/ibuprofen) THREE TIMES A DAY for 2 weeks after surgery.

1. Ibuprofen (Motrin/Advil) 200 mg: Take 600 mg (usually 3 tablets but check medication dose before using) every 8 hours with food or milk for 2 weeks. After 2 weeks, take as needed for pain. DO NOT TAKE IF YOU TAKE A BLOOD THINNER, TAKE ASPIRIN DAILY, OR HAVE HEARTBURN. DO NOT TAKE THIS WITH CELEBREX (CELEBREX REPLACES THIS MEDICATION).

1. Tylenol 500 mg: Take 2 tablets (1000 mg) every 8 hours for 2 weeks. After 2 weeks, take 1-2 tablets as needed for pain every 8 hours.

• Colace 100 mg: Take 2 tablets twice a day to prevent constipation. If you have loose stools take 1 tablet daily. If you still have loose stools then stop this medication.

• MiraLAX (Purple Top container): take 1-3 capfuls daily with liquid for constipation. Put the powder in a liquid and mix it. Wait 10 minutes for it to fully dissolve; this will significantly help the taste. Then drink the liquid. If you have loose stools, stop this medication.

• Celecoxib (Celebrex) 100 - 200 mg: Take 1 tablet or capsule 1-2 times per day (your prescription bottle will provide full instructions). This is INSTEAD OF IBUPROFEN if you have a history of heartburn. DO NOT TAKE IF YOU TAKE A BLOOD THINNER OR TAKE ASPIRIN DAILY

• Oxycodone 5 mg: Take 1-2 tablets every 4-6 hours for pain not controlled by Tylenol or Motrin.

• Baclofen 5 - 10 mg: Take 1 tablet 1-3 times daily for muscle spasm pain. This medication can you make you sleepy so start this medication at night.

• Lidocaine Ointment or Cream: apply to the area 1-2 times per day

• Gabapentin 100 - 300 mg: Take 1 capsule at night. You can increase this up to 3 times a day. This medication can cause you to be sleepy or dizzy. If this happens, stop taking the medication.

• Journvax (suzetrigine) 50 mg: Take this medication every 12 hours. For the FIRST dose, take 2 tablets on an empty stomach. For all of the following doses, take ONE tablet with or without food every 12 hours.

When Should I call the Physician? 

• Diarrhea: Occasional loose bowel movements are not uncommon. However, constant watery diarrhea, especially with fever, can mean there is an infection of the bowels. 

• If you do not have a bowel movement for 3 days despite doing all of the recommended steps (Colace AND MiraLAX AND fiber AND water AND magnesium citrate or milk of magnesia).

• Inability to drink liquids due to nausea 

• Fever with or without cough (temperature of at least 101.4F): This could be a sign of lung, wound or stomach infection. Elevated heart rate: If your heart rate is more than 100 beats per minute, this could be a sign of infection.

• Sudden shortness of breath and/or chest pain: This could be related to a heart problem, such as a heart attack, or could be related to a blood clot to the lung (pulmonary embolus) or a lung infection. 

• Leg swelling and pain: Blood clot formation in the leg, particularly if it is on one side, could cause swelling with pain in the calf. 

• Passing out: This could be a sign of low blood pressure, which could be caused by blood loss, low blood sugar or other causes. 

• UNABLE TO URINATE WITHIN 8 HOURS AFTER YOUR SURGERY

• If you are concerned, then call. It is better to catch any problem earlier rather than later.