Open Haemorrhoidectomy
Information for pre and post operative care
What to expect during and after your surgery…
Anaesthetic
You will be having a full general anaesthetic for your surgery. If you have had any issues previously, with post-operative nausea and vomiting, or have drug allergies, or have experienced anaesthetic complications previously, please inform your Anaesthetist prior to surgery, when you are interviewed by them.
The anaesthetist will provide a separate quote prior to surgery for their services.
Your anaesthetist will provide a prescription for post-operative pain relief and nausea, if required.
Operation
During the operation Dr Borrowdale will place long-acting local anaesthetic into your bottom and you should wake up pain free, or with minimal discomfort. The local anaesthetic wears off after 6-10 hours.
Pain & Pain Relief
Pain is generally the most intense for the first 48 hours after surgery and will gradually improve on a day-to-day basis. Some patients experience pain beyond 48 hours, but this will resolve in time. You will be discharged with plenty of pain relief.
Medications
You will be discharged with a prescription for several medications.
Antibiotics: Metronidazole (*Flagyl) is an antibiotic and should be taken three times a day until finished.
Pain Relief: Dr Borrowdale prescribes *Mersyndol Forte (maximum of 8 tablets per day) containing a combination of paracetamol and codeine. He also prescribes diclofenac (*Voltaren). Pain relief should be commenced as soon as you experience any pressure or pain when the local anaesthetic starts to wear off. You will also receive a prescription for *Endone, as a stronger pain relief, if the pain persists after taking Mersyndol &/or Voltaren.
Laxative: please start the *Movicol (1-2 per day) on the day after your surgery to keep bowel motions soft and to avoid constipation.
Dressing
You will have a pad taped to your bottom post-surgery. This can be removed at your convenience. There is a special dressing inside your rectum which will pass like a small slimy stool.
Constipation
It is always much easier to prevent constipation than to treat it afterwards. Please take the Movicol as directed for a week following surgery. If your bowels have not opened after 2-3 days, please purchase a Fleet enema from your chemist. This is very effective in encouraging bowel clearance.
Passing Urine
The inability to pass urine is a common problem after any bottom surgery.
Because you are often dehydrated after surgery, you may not pass urine for 6-12 hours. The best way to manage this is to minimise oral intake of fluids until you have passed urine for the first time post-surgery.
Measures to help pass urine include running a tap, showering, and taking a warm bath.
Once you have passed urine for the first time, you should not have any significant issues. Unfortunately, some patients cannot pass urine and require catheterisation at your local emergency department. If this happens, please notify Dr Borrowdale and he will arrange removal after 48 hours.
Discharge
You will either be discharged or kept in hospital overnight.
You cannot drive yourself home from the hospital. You can drive again when you are moving normally, are no longer taking any opioid pain relief (Endone) and can fully control a vehicle. This time frame is different for every patient, but generally will take at least 3-5 days.
Work
You should take 5-7 days off work depending on your occupation. For physical labour jobs, you may require longer. Please discuss this with Dr Borrowdale.
Bathing
If you have had skin tags removed, the area will be very painful for the first 5-7 days, and it will take several weeks to heal.
Warm baths with Epsom salts or a cup of table salt are very soothing for this pain. Dr Borrowdale has small sitz baths available that can be placed inside the toilet bowl if required in your home. They are available for purchase in the practice rooms for $30.
A barrier cream (such as *Sudocream, or zinc cream) can be applied, before and after bowel motions.
Diet
You can eat normally following the operation, however eating a low fibre diet for the first week can help to reduce the amount of stool needed to be passed for recovery.
Activity
We advise that the best way to recover is to rest for the first 2-3 days, then resume normal activity. The surgery and wound site cannot be damaged by normal everyday activities but avoid significant heavy strain (eg. lifting furniture, heavy boxes etc). Walking, shopping, light cycling on a fixed bike, and light household duties are all reasonable in the first week or two. It is important to get moving after the first couple of days, as this will aid recovery.
Sport
There are no restrictions on sporting activity after 4 weeks. Prior to that, we suggest introducing sporting activities gradually and gently, and to follow the simple rule…if it hurts, don’t do it. Be mindful that the most strain on your bottom occurs during squatting exercises, especially under heavy strain/with weight bearing.
Follow Up and Nurse Support
After discharge, Elaine (Dr Borrowdale’s Nurse Practitioner) will call you during the following week to check on your progress, and to answer any questions, Elaine is available in the rooms on Fridays, at Northside General Surgeons, ph. (07) 3910 5150.
Commonly Experienced Issues
‘I have to go to the toilet as soon as I feel the urge’
Faecal urgency is a frequently experienced issue in the first few weeks after haemorrhoidectomy. This will improve over time
‘I am passing very small stools frequently’
The inside of your rectum is very swollen and oedematous following surgery and can take possibly take several weeks to return to normal.
‘I am going to the toilet 6-8 times per day’
Having a haemorrhoidectomy surgery can disrupt your bowel pattern significantly. However, if you are passing bowel motions more than three times a day, stop taking the laxative medication and start some fibre supplement. Commence Metamucil, 1-2 teaspoons dissolved in 250ml of water, twice per day. This will slow your bowels down and help return your bowel habit to normal.
‘I have taken Movicol, but it isn’t working’
You may need to change your laxative medication to Coloxyl with Senna if the Movicol is not working. If you have not had a bowel motion for several days, then use a Fleet enema (available for purchase from the pharmacy). Fleet enemas are very effective as treatment for constipation.
Complications & Risks
Haemorrhoidectomy is very safe, and Dr Borrowdale has many years of experience as a specialist surgeon. He has performed this operation many times throughout his career. However, no surgery is without risk.
Complications are rare and can include:
- Bleeding Recurrence
- Sphincter injury
- Deep vein thrombosis/
- pulmonary embolism
- Infection
- Rectovaginal fistula
- Incontinence
- Chronic pain
- Cosmetic deformity
- Anaesthetic complications
&