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My CR surgeon has recommended the PPH stapling procedure for my type 3-4 hemorrhoids. Any suggestions/anecdotes/advice/reassurance or other discussion from those who have undergone this? Thanks.

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I just had the PPH procedure done on last Friday. Along with a sphincterotomy done. All I can say is I really didnt think it was gonna hurt this much. This was my 1st surgery also. Numerous and frequent hot sitz baths, a frozen washcloth, and alot of support from my husband has made it bearable. Whatever you do, dont use milk of magnesia in place of a good stool softener! I did this on the advice of an E.R. doctor, and all it did was gave me diarreah, and made my bottom raw. This pain added on top of the surgery pain isnt good. I know you are gonna fear your 1st bowel mov., but it will be ok! Dont stop eating.....try soups 1st, this was easier for me and mor productive. You dont want to sit on the toilet too long with out doing anything....this can make you swell and very uncomfortable to sit or lie or anything. After your bowel mov. you may feel like your bottom is "pooching out" Dont worry, this is part of the internal swelling and makes you feel like you still have to go, but you dont. This is where the frozen washcloth comes in. Place it on your bottom, area around the anus, a ring that swells.....and it hurts.
I hope my experience has helped you,
It will be O.K.!!!! ;-)
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It hurts. But that is normal.

I was reading a lot about this. It seems to me that hemorrhoidal circular stapler set is a very trusted alternative to conventional hemorrhoid procedures according to some statistics.

My good friend told me that once you do this procedure, every patient will experience a quicker return to normal activities compared to those treated with standard treatments that you can do. I think that you doctor can explain this better to you than I am doing now.

Anyway, when we are talking about this procedure, you should also know that PPH is performed above the dentate line inside the anal cavity, and so it affecting fewer nerve endings than traditional procedures.

Once you do this, all that you will have to use in your recovery process are hemorrhoids creams.

Good luck there. 

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What I was told vs. what really happened:

I was told, by my surgeon, that the recovery time for PPH is remarkedly less than that of traditional surgery. Mainly because the work would be done above the more intense nerve areas (where the internal hemorrhoids mostly "reside" and the external ones begin). He further said that the internal work would prevent the external from reoccurring, by drying up their source.

I also have external "tags" as a result of years of thrombosis. Was told these would improve dramatically but might not disappear completely. Also told that the pain would be rough the first few days.

I am now 6 weeks out and the part about rough pain was only partially true. Will not address the veracity of the statement comparing PPH recovery tie to traditional since I have not had traditional. It is perhaps too early to definitively judge the other statements but they appear to be more true, no problems with thrombosis so far and the tags are minimized. Not to be gross or too explicit, but, when I clean myself, it feels entirely different, the skin is much tighter ... in a good way.

Now, back to the pain ... a few days is the most exaggerated statement ever! Try a few/several weeks. I was still taking Lortab in my sixth week. Had tapered down to 3/day (took up to 12/day, 7.5 and 10s, for the first 3 weeks, partly because of catheter related urinary problems (another story for another day but it involved two ER trips and several more to a urologist), ran out of Miralax (my surgeon recommended Miralax and mineral oil and they work wonderfully to keep the stools soft) and fell back into the pain. Bought more Miralax and 2 days later was able to stop the Lortab for good ... exactly, to the day, 6 weeks after the surgery.

Hardly any pain now, more like the minor discomfort that you feel in the early stages of a hemorrhoidal flare-up. But, now I enjoy the comfort of knowing that the pain will be growing less, not that resigned fear I used to have.

One more point ... even though I tapered down on the Lortab, I still had withdrawal symptoms (won't bore you with the details, but those scenes in the movies are more accurate than I had ever imagined). Could tolerate the daytime but the insomnia was rough (even when hurting badly, sleep offers some respite). Doctor prescribed clonazepan and I slept wonderfully last night. Feel great today. Took my dog, who has been hiding from me, for a long walk this morning.

Was it worth it? Three weeks ago, I would have said, hell no! Today I say, without a doubt.

BTW, I am a 63 year old male, who had his first external hemorrhoid while on a senior year high school spring break beach trip, had no idea what it was but assumed the worst (a deadly tumor, most probably caused by beer - damn, the parents were right - had to wait until I returned home to learn the truth), and stupidly waited many, many years too long to have it corrected.

Good luck!
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If you have specific questions, post them here. I will check here for the next few days and do my best to answer.

My top recommendations:

Sitz bath - the one thing you will never regret having ... helps with pain and bowel movements (and, perhaps surprisingly, the gas ... believe me, that hurts too) ... you get over the grossness quickly ... enough pain will do that

Miralax and mineral oil (both OTC, keeps the stools soft)

Tub soaks (helps with pain)

Hydrocortisone Cream (OTC, soothes raw exterior anal area ... tried lanacaine and it did not work for me, burned more than no cream at all)

Taper your pain medication ... do not stop cold turkey. If your doctor does not mention this (as was the case with mine), you bring it up.

