Instructions

Post-Operative

Homegoing Instructions after Anorectal Surgery

Wound Care:

  1. Apply an ice bag to the affected area (20 minutes on and 40 minutes off) each hour for the first 12 hours.
  2. Begin 15 minute sitz baths in warm water 2-3 times daily in the morning. This may be continued for 5-7 days.
  3. You may remove the gauze bandage the morning after the procedure and reapply only as needed to protect your clothing. If you have had an abscess drained, remove the gauze packing in your first sitz bath in the morning.
  4. You may notice some drainage from your wound and/or some bright red blood. This is to be expected. If there is significant bleeding from the skin edges, apply pressure for 10 minutes with a washcloth. If it continues to bleed, call Dr. Kafka.

Pain Management:

  1. It is essential that you begin the pain pill prescription within 1hour after the procedure. Most of the pain is muscle spasm and the pain cycle must not be allowed to start.
  2. Your pain medicine may include some of the drugs listed below. Please confirm with our office to make sure you have the right items:
    • Ibuprofen (Motrin) _______mg every 6 hours for _____ days.
    • Vicodin _____ pills every 4 hours , as needed for pain.
    • Vicodin ES _____pills every 4 hours, as needed for pain.
    • Percocet _____ pills every 4 hours, as needed for pain.
    • Oxycodone _____mg every 4 hours, as needed for pain.
    • Lidocaine ointment to anus, as needed for pain.
    • ELA-MAX cream to anus, as needed for pain.
    • EMLA cream to anus, as needed for pain.
  3. The ice pack and sitz baths are important parts of the pain management.

Bowel Management:

  1. You must eat a high fiber diet and supplement it with Metamucil, Citrucel or Unifiber (1 Tablespoon in water twice a day) or Konsyl (1 teaspoon in water twice a day). This is to prevent you from becoming constipated.
  2. Drink at least 8-10 glasses of water per day.
  3. Take Colace 100mg three times daily.
  4. If you do become constipated (no bowel movement for 3 days), you may try 2 Tablespoons of Milk of Magnesia at bedtime. If this does not work, carefully administer 1 Fleet enema (this will not disturb healing).

Activity:

  1. Do not do any heavy lifting for 5-7 days after excision of a hemorrhoid and for 1-2 days after sphincterotomy for anal fissure.
  2. You may resume your other normal daily activities tomorrow, as tolerated.

Follow-up Care:

  1. Please make an appointment for a follow-up visit in 3 weeks.
  2. If you notice anything unusual, such as inability to urinate for 8 hours (first try to urinate sitting in a tub of warm water), increasing pain, inability to have a bowel movement after trying Milk of Magnesia and an enema, excessive bleeding (you can expect spotting – this is normal), excessive drainage, fever, or chills, please call the office.
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