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What you need to know about Internal Hemorrhoid Surgery (Hemorrhoidectomy)

OK, so you’ve had it enough of squirting blood each morning when you have a bowel movement. Or perhaps you’re concerned about the possibility of cancer if you don’t have those troublesome hemorrhoids removed.

Trouble is; your hemorrhoids are located up inside your rectum and that requires internal surgery…

First and foremost, you need reliable information: Many surgeons CAN perform a Hemorrhoidectomy; however, not all are equally proficient at it. YOU NEED TO ASK AROUND to find that ONE GUY who is considered to be THE BEST and MOST EXPERIENCED in this procedure.  In short order, one doctor’s name will be mentioned far more often than all others… THIS IS PROBABLY THE GUY YOU WANT TO PERFORM YOUR PROCEDURE.  You need the best, because a Hemorrhoidectomy is a somewhat complicated procedure, and if performed by a surgeon who does not SPECIALIZE in performing it, there is a far greater risk that you will be incontinent for life. ‘Nuf said.

Set the Date: Ok, so now you’ve found THE GUY.  Now, it’s time to set the date.  If possible, arrange to have your operation just before a holiday, such as the week before Thanksgiving.  This way, you won’t be missed much at work, and can heal in peace.  Besides, are you REALLY going to miss seeing your in-laws and eating dry turkey THAT MUCH?

Once the date is set, get ALL those household chores done BEFORE your operation!  You know, the ones you’ve been putting off… cleaning the gutters, raking leaves, trips to the dump, replacing roofing shingles… whatever. Because the last thing you want to have is water leaking into your house while you are recovering…  BECAUSE THERE WON’T BE A DAMN THING YOU CAN DO ABOUT IT.

Talk with the family:  It is imperative that you sit down with the kids and your spouse, and tell ’em the facts of life. The conversation should go like this: Daddy (or Mommy) is about to undergo a VERY painful surgery and will be in a GREAT DEAL OF PAIN.  So, no fighting or yelling; NO MATTER WHAT (you’ll be doing enough for everyone... but more on pain later).

Location, Location, Location:  For at least 7 days after your surgery, you will be LIVING IN JUST TWO ROOMS; the Bedroom and the Bathroom.  Make sure that they are located AS CLOSE TO EACH OTHER AS POSSIBLE and definitely NOT on different levels of the house.  If you must, kick your daughter out of her bedroom and have her sleep with the wife, because YOU NEED TO HAVE A TOILET WITH A TUB CLOSE BY, and they need to be mostly unoccupied.  If you have only one bathroom in your home, make sure the kids know NOT to tie it up unnecessarily!

Items you need to purchase before surgery:

-          Stool Softener

-          Medicated Flushable Wipes (96 pack)

-          Panty Liners (96 pack; even for you Jack.)

-          Hemorrhoid Soothing Spray

-          Tylenol or other pain killer (preferably coated) NOT ASPIRIN… it promotes bleeding!)

-          Epsom Salts

-          Prune Juice

-          Assorted Fruit Juices

-          Foods with High Fiber Content (Barley, Rice, Cereals, etc.)

-          Gatorade (to maintain your electrolytes)

-          Heating Pad

Preparations: Start by cleaning the bathroom you will be using. You want the tub to be really, really clean; to minimize the risk of infection. Then place plenty, and I mean PLENTY of reading materials near the tub. REALLY… you’re gonna spend A LOT OF TIME in that tub. Ever wanted to read War and Peace?  Here’s your chance.

When can I get to go back to work?  If your job is non-physical (ie: desk job) you can expect to return to work in two (2) to three (3) weeks.  If you have a physically-demanding job (e.g:  farmer, truck driver, heavy equipment operator, etc.) plan on being out of work for four (4) to five (5) weeks.  Yes, really.

