Hemorrhoids are normal vascular (containing blood vessels) cushions of tissue in the rectum that play a role in continence (being able to hold in gas or stool). With high pressure, such as after pregnancy and child-birth or with prolonged constipation, hemorrhoids can become enlarged and protrude from the anus, bleed, or cause significant pain.
Hemorrhoids can be internal, coming from inside the rectum, or external, coming from the skin around the anus. Internal hemorrhoids more typically cause bleeding or mild discomfort, but only cause significant pain if they are very large and protrude through the anus. External hemorrhoids more typically cause irritation, itching and pain. Severe pain can occur if the hemorrhoid thromboses, or clots, resulting in a very painful, swollen, blue-black hemorrhoid.
Hemorrhoid surgery is needed when there is persistent or recurrent bleeding, significant pain, significant protrusion from the anus, or acute clotting occurs. Most often, changes in diet and bowel management can delay or prevent the need for surgery. Drinking plenty of water, increasing dietary fiber intake, taking fiber supplements, taking stool softeners, or taking laxatives can improve constipation and can lead to less symptoms and even regression of the hemorrhoids. The goal of this approach is to have regular, soft bowel movements that do not require straining or prolonged sitting.
Preoperative Information
Prior to hemorrhoid surgery, you will be asked not to eat or drink anything after
midnight prior to your surgery. You will be given specific instructions from your
surgeon or anesthesiologist about which medications you should or should not take
prior to your surgery. You should not take any blood thinning medications at least
5 days prior to your operation. This should be discussed with your surgeon at your
preop visit.
You will probably be given instructions for a bowel prep. Various bowel preps may be used, but typically involves an enema and / or laxative taken the night before and the morning of surgery. This may vary depending on exactly what procedure you are having and your surgeon's preference. Talk to your surgeon about your bowel prep.
Postoperative Information
Your recovery will vary depending on the type of hemorrhoid surgery you have.
Activity
You may resume activity gradually beginning shortly after surgery. You should begin
walking the night of surgery or the following morning and continue to increase as
you are able. Increased activity reduces the risk of blood clots, and improves breathing
to prevent pneumonia.
Depending on the type of hemorrhoid surgery you have, you may have significant limitation in sitting or walking for long periods of time. A soft pillow or donut pillow will help to displace the pressure of sitting away from the site of your surgery.
Avoid driving until you no longer need narcotic pain medication and you feel you can make rapid movements unimpaired by pain. Driving while taking narcotics can impair your ability to drive safely.
You should be able to return to work within 2-4 weeks after surgery, depending on what type of hemorrhoid surgery you had.
Wound Care
The most important part of caring for your wounds after hemorrhoid surgery is keeping
the anal area clean and dry.
After hemorrhoidectomy (removal of the hemorrhoid), Sitz baths should be done 3 times a day and after any bowel movement. This involves sitting in warm soapy water to clean the area. Showering after every bowel movement is also effective. You should avoid excessive wiping, as toilet paper may irritate the skin or incisions around the anus. Moist toilettes or baby wipes are preferred.
Sometimes the skin around the anus where external hemorrhoids were excised will be left open or separate after surgery. This is normal. Sitz baths, showering and moist toilettes should be used as above.
Bloody and / or mucous drainage and stool leakage is common for the first several days after hemorrhoidectomy and may last up to a week or more. You will probably want to place gauze or absorbent material such as feminine napkins over the area to protect your underclothes.
After hemorrhoid banding, you should have no wound care to worry about.
You may shower beginning the day of surgery.
If you notice redness spreading onto the surrounding skin, develop fever, or have severe amount of bleeding or bleeding that lasts for more than a week, you should contact your surgeon.
Medications - Pain Management
Pain can be fairly severe after hemorrhoidectomy, particularly with bowel movements
. You will be discharged with pain medication, typically a mild to moderate strength
narcotic, depending on the type and extent of surgery you had. Take as needed and
as prescribed. You may also take over-the-counter medications such as ibuprofen for
pain. Most narcotic medications prescribed are combined with Tylenol (acetaminophen)
and you should not take additional Tylenol if you are taking a narcotic medication
that already contains Tylenol.
You may be given a topical pain relieve cream or gel. Use as directed.
Pain with bowel movements will be limited by ensuring you have regular, soft bowel movements that do not require prolonged sitting or straining. See below for bowel regimen.
Hemorrhoid banding should have very little pain and is typically limited to fullness and discomfort in the area. If you experience severe pain after banding, call your surgeon.
Bowel Regimen
You will be prescribed a bowel regimen when you go home, typically a stool softener,
fiber supplement and a laxative. This is vital to enable you to have soft bowel movements
after surgery to protect the incisions made AND to prevent your hemorrhoids from coming
back. You may also be given nausea medication if you have experience nausea or vomiting
from taking your pain medication.
Over the counter medications can treat this well. Senna, Miralax, or dulcolax are
some of the most common laxatives and are available at most drug stores or grocery
stores. Take as directed by your surgeon.
You should drink at least 6-8 glasses of water a day. This will help you have soft,
regular bowel movements.
If you are having trouble having a bowel movement AND have abdominal bloating, nausea
or vomiting, and not passing gas, you should call your doctor.
Home Medications
Unless otherwise instructed, you should be able to resume your usual home medications
the night of or the morning following your surgery.
Click here for more detailed information on commonly prescribed medications.
Diet & Bowel Care
You may resume your regular diet with no restrictions.
You should drink at least 6-8 glasses of water a day. This will help you have soft, regular bowel movements.
Follow Up
You will be given a date and time to see your surgeon following surgery, usually in
10 days to 3 weeks. If you are discharged late in the day or over the weekend, you
will be given a number to call the following business day for an appointment. If you
are having trouble making an appointment, you should call your doctors' office directly
for assistance.
Call Your Doctor If:
Contact Information
Daytime hours: Call 706-721-4686
After hours and weekends: Call 706-721-8400