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Post Operation Instructions

Instructions following hemorrhoid ligation (Rubber Banding)

  A rubber band has been placed around the hemorrhoid to choke off its blood supply and will eventually cause the hemorrhoid to fall off.

    You will have a dull ache for the next 24-48 hrs which will be noted as soon as the rubber band is applied.  When you sit down, it may feel like you are sitting on a ping-pong ball.  You may also notice some blood over the first 24-48 hours.  This is normal.

    Hot baths provide the best pain relief, and should be used liberally.

  Hot baths should be used 2-3 times each day AND especially after each bowel movement.  You may use your bathtub.  The bath can be shallow- just enough to soak your bottom.

 You may take Tylenol or Ibuprofen for any ache or discomfort.  Narcotic medications can cause constipation, which should be avoided.

•     No special diet is necessary.  However, it is important to keep your stools soft and avoid constipation.  Take fiber (Konsyl, Metamucil, or Citrucel), one heaping teaspoon each morning.  You must drink plenty of fluids throughout the day for the fiber to work.  You can add Colace (stool softener), 1 to 2 per day as needed.

•  The rubber band may give you the sensation that you need to have a bowel movement.  If you feel the need to move your bowels, try to do so, but do not strain.  If you push hard enough, the rubber band could come off.  Sit down and try, but if nothing is happening, realize that it is probably the rubber band that you are feeling.

•     You may resume all your normal activities as they are tolerated.

•     Do not take aspirin or aspirin containing products for 1 week before and after the procedure

•    Bleeding and protrusion can persist until all of the hemorrhoids have been treated.

•    If fever, severe pain, or inability to urinate occur, contact me immediately

•    After 7-14 days the hemorrhoid and rubber band should fall off and be passed with your normal bowel movement.  You probably will not notice the hemorrhoid itself but you will likely see a small amount of bleeding when it does fall off.  If severe bleeding occurs (3-4 bloody bowel movements), call the office immediately.


Post Operative Instructions for Ambulatory Anorectal Surgery

 
WOUND CARE 
• Take any bandages off in the late afternoon or evening and take the first hot sitz bath  
• The bath water should be as hot as tolerable, without causing burns  
• It is NOT necessary to add anything to the water (such as Epsom salt)  
• Hot baths should be used at least 3-4 times each day AND especially after each bowel movement.  You may use your bathtub.  The bath can be shallow- just enough to soak your bottom 
• If there is any "packing," it should be removed from the anus during the first bath  
• Expect some oozing or slight bleeding, especially with bowel movements 
• No bandages are necessary, but may be used as desired to absorb any drainage.

 
PAIN 
• The anesthetic that was injected at the time of surgery should last 3-6 hours  
• It is normal for the anal area to be very painful for several days, and especially after the initial bowel movements  
• Hot baths provide the best pain relief, and should be used liberally  
• The prescription you have been given is for a strong narcotic pain medication  
• Use the pain medication as necessary, but be aware that it will cause some degree of constipation.

• Also, avoid driving or other activities that require your full attention while taking narcotics as they can be sedating. 
• If the pain is less severe, Ibuprofen/Advil (up to 600 mg every 6 hours) or Tylenol (up to 1000 mg every 4 hours) can be substituted  
 
DIET  
• Eat as much fiber as possible: fruits, vegetables, salads, whole grain breads, bran cereals, bran muffins, prunes and prune juice  
• Drink lots of fluids: water and juices  
• Avoid spicy foods until the wounds are healed  
 
BOWEL MOVEMENTS  
• It is common not to move your bowels for 2 or 3 days after surgery  
• The first bowel movement will hurt.  This is normal

• It is important to try to avoid becoming constipated  
• A high fiber diet is essential  
• Take a stool softener such as Metamucil once or twice a day, and/or Colace three times a day.  These can both be purchased over the counter 
• Excessive pressure in the rectum (or even pain) may indicate the need to have a bowel movement  
• If a laxative is required usually try two tablespoons of Milk of Magnesia; if this is not effective, take 6 oz of Citrate of Magnesia  
 
ACTIVITY  
• You may resume normal activities, including exercising, as soon as you feel up to it 
• You can return to work whenever you feel able  
• There is no way you can do yourself any harm or affect the success of the surgery by excessive activity but sitting/standing for a prolong time can be harmful.  
 
THINGS TO WATCH FOR  
• A small amount of bleeding or oozing is normal, especially with bowel movements; if bleeding is heavy, or does not stop after bowel movements, call the office immediately.  
• It is not unusual to have difficulty urinating after surgery.  Often it is necessary to urinate while sitting in a hot bath; frequent urination of very small volumes is abnormal and requires that you call the office.  If you have not urinated at all by the first evening, call the office

 
FOLLOW-UP 
• If your surgery was scheduled through my office you should have already been given an appointment for a check-up about 2-3 weeks after surgery.  If not, please call the office within a few days, and make an appointment.

  1. Expect to be out of work for a minimum of 2-3 days and depending on the extent of your surgery and your degree of discomfort, as much as 2 weeks.  You may go back to work whenever you feel comfortable.


ADDITIONAL SPECIFIC INSTRUCTIONS

  1. In certain procedures, you may have one of the following.  Please follow the additional instructions associated with the procedure that pertains to you.


[  ] Drains/Setons:  If a drain or seton has been left, this should not be removed.  If the drain does fall out, it is not an emergency.  You can call the office during normal business hours to discuss the plan.

 

[  ] Wound Packing:  The packing that has been left in the wound is intended to be replaced.  The first packing should be removed with the first hot bath and replaced with a piece of gauze.  After that, the gauze can be replaced twice a day.  Removing the old gauze is usually easiest during a hot bath and a new one can be placed immediately afterward.

 

[  ] Fistula plug:  With the fistula plug, you should avoid any heavy activity for the first 2 weeks.  This includes running or bike riding or anything else that can produce repetitive movement /friction around the area of the plug.  Drainage is to be expected with the plug in place and may continue for up to a month.  If the plug falls out, it is not an emergency, but you should call the office during regular business hours to let us know.





 

Sanghyun Alexander Kim,M.D. 

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