When and how are my stitches/staples removed?
Most stitches will dissolve or fall out within a few days of the procedure. It is normal to see them in the toilet bowl. Please refer to the Anal Rectal Discharge Instructions for further instructions.

Are drainage and/or bleeding normal after surgery?
Some mucous discharge and minimal bleeding is normal following surgery. It may occur until the wound is completely healed. Placing clean dry gauze over your wound between the buttocks will help absorb the blood and protect your clothes. Most often, bleeding occurs with bowel movements, wiping, and excessive activity, if bleeding becomes heavy and/or constant, please contact the office immediately.

Is swelling common after surgery?
Swelling is a normal side effect and individual to the patient. There is no definite time frame for residual swelling. It is generally caused by the body’s reaction to the sutures. Often, it is common for patients to misinterpret swelling as hemorrhoids. These may actually be skin tags which will decrease in size over time. It is important to take warm water baths at least 3-4 times daily. Please refer to the Anal Rectal Discharge Instructions for further instructions.

How long should pain last after surgery?
Depending of the type of surgery, post operative discomfort might be minimal, last only a few days, or last for 1-2 weeks. Following the instructions located on Anal Rectal Discharge Instruction sheet will help reduce the pain and discomfort associated with an anorectal surgery.

How long will I need to be out of work?
Most patients may return to work within a few days depending on a patient’s job duties and activity level. Contact your physician for further information.

How long should I take the mineral oil after surgery?
Take the dose indicated on the Anal Rectal Discharge Instruction sheet until the first smooth bowel movement. Then you may reduce the mineral oil to 1-2 tablespoons twice daily. If you have any questions or concerns, please call your physician’s office.

Prescription Refills
Please contact your physician’s nurse during regular business hours. Prescription refill requests after 4PM may not be processed until the following business day. Due to legal constraints, we cannot refill pain medications after hours.

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1. Drink 8- 10 glasses of non-carbonated, non-caffeine containing, non-alcoholic beverages per day.
2. Take one teaspoon of Konsyl 6.0 fiber supplement in liquid per day or 1 teaspoon of Metamucil 2 times a day.
3. Take 3-4 tablespoons of mineral oil 3 times a day.
4. Eat a high fiber diet.
5. If applicable, remove the outer bandage tomorrow or prior to a bowel movement this evening. The small gauze pads further inside will come out with a bowel movement.
6. Resume normal actvities. No heavy lifting, straining, pushing, pulling, or exercise for two weeks.
7. Take warm water sitz baths for 10-20 minutes 3-4 times a day and after a bowel movement.
8. For postoperative pain a prescription is provided.
9. Should you become constipated, take 1 oz. (30ml) of Milk of Magnesia. If there are no results in six hours, repeat.
10. You will have blood in your bowel movements for a few days to a few weeks. If it becomes steady and/or excessive, call the office.
11. Mucous discharge and swollen anal tissue are common after surgery and usually does indicate a problem.
12. Call to make an appointment for an office visit in __week(s).
13. DO NOT take any aspirin-containing products for at least two weeks. Tylenol approved.
14. Most stitches will dissolve. It is normal to see them in the toilet bowl.
15. If you have further questions or concerns please do not hesitate to call one of the offices listed below.

Please call during the hours of 9 a.m. - 4:30 p.m., Monday through Friday for prescription refills. No refills approved after 4:30 p.m. M-F, or weekends & holidays.

Following Hemorrhoid surgery, patients can experience a wide range of symptoms including but not limited to: pain, bleeding, swelling, constipation, nausea, diarrhea, difficulty with urination, burning and itching. Each patient is individual to the post operative process. A few factors may influence what type of symptoms a patient experiences: the number of hemorrhoid bundles removed (severity of the surgery), the condition of the hemorrhoids pre-operatively, and patient response. Regrettably, a patient’s response to surgery cannot be controlled by your surgeon. Our doctors rely on patient’s compliance to the post operative instructions to reduce or eliminate these symptoms. A majority of our patient population does very well. If you have any questions or concerns regarding your surgery or recovery, please do not hesitate to call the office.

What if I am experiencing:

Pain
Do not be alarmed. 7-10 days of post operative pain is normal. The pain should slowly decrease over a period of time. A pain medication is prescribed and should be taken as directed. However, be aware that excessive pain medication use can lead to constipation and hard bowel movements. It is important to drink at least 8-10 glasses of non-carbonated clear liquids daily to help prevent these side effects. When possible, it is recommended that patients use Tylenol as an alternative to the prescribed pain medication. Accordingly, warm water baths also reduce the pain associated with natural post operative swelling. Warm water baths should contain plain clear water only. Do not add Epson salt, soap, etc.

Hard bowel movements also lead to post operative pain and can be avoided by following the post operative instructions. These include the use of a fiber product, increase in liquid intake, and the use of mineral oil. You should avoid rectal suppositories, enemas, or any other medication taken per rectum unless directed by a physician. Having a warm water bath ready after a bowel movement will also help to reduce pain and swelling.