The day of your surgery:  Doctors will typically not allow patients to fill their pain medication prescription until after they have received their surgery; but there is some good news… many hospitals are now offering an Internal Pharmacy Service…  USE IT.  This is definitely NOT the time to save a few bucks!  The internet is resplendent with stories of people who waited until they got home to get their prescriptions, only to encounter insurance issues, closed pharmacies and the like. Don’t be stupid… get your pain meds filled ASAP!

Now… let’s talk about the Pain:  Make no mistake: THIS IS AN INCREDIBLY PAINFUL PROCEDURE, because the rectum contains more nerve endings than any part of the human body (and who knew?).  Am I trying to scare you away from getting your surgery?  No… I am trying to make DAMN SURE you are prepared with the PROPER AMMO. The proper ammo is NOT Tylenol. It is your pain meds, which (unless your doctor has a death wish or you are allergic) will be Percocet, OxyContin or Vicodin.  During the first 6 days after your surgery, there will be times when the pain is so gripping and crippling that you will wonder if you are going to make it, even with the strongest pain medication.  Checking the Internet reveals many stories of men and woman who have contemplated suicide, after their “doctor” sent them on their way with instructions to take Tylenol for the pain. These “doctors” should be reported to the state and their licenses revoked.  If you are unable to take these medications (and many people can’t for a variety of reasons) you and your doctor need to discuss alternative pain medications or work out a Pain Management Plan in advance of your surgery.

Pain Management:  Better doctors and nurses will tell you the fundamental principle of Pain Management: STAY AHEAD OF THE PAIN. This means that BEFORE THE ONSET OF PAIN you must take your pain meds.  If you delay, it can take several hours to get the pain under control. If you are cannot take the “heavy-hitters” (Percocet, OxyContin or Vicodin) again I say, work with your doctor to discuss alternative pain medications; or arrive at a Pain Management Plan in advance of your surgery.  So why did you buy the Tylenol?  That’s for the days 7 through 10 after surgery.

Why is it so COLD in this house?  Shortly after your surgery, you may find that you are S-H-I-V-E-R-I-N-G, despite being wrapped in multiple blankets.  No worries, this too will pass.  It’s just your body’s reaction to the trauma of surgery. Turn the electric heating pad up. 

Going to the Bathroom: Here is the biggest tip that the medical community never tells you…  STAND TO sh*t.  You heard me… STAND (or squat) OVER THE TOILET, AND LET ‘ER GO.  If you sit down on the seat, you will likely INCREASE your pain, potentially to the point where you give up trying to go… AND NOT HAVING A BOWEL MOVEMENT IS REALLY, REALLY BAD.

Stool Softeners, Metamucil and Prune Juice:  Your goal is BALANCE…. avoiding diarrhea (which is bad for you healing) while also avoiding constipation. Pain Meds, like Percocet and Vicodin CAUSE CONSTIPATION!  Balance is also important because, if you stools are too soft, they will “burn” your butt so badly, it will feel like someone cut your rear end with a seriated steak knife; but if the stools are too hard, your stitches can tear.  So find what works for you… BALANCE.  Stool Softeners work slowly, Prune Juice works quickly. Metamucil is advised to provide a fiber source, to keep things moving. 

The Tub - Your New Best Friend:  Ahhhha… whiling away the minutes (and hours!) with your new best friend: The Tub.  You SHALL BE ONE with the Tub.  Here’s what to do.  Before opening the lid of the toilet to attempt a bowel movement, close the drain on the tub and begin filling it with warm water.  Then, when the extreme pain of your bowel movement bites you in the you know where, your friend the tub will be READY to provide relief.  These baths are also known as “Sitz” baths; and should be done three (3) to (4) times a day. I suggest adding a sprinkle of ordinary Epson Salts to sooth the pain away.