Bullet to bite on (always wondered why they did this ... now I know, it's not for your pain, it's for theirs ... you can't scream as loudly when you are biting on something, LOL)

Patience and a sense of humor ... otherwise you will be just another pain in the butt! Sorry, I could not resist that.

Good luck!
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Thanks for offering to answer questions. After my operation I will do the best to answer questions also....as of right now I'm pretty scared of what's coming.

My main question is about fixing the internal hemmies and that "fixes" the problem of the external hemmies.

I'm going with the traditional surgery and I believe the doctor said that he's going to fix internals by cutting and that would result in the external hemmie (the one that causes me great pain every couple months) not to hurt anymore.

Is that pretty much what your doctor said also?

And is it working the way he said?
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Yes, basically, that is what my Doctor said. His analogy was that of a stream. If the source of the water is removed, the stream dries up. That's what I wanted to hear, too, because my pain was from the external ones.

With the caveat that I am only 6 1/2 weeks out, it does seem to be working that way. I have had no external protrusions so far. IMHO, the true test will be when I am back on a regular diet and not taking the miralax and mineral oil.

BTW, I should have put another recommendation (VERY IMPORTANT) that I learned by reading other posts:

For a couple of days before surgery and as many days after that you can stand, go on a liquid or soft diet ... I actually bought baby food. Also, diet shakes, jello, yogurt, soup, broth, pudding and ice cream. Mixed in oat meal and cereal.

I actually lost 18 pounds (gained back 3 already, but 15 is not bad in 6 weeks. LOL).
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Nice. At least I'll lose a few pounds XD
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thanks for sharing the experience.

so 2 years later now and with regular diet, does the problem comes back?

my wife is considering for a PPH soon and she is scaring to death of the pain...
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Wow, has it really been 2 years? Tell your wife that my pain is a distant memory ... I have absolutely no regrets. I remember my Doctor's saying that he had no repeat patients. Shortly after the surgery my thought was that no one came back because no one was foolish enough to go through that misery twice. Now, I have changed my thinking. I feel it was a total success; but, perhaps more importantly, if it turns out not to be so, I would not hesitate to have the surgery again. The relief is that great.

I do have one more suggestion. After a trip to Japan I started shopping for a bidet. The first ones I found were very expensive but I kept looking and found an "add on" on Amazon made by Hyundai (it was on sale for less than $100). I am not very handy but I installed it myself on my toilet ... and it works ... well. No more handi wipes. Toilet paper is used only for drying, the spray of water does the cleaning.

Good luck!
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thank you for your reply and glad that it has solved your problem..

praying hard for my wife!
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I am scheduled to have PPH done the Friday after Thanksgiving. Can anyone tell me really how much pain I will be in? I went thru the banding twice; unsuccessful. Mine are stage 2 and 3; I have two. I am 45 year old and in good health; I exercise at least 5 days a week and follow a gluten free diet. I've had the one hemorrhoid since about the age of 16 and who know when the other one came along. I am just trying to prepare myself (and my family) and get as much information as possible. I've been told that the pain would be not much worse than the two bandings I've endured; plus, I'll be asleep for the PPH and be sent home with pain meds. How long should I expect to stay at the hospital? I know it's outpatient, and I have to urinate before being discharged. Just wondering how much time I'll be there. Should I invest in a stiz bath as well? I bought one when I had the first banding done, but didn't need it, so I took it back. I see there are postings to have Miralax and mineral oil on hand as well as hydrocortisone cream. Any particular brand of cream? Thanks to anyone who can offer any advice.
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Don't do it. I'm a physician. The FDA does not protect us from unsafe medical devices. This has been shown multiple times with gynecologic procedures (my area). My mom had the stapler used for hemorrhoids, now has an extremely painful rectovaginal fistula requiring a colostomy. Much data on this device shows a higher rate of fistulas with it compared to conventional surgery. Was only introduced in 1998. Should be off the market.
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I had stapling done on Friday. It is now Monday. I am three days post-op, and I can say that every day, the pain lessens. I stopped taking Lortab two days ago. I now take an Aleve every once in a while. The best comfort is a very warm bath. The first time I passed gas (yesterday) was a bit painful, but isn't anymore. I've been on a soft diet, have been taking Colace (stool softener) and I just started taking Milk of Magnesia. I am prepping for the first bowel movement, which I dread...but I know that once that happens, I will be in the home stretch! 

I can say this... The pain I have felt since the surgery is NOTHING compared to my worst day with Stage 3 & 4 hemmorhoids. I'm three days post-op and I would recommend this surgery to anyone who has bleeding thrombosis to the point of crying. I am looking forward to a new, pain-free life!

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Hi,any new updates? How was your first bm

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