I've copied this advice from a posting by AllenN to help others find the very useful information he provides. Had I discovered this informatiojn prior or immediately after my hemorrhoidectomy and rectal prolapse surgery, I'm certain my recovery would have been much less painful and prolonged. It would also have been less risky to a full recovery as it would have avoided the times post op that i reluctantly had to strain to complete a BM to relieve the crippling, unbearable cramps and urges to pooh i experienced. Here is the salient part of Allen's advice.
Anyway.. this is my pain control recommendations for those going through this procedure. For the first few days, I did not take any Percocets at all! I just took a combination of Ibuprofen and Tylenol. Specifically, I took 400mg of Ibuprofen, then two hours later, I took 500mg of Tylenol, then two hours later I took 400mg of Ibuprofen, then two hours later 500mg of Tylenol and 5mg of Flexoril (a muscle relaxant). This was my own recipe as I explained I'm a doctor who specializes in patients with acute pain.... I didn't want to take narcotic as it would cause constipation and more difficult Bowl Movements. I worked out the plan ahead of time and the dosage is not toxic for an average weight individual (I'm 180 lbs and in excellent shape). Your max daily dose of each Ibuprofen and Tylenol is 4g (or 4000mg) for an adult. So, you can take 4g of Tylenol per day and 4g of Ibuprofen. The two drugs don't interact with each other and piggy back off of each other. Most recent studies have clearly shown that the combo of these two over the counter meds are as effective - if not more effective - than narcotics (but without the side effects!) So, it's safe to take them concurrently. The pain was very bearable with this formula.
The 5mg of Flexoril every 6 hours was especially very helpful for the first 4 days as it helped me sleep around the clock for the during that time and relaxed the muscles down there. I definitely recommend it as the one prescription you should take. My iPhone's timer was set up to wake me up every 2 hours, where I would take my pills according to schedule with plenty of water and go back to sleep (no matter what, even if I didn't have any pain!) It's important to combat pain before it arrives (that's true about any procedure.) Taking analgesics after you have pain is very ineffective as pain itself brings about more pain through involuntary muscle contraction and release of pro-inflammatory neuropeptides. So, you must go on this regimen before the local anesthesia (Marcaine) from the surgery wears off in the rectal region and have to be on it for about 4 days straight without missing a beat (you should consult your physician if you have a history of liver disease or bleeding tendencies/bad stomach!) It's tough but it really makes the whole experience less painful. I only had some discomfort after the BMs in the early phase. After 3 days or so I would take a Percocet once in a while after a BM to see it it helps more, which it didn't for me. <?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" />
My diet consisted of vegetable soups and lots of fruits/water (I was also drinking plenty every two hours with my pills.) I had the surgery on Thrusday morning and I had a first BM Friday night. I think that's because of not taking narcotics and taking a healthy dose of fruits and vegetables. I did not take any laxatives at all. Completely natural (except for the Tylenol, Ibuprofen, and Flexoril!) Well, as you've heard here everywhere the Bowel Movements are the single most unpleasant experience of one's life during the recovery phase. Since I wasn't on narcotics and taking a lot of fiber via vegetables, I was having three fairly large BMs around the clock since that Friday night!! Well, very quickly I realized I don't need to be fibered up that much! It's not worth the pain after a BM and I'm not trying to break a record over here with my intestinal motility! I regulated my fiber intake so I would have one BM per day thereafter, which was my routine from before surgery.
Anyway... it gradually got better over time and while it still hurts it's much much better (Thank God, or whoever or whatever is in charge of and overseas my butt!)... actually, today, I didn't take any pain killers at all. I haven' done so in a couple of days and seem to be healing well. I'm still having my BMs in the Sitz Bath though! Yes, gross... and I tell you, the thought of it before this surgery would have caused nausea for me but it's amazing how we are as human beings and how WE CAN deal with adversity! The Sitz Bath BM, in my opinion, is a key, key factor! Get over it! The hot water relaxes your sphincter and allows for a much easier passage... Almost immediately after you sit in the hot water you'll have your BM! Just make sure it's hot enough.. obviously you don't want to give yourself third degree burns and getting the right temperature is a whole art into itself... but you'll have time to master this art during your recovery! A thermometer would be very useful to avoid burning your butt!
