Anal Surgery
1) How long should pain last after anal surgery (e.g. hemorrhoid surgery)?
- Patients typically experience pain for 1-3 weeks after anal surgery.
2) What can I eat after anal surgery?
- After anal surgery, you have NO dietary restriction, but we recommend foods that do NOT cause constipation.
3) What can I do to help relieve the anal pain?
- You can take the prescribed pain medication, typically oxycodone.
- If you choose Acetaminophen (i.e. Tylenol), you can take as directed, up to 4000 mg in 24 hour period.
- You can also use Ibuprofen OR naproxen, as directed.
- You can call our office for a prescription of a compounded ointment, Diltiazem with Lidocaine, which can help relax the internal anal sphincter and help with anal spasms.
- You can do warm water baths or Sitz baths to help relax the anal spincter muscle. This refers to irrigating the anal opening in a basin of warm water. You can do this for 10-15 minutes 3-4 times daily.
4) I feel a loose stitch near the anus. Is this a problem?
- No, it's not a problem. I use absorbable stitches that dissolve. However, if you feel a stitch causing irritation, you can call us to assess in office. Often we can cut the excess suture material to avoid irritation.
5) Is bleeding normal after anal surgery?
- Yes, it is quite common. You may experience some bleeding and mucus drainage. Bleeding can occur with bowel movements or vigorous wiping. You can use wet wipes or cleansing foam on toilet paper. You can use gauze or sanitary pads to avoid staining your clothing. If bleeding is continuous or seems excessive, please call us or go to the closest emergency department.
6) How do I clean and protect the skin around the anus?
- You can shower immediately after anal surgery. You can wipe the anus normally with toilet paper, wet wipes, or both. You can apply a thin layer of the over-the-counter antibiotic ointment or over-the-counter Calmoseptine to the skin around the anus.
7) I feel like there is a new hemorrhoid, what do I do?
- Although postoperative swelling is common, some patients may interpret swelling as a new hemorrhoid. You are welcome to call us to assess. Occasionally, patients can develop a postoperative thrombosed hemorrhoid that we can address in the office. Over time, however, swelling should improve.
Abdominal & Pelvic Surgery
1) What foods should I avoid after an operation where a piece of bowel is removed? (e.g. colorectal, small intestine surgery)
- After abdominal/intestinal surgery, where a new intestine connection (anastomosis) is made by Dr. Parker, you can eat many foods, but PLEASE AVOID ROUGHAGE and INSOLUBLE FIBER for 3 WEEKS.
- Examples of roughage include lettuce and other leafy greens, celery, asparagus, cauliflower, and other hard-to-digest vegetables. Please peel fruits and chew well. You can remove most seeds from cucumbers and tomatoes and then chew well.
2) When can I eat anything I want?
- After 3 weeks postoperatively, you can eat anything without restriction.
- Immediately after surgery, you can take supplemental fiber products, (e.g. Metamucil, Fibercon, Benefiber).
- Immediately after surgery, you can eat foods without significant "roughage". For example, peeled and cooked carrots are fine. You can eat beans (pinto, black, kidney, lentils, chickpeas and green peas) in small, cooked portions.
Return to Work
1) How long should I be out of work after anal surgery?
- Patients typically return to work within 1-3 weeks after anal surgery, depending on the degree of pain.
2) How long should I be out of work after abdominal surgery?
- Patients can return to work within 2 weeks after abdominal surgery, if patient feels well and does not require heavy lifting. Otherwise, I recommend 4 weeks out of work, if your job requires lifting over 25 pounds.
Urination & Bowel Movements
1) I am unable to properly urinate after surgery, what do I do?
- If you have not urinated for approximately 6-7 hours since last urination, or if you have pelvic pain/pressure, please come to the emergency department. Before that, you can try urinating in the shower, because warm water can relax sphincter muscles to better release urine.
2) What do I do for constipation after surgery?
- It's okay to NOT have a bowel movement for 1-2 days after surgery. However, symptoms should be reported to us, such as bloating and cramping that is persistent.
- First, pleased drink about 2 liters (64 oz) of water and non-caffeinated beverages per day, if your heart and kidneys allow.
- Second, please consume adequate fiber intake using supplements and fiber-based foods (25 - 35 grams per day).
- Third, you can use one (or two) of the following to help alleviate the constipation:
a) Milk of Magnesia (15-30 mL) use 1 dose every 4 hours as needed
b) Miralax: 17 grams taken 1-2 times daily
c) Magnesium citrate (follow instructions on bottle)
Post-operative Questions
1) When should I have my postoperative visit with Dr. Parker?
- Typically, patients are seen about 4 weeks after surgery, unless otherwise directed. You may choose an appointment in the office, by telemedicine, or be telephone call.
2) What should I watch out for after surgery?
- Please call our office if you have persistent fever, chills, nausea/vomiting, or inability to move bowels, despite trying laxatives.
3) What are my restrictions after abdominal surgery (colon, rectum, abdominal hernia)?
- No aerobic exercise for 2 weeks and no lifting over 25 lbs for 4 weeks.
Miscellaneous
1) I am scheduled to have part of my colon/rectum removed and Dr. Parker mentioned an ostomy bag is a possibility. How does that work?
- Dr. Parker advises patients that a "temporary" ostomy bag may be needed to divert stool away from the new bowel connection, especially if that bowel connection has a higher risk for leakage, as determined preoperatively or during the operation.
- If an ostomy is created, nurses will educate you on how to manage this until the ostomy is reversed. Ileostomy reversals are typically done 8 weeks later. End colostomy reversals are typically done 12 weeks later.
2) Who should or should not consider an operation for diverticulitis?
- Patients with complicated diverticulitis are more likely to choose surgery. Complicated diverticulitis includes:
a) pelvic abscesses
b) colonic stricture (narrowing)
c) colon being abnormally connected to the bladder or vagina (a.k.a. fistula)
- If you choose to have surgery, and if the outcome is successful, your risk for further diverticulitis is about 4%.
- People with immune system compromise are more strongly considered for an operation.
- People who have ongoing symptoms, even if the episodes are uncomplicated, can certainly consider surgery.