Pain medication prescriptions are called in only during office hours, Mon-Fri 9AM to 3:30PM. Due to legal constraints, we cannot refill pain medication after hours.

Swelling
Swelling is a normal side effect and individual to the patient. There is no definite time frame for residual swelling. It is generally caused by the body’s reaction to the sutures. Commonly, a prescription is given to help reduce immediate inflammation. It is common for patients to misinterpret swelling as hemorrhoids. These are actually skin tags which will decrease in size over time. It is important to take warm water baths at least 3-4 times daily. Warm water baths should contain plain clear water only. Do not add Epson salt, soap, etc.

Constipation
It is common to experience some constipation after surgery. The use of anesthetics during surgery and prescribed pain medication after surgery may lead to increased constipation and production of hard bowel movements. Often patients will state that they are “constipated” because they have not had a bowel movement within 1-2 days following surgery. Some patients experience their first bowel movement up to 3-4 days following surgery. Constipation is most often noted by symptoms of bloating, the sensation of feeling full, or straining with hard bowel movements. Usually, constipation can be relieved within 24 hours with the use of a fiber product, mineral oil, and increase in liquid intake as directed in the post operative instructions. If after following these instructions over a 24 hour period, a patient is still experiencing constipation, he/she should contact the office.

Difficulty with Urination
A small percentage of patients have difficulty with urination following surgery. This is due to post operative swelling preventing the flow of urine through the Urethra. Soaking in a warm water bath to help reduce the swelling may help a patient to urinate. It is ok to urinate in the tub if this helps. If the patient is able to urinate with the help of a bath, he/she should repeat this process as often as needed. If within 24 hours, baths are still needed to urinate, contact the office. However, after trying the warm water baths, a patient still cannot urinate; contact the office for further instructions. Sometimes, patients will need to have a catheter inserted for 2-3 days while the swelling decreases.

Diarrhea
Due to a patient’s individual response to fiber and mineral oil, some patients may experience diarrhea following surgery. Diarrhea may lead to swelling, pain at the surgery site, and the sensation of burning and pain of the skin surrounding the site. Please call the office for instructions to modify the post operative course of treatment.

Nausea
Nausea most often occurs as a side effect of the anesthetic drugs used during surgery; as well as the use of prescribed pain medications following surgery. Patients are instructed not to take pain medications on an empty stomach. After arriving home from the procedure, she/he should attempt to consume soft and/or liquid foods; starting with clear liquids such as 7-up, Sprite, or clear juice and then advancing to a regular diet. Antacids (Tums, Maalox, Pepto-Bismol) or carbonated beverages help to alleviate nausea. If vomiting occurs and is persistent, please call the office.

Bleeding
Minimal bleeding is a common side effect following surgery. It may occur until the wound is completely healed. Placing clean dry gauze over your wound between the buttocks will help absorb the blood and protect your clothes. Most often, bleeding occurs with bowel movements, wiping, and excessive activity, if bleeding becomes heavy and/or constant, please contact the office immediately.

Burning, Itching
A few days into the recovery period, patients might describe burning or a “knife-like” pain. Most often it is a condition of the skin of the area surrounding your surgical site. It is similar to “Diaper Rash.” As your wound heals, it expels the dead tissue from the surgery. This drainage from the wound soaks the skin and keeps it moist. The area then becomes red and inflamed. You then start to feel a burning or “knife-like” pain. To help heal and prevent this from occurring, start by cleaning the area using a soft spray or soaked wash cloth (no rubbing) of warm water. Do not use soap, creams, or any other products on this area unless directed by your physician. Place 1-2 pieces of gauze between the buttocks over the wound to catch any drainage and protect the skin. The gauze should be changed out at least 3-4 times a day. As the area is allowed to “dry-out,” the symptoms will decrease and the area will heal. The key is keeping the area clean, dry, and chemical-free (soaps, creams, etc). You should see improvement within 24-48 hours. If no improvement is seen or symptoms increase, please contact the office.

Please Remember
If you have any questions or concerns regarding your surgery or recovery, please do not hesitate to call the office.

A thrombosed external hemorrhoid is caused by a blood clot in the external hemorrhoid just below the skin around the anus. Blood clots forming in the external hemorrhoids can vary considerably in size as well as cause a great deal of discomfort. A blood clot in this area is not at risk to travel to the lungs as is a blood clot in the leg.

The excision of a thrombosed hemorrhoid involves the removal of the skin over the blood clot as well as removal of the blood clot itself. By having a thrombosed hemorrhoid excised today, you have not had a complete hemorrhoidectomy. You still have some remaining hemorrhoidal tissue.