Anyway. This whole experience has been metaphysical for me. Not only I've come to learn a lot about myself, my ability to deal with adversity and have now developed a very healthy dose of sympathy for my patients in pain, I've also developed some philosophical insight about life. Basically, where there's hope on the other side of adversity, we can all get through it. When you know what you go through will eventually be rewarded and things will be fine again, then the struggle is not as horrible and life is worth living. For those of you about to have this procedure, make sure you do your research, find a good surgeon (colorectal surgeon) with a lot of experience in this area, have a loving family member and a support system who will care for you during the first week or two. And know the recovery is not easy.
But also know that the there's light at the end of the tunnel and things will be back to normal before you know it. It' just two-three weeks. Then it's all kittens, roses, and butterfly kisses. Well, maybe not those. But your ass will thank you, and you'll be once again grateful to your ass and the service it renders seamlessly when you sit down, when you go to the bathroom, and when you just don't have to think about it again! Then you'll have a new outlook on life and are hopefully a better person because of it.
I wish you all good luck.
Here's what I would do for the BM every morning, when I usually go (my routine): Wake up and immediately apply a little topical anesthetic to the anus area. Then turn the hot water in the bath tub and start filling the bath (hot water!) Meanwhile, have some high fiber cereal. Then get a Sitz Bath going on the toilet (the water in the Sitz bath as warm as I could tolerate without burning my ass!) As soon as I would sit on the Sitz bath this would trigger the relaxation of the sphincter muscle and initiate the bowel movement. I know it sounds gross but the best way to make your BMs painless is to just go in the Sitz Bath! Hey, it's your own sh*t and if you're eating lots of fiber it's really not a big deal! I would have 3, sometimes 4 passings of stool during each bathroom session. So, after each passing I would empty the Sitz Bath bowel and its content into the toilet, flush, rinse and refill the bath with hot/warm water. This process would take a couple of minutes, so buy the time I would sit back down into the newly filled fresh hot water of the next Sitz Bath it would immediately trigger the next BM. So, this would repeat 3-4 times and then I would finally sit down in a fresh water Sitz Bath with just lukewarm water and activate the water bag that would work like a bide and clean up the area. Didn't require wiping as a result.
This way, the actually passing of stool was not as painful as the pain after the passing when the sphincter would go into contraction again. Believe me, I'm the biggest neat freak, but necessity is the mother of invention and if I could do it so can you. So, once I felt the area is clean I would move to the bath tub which was hot and full at this point. In the bathtub I would watch a couple of episodes of Family Guy on my iPad and just relax with the goal of relaxing my sphincter (oh what lofty goals!) Yes, you have to distract yourself 24/7.. if you think about the whole experience then it becomes overwhelming... but if you just think of it mechanically and understand your goal is to pass time and let your body do what it needs to do... then it's a lot easier. My recommendation is get NetFlix and watch a thousand old shows on their instant streaming! You can't really get comfortable sitting in the early phase of healing (or at least I couldn't!) So, I was always lying on the side in bed... and watching these shows on my computer or tablet was all I could do to distract myself, or sleep.
I found that squatting in the shower for a bowel movement is the way to go. I have a large cup and would poor warm water over that area and then put my hand in a bowl of warm water. This made me relax so I could go quite easily. Also the squatting in the shower vs sitting on a toilet seemed to help a lot. The first week after I finished my bowel movement I would immediately have a five minute sitz bath as the area would burn once stool came through. Now, two weeks later, no need for that I just rince myself off as there is almost zero pain. Having a bowel movement in the shower is nasty in terms of clean up and stench, but it has been a life saver in terms of pain and healing for me.
Squatting is the best position for bms at all times as it aligns everything so you don't have to push. I have been squatting for the past 2 years since I read up on it using an upturned bucket to put my feet on. If I need a bm in a public place or somewhere where there is nothing to put my feet up, then I take off my trousers and underwear, and squat with my feet on the toilet seat! Can't be in this position to urinate though - it goes everywhere! Unfortunately, I learnt this info too late and my hems were already past remedial help and I'm currently recovering from a hemorrhoidectomy. I will say though, that I will squat for bms for the rest of my life. My hems weren't caused from pushing or constipation, but the delightful side effect of child birth, but now they're gone I will do everything I can to prevent them coming back.