Anorectal Surgery Post-Op

General instructions

You will have some residual drowsiness from your sedative/anesthetic. Have someone drive you home. Do not drive or operate machinery for 24 hours or under the influence of narcotic pain medication.

Diet

Let your appetite guide you. If you are not hungry, do not force food. Drink plenty of liquids. If you have nausea, stay with clear liquids until it resolves, then take only easily digestible foods. Resume your normal diet when you can. Increase the amount of bulk (fiber) in your diet. Avoid foods that cause diarrhea or constipation.

Activity

Take it easy. Get plenty of rest. You may walk and go up and down stairs as usual. Do not use an inner tube cushion to sit on. You may use a pillow if needed. Change positions regularly. Lying down may take some pressure off the perianal area. Do not lie in one place too long. Stay active. Stay home to care for yourself as instructed. You may shower or bathe as usual. Abstain from sexual activity while healing until pain resolves. Abstain from vigorous exercise or weight lifting until pain resolves (seven to 10 days). You may ride in a car.

Medications

Resume all prescribed medications you were taking regularly before surgery unless otherwise instructed. Take prescribed postoperative medications as instructed.

Pain control

The goal is to relieve acute pain to a tolerable level. During healing, some pain is normal. Do not take pain medicines on an empty stomach.

• Advil (Ibuprofen): Two 200mg tablets (400mg) every six hours, reduces pain and swelling. If you suffer ulcers or stomach irritation, do not take. If bleeding is excessive, discontinue. If you are allergic to aspirin, do not take.
• Tylenol (acetaminophen): Two 500mg tablets (1,000mg) every six hours.
• Alternate Advil and Tylenol to take one or the other every three hours. You may substitute Vicodin or Percocet for Tylenol. Tylenol dose should not exceed four grams (4,000mg) per day.
• Hydrocodone (Vicodin) or oxycodone (Percocet): One every four hours or two every six hours. These contain acetaminophen (Tylenol). You may substitute for Tylenol. Do not add any more Tylenol.

Perianal care

Warm water is soothing, helps relieve pain, reduces swelling, increases blood flow and promotes healing. Keep the perianal area clean, especially after stools. Take sitz baths (very warm water soak -- do not burn your skin) for five minutes two to four times a day, especially after every bowel movement. Blow dry with a hairdryer after sitz baths. Do not apply any creams unless instructed. Use soft moistened wipes instead of dry toilet paper (Baby or pre-moistened wipes). Be gentle. Dab don't wipe. Some bloody discharge is to be expected. You may see some blood with initial bowel movements. This is normal. You may need to wear a panty liner or pad in your underclothes for spotting and cushioning.

Bowel and urinary management

Bowel movements may be associated with some discomfort initially after surgery. This will diminish as healing occurs. Constipation is to be avoided. Straining at stool is to be avoided. Do not sit on the toilet for extended periods of time (over five to 10 minutes). Bulk laxatives and stool softeners help: Fibercon (calcium polycarbophil) two tablets with 8 ounces liquid or Metamucil (psyllium) or Citrucel (methyl cellulose) one packet (1 tablespoon) or two tablets with 8 ounces water three times a day (with each meal). Colace 1 (docusate) 100mg three times a day. If you have not had a bowel movement in two days, take 60cc Milk of Magnesia with 8 ounces water at bedtime and two Senna or Dulcolax (Bisacodyl) tablets at night of the second day without a bowel movement. If this is not effective by the next night, take 8 ounces of magnesium citrate at bedtime with plenty of water.

Perianal pain may make it difficult to urinate. If you cannot urinate, try a sitz bath and pain medicine. If you still cannot urinate for six hours and feel uncomfortable despite adequate fluid intake, call the number below.

Common potential problems

• Excessive bleeding: If bleeding is excessive (greater than 1-2 ounces every 15 minutes that will not stop with pressure applied locally) call the number below. If you pass a large amount of blood (1 cup or more) or feel faint or dizzy from bleeding, call.
• Urinary retention: If you cannot urinate for six to eight hours, call.
• Infection: If you have foul smelling, purulent (pus) drainage, call. If you run a persistent fever greater than 101 degrees, call. If you have redness and an increase in pain, call.
• If you have nausea and vomiting and are unable to take liquids, call.

Contact information

Appointments: 310-794-7788. Dr. Sack's Office: 310-267-0430.

After hours: Call the page operator at 310-825-6301. If you have a true emergency and cannot reach anyone by phone, come to the emergency room and seek immediate medical attention. Use common sense.

Follow-up appointment: Call the appointment scheduling number to schedule your follow-up appointment.