Please note the following instructions for care of the wound:

1. A dressing has been placed over the wound. This should be left in place until your bowels move or until you are directed to soak it off in the tub by your physician. This may be before going to bed in the evening or when you first get up the following morning.
2. Avoid any strenuous activity for the next eight hours to prevent any significant additional bleeding. Do not lift over 20 pounds for the next five days.
3. There will be pain and discomfort when local anesthetic wears off. Tylenol or Advil will usually control this discomfort. If it does not, please call your physician for a prescription.
4. It will take approximately 10-14 days for the skin wound to heal. During this time, do not be alarmed if you notice some bleeding, discharge, or itching. This is normal during this period of time.
5. It is important to keep your stool soft and moving daily. If necessary, take a bulk laxative such as Konsyl, Metamucil, or Citrucel. You may utilize a tablespoon of Milk of Magnesia at bedtime if necessary.
6. Keep the area as clean as possible. You may find it comfortable to sit in the tub with warm water 2-3 times per day.
7. Return to the office for a follow-up visit as directed by your physician in ____ weeks.

Remember: Do not hesitate to call at (404) 252-5669 if you have any problems or questions.

Your hemorrhoids were treated today with a technique known as rubberband ligation. This method utilizes the application of a small rubberband over tissue associated with an internal hemorrhoid. The elasticity of the rubberband causes slow tightening and strangulation of the tissue. This may result in the feeling of a dull ache for 36-48 hours following treatment. You may also have a feeling of fullness in the rectum. This will be noted as soon as rubberbands are applied. You may have the feeling that you want to have a bowel movement. This dull ache is usually well controlled with Tylenol.

The banded tissue will usually fall off in 5-7 days. Frequently, you will not notice when this occurs, but occasionally, some bleeding will occur. Should severe bleeding occur at that time, you should contact your physician immediately.

It frequently takes 2-4 treatments at intervals of 4-6 weeks in order to remove all internal hemorrhoids. Only one hemorrhoid or perhaps two are treated at a time in order to minimize discomfort.

Please note the following instructions regarding your rubberband ligation:

1. If necessary, use Tylenol for discomfort. Avoid Asprin, ibuprofen, and blood thinners. You may also utilize warm tub baths for 15-20 minutes at a time up to 3-4 times per day. This will allow the muscle to relax, relieve discomfort, and reduce swelling.
2. Although no special diet is necessary, a high fiber diet will help maintain a daily bowel movement. If necessary, you should supplement your diet with a bulk laxative such as Konsyl, Metamucil, or Citrucel. One tablespoon of Milk of Magnesia may be utilized at bedtime if necessary.
3. You may continue normal physical activities except you should avoid lifting over 20 pounds for the next week. You may drive your car immediately after treatment.
4. You should call your physician immediately if the pain gradually increases over the next 24-48 hours. You should also call your physician immediately if you are unable to empty your bladder or if you have extreme difficulty with emptying your bladder or if you develop a fever.
5. Return for a follow-up visit as instructed by your physician on :_______________

Remember: Do not hesitate to call at (404) 252-5669 if you have any problems or questions.

An abscess around the anus develops as a result of an infection in glands within the anal canal. Although this infection usually does not become serious, occasionally it may reach the deeper tissues surrounding the anus. This results in the formation of a painful collection of fluid and pus. An incision and drainage of the infected fluid can relieve this pain.

Following the drainage of an abscess, there is approximately a 50-50 chance for the further development of a fistula. A fistula is the result of incomplete healing of an abscess. It is a tunnel beneath the skin which starts at the gland which caused the infection and runs to an opening outside of the anus. This causes persistent drainage. A fistula may result in the development of further abscesses in the future. It usually requires further operation.

Please note and follow these instructions for the care of your wound following drainage of your abscess:

1. A dressing has been placed over the wound. This should be left in place until your bowels move or until directed to be removed by your physician. This may be in the evening or next morning following drainage. At whichever time you are directed, the dressing should be soaked off while sitting in a tub of very warm water. You should then continue to take tub baths (sitz baths) with warm water three times a day for 10-15 minutes.
2. Avoid strenuous activity for the next eight hours in order to prevent excess bleeding.
3. Your wound may continue to drain a large amount over the next several days as the infection slowly heals. You may apply gauze dressing to the wound to protect your clothing. You may also use a sanitary napkin for further protection of your clothing. You may notice bloody discharge for the next four to seven days. It is important to keep your stool soft and moving daily. You may use a bulk laxative such as Konsyl, Metamucil, or Citrucel. If necessary, a tablespoon of Milk of Magnesia may be taken at bedtime.
4. It may take two to three weeks for the wound to heal. If the wound had not healed by this time, you may be developing a fistula.
5. Return to the office as directed by your physician for a follow up visit in _____ weeks.

Remember: Do not hesitate to call us at (404) 252-5669 if you have any questions or problems such as increasing fever, pain, or difficulty in urination.