What is that BURNING sensation immediately after I have my bowel movement?  Simply put, it’s Diaper Rash… and now you know why babies cry like; well you know what.  It can feel as though a sword has just been drawn across your anus, and it hurts enough to make a grown man cry. All you can do is to hold on for dear life, and remember that your friend the Tub is ready to help make things better.  Now you know why we fill the tub BEFORE we begin our bowel movement!  Since the CAUSE of the pain is the constant wetness (from draining anal mucus) around the exterior of your anus, the CURE is to keep it clean and dry (hence the panty liners and shot of “soothing hemorrhoid spray”; which contains a natural astringent, Witch Hazel).

But I can’t seem to Pee:  Some people who have had this surgery to have difficulty peeing… and this is also REALLY, REALLY BAD.  If you can’t pee, YOU WILL HAVE TO GO TO THE EMERGENCY ROOM where they will likely catheterize you (OUCH!).  To avoid this, keep hydrated… drink lots of water and fruit juices, and if you can, PEE IN THE TUB (you can always wash it down later!)  Or lay on a towel on the floor and pee into the towel.

What the HELL was THAT?  Bam… your Rear End just CLOSED UP SHOP.  I mean, that sucker slammed-shut.  What is it?  Just a “spasm” and they happen sporadically for the first 3-4 days after surgery.  It’s normal, and will stop in just a few days. Until then, when it happens GO TO THE NICE PLACE (stay calm and think soothing thoughts) and it will subside more quickly.        

What is that SMELL?  You’re gonna smell… bad. Particularly your bed sheets, which can get downright rancid. Don’t fret, it’s just your body expelling those pain meds and doing the healing thing. Replace the sheets and get on with it.

Anal Leakage:  Bet you didn’t know this, but you butt produces mucus, just like your nose.  This mucus coats the inside of your anus to protect it, and allow the poop to move along smoothly. Well, your butt is going to OVERPRODUCE  mucus to compensate for the trauma of surgery… and HERE’S WHERE THE TUB COMES IN.  Three-to Four times a day, and after EACH and EVERY bowel movement, YOU MUST BE IN THE TUB for 30-60 minute. No exceptions.  

Underwear and Panty Liners:  ALWAYS WEAR UNDERWEAR; even when sleeping.  And remember to place a panty liner inside your underwear. The panty liner “self-sticks” to the underwear (pull off the backing, dummy!).  Don’t be surprised when you see small amount of blood, ass mucus or poop on the pad.  It is all part of the healing process.  

Bleeding vs. Spotting:  While it IS NORMAL to see small amount of blood on the panty liner (this is “spotting”) it is NOT NORMAL to have blood flowing out your rear end.  In the unlikely event this should happen CALL YOUR DOCTOR IMMEDIATELY.

Can I take Showers?  Of course, and you SHOULD…  after your tub time.  Soap? Yes.  Bubble Bath? No.

What can I eat?  You NEED fiber. You can get it from cereals, barley and rice. Drink plenty of water or fruit juices. If you ever feel faint, it is very likely that you have lost some of the electrolytes in your body; and this is where Gatorade comes in: Drinking it will replenish lost electrolytes.  AVOID ALL CARBONATED BEVERAGES.  NO ALCOHOL. NO PEANUTS OR NUTS. NO POPCORN. NO PEPPERS!

When will I feel better?  You WILL start to feel better after 8-10 days after your surgery. You should continue soaking in the tub regularly for at least four (4) weeks after surgery.  It will get better; and some days, it may seem like you’ve lost a little ground; but after about two (2) weeks the worst is over.

Good Luck and God Bless... Dr. Love

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Thanks Doc......,

It help very much.,%-)

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Thanks Doc......,

It help very much.,%-)

I have had surjery 10 days ago, now pain got decrease but, at bowltime it get worse.my doc said that i'm healing finly, and this process will take time...

I'm not sure how many days i have to suffer

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Hi J had a hemmriod operation about two months ago .. I'm still in pain ... J take fiber and one stool
Softener To go easy and drink water and take sitz baths on top of it .. Had follow ups already ... I'm active too I work ! When is a person completely healed ? Oh u spot bleed sometimes too !
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