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Hemorrhoidectomy Surgery AccountApril 2013

Hi,

I am a happy and healthy 34 year old mother of two girls of 3 and 6. I have always been fit, thin, and kept a very healthy diet. Since suffering with haemorrhoids (H's) with both children I have just had an Open Hemorrhoidectomy on the NHS! This is an honest and hopefully helpful account of H's and the traumatic surgery needed to eradicate them forever (fingers crossed ). Feel free to ask any questions. 

* This is obviously a personal account and I advise anyone to talk to their G.P regarding different pain relief options following the surgery. 

BACKGROUND

I have suffered with two tiny H's since I was around 16. At this point they were not painful at all. Since having children, those tiny inhabitants became a large prolapsed problem. Following useless advice from my GP and Consultant, they became thrombosed and extremely painful. After several visits to my consultant, he advised Halo banding as a first measure (basically cutting off the blood supply to the H's by tying the arteries off). I had this done in September 2012 and suffered excruciating pain following the Op resulting in another trip to A&E Emergency Medical Admissions Unit. Needles to say the Op was unsuccessful and the problem just became worse.

Eventually the Consultant agreed to perform an Open Hemorrhoidectomy. He was very dubious due to my age and all the complications that can arise after surgery. However, following lots of research and weighing up the pain of my H's against my lifestyle it was a no brainer! The H's were affecting my whole life.... no intimacy with my husband, no exercise (too painful), not able to lift my children, unable to sit at work for long periods, depression, no social life. So I was booked in for the op on the 28th March 2013.

PREPARATION

Following hours and hours of studying this forum I came up with the following:

  • A Diet plan
  • A Pain plan
  • A support network
  • A list of all the things I needed around me in preparation

Bearing in mind that everything I read suggested that the first two weeks would be hell I warned work that I would be off for 4 weeks in total. I did NOT want to risk having the Op and pushing myself to quickly, hence undoing all the surgery. The following plan is specific to me and it worked. I had one night of severe pain but the strict timings of pain relief minimised the effect and the emergency top up relief was definitely needed. At all costs you need to make sure that you don't end up back in Hospital again where they may examine you internally and cause more problems.

Diet Plain

Diet and pain go hand in hand. The pain relief I used is Codeine based which tends to constipate you. Thus without the right high fibre diet and supplements... you are screwed!!

Pre Op:  Two days before the Op I stopped eating bread and meat. I started a very high fibre diet without any foods that cause bloating or constipation. I also took 10ml Lactulose twice a day. So lots of bran, soup, vegetables, and fruit. (and the odd tiny bit of chocolate to keep you sane!!)

 

Post Op: 

Day 1 - 2: Lots of water throughout the day and very small meals so as not to swell your tummy (it may take up to 7 days to go for a Poo (BM) so you must not fill your tummy too much or it will be painful)

Breakfast:     Weetabix/ Allbran in the morning with a mug of Green Tea sweetened by 15ml Lactulose, and a drink of Fresh Orange. An Aloe Vera capsule (to ease the tummy and help healing), Butchers Broom Tablet (to strengthen veins and help recovery).

Lunch: Soup and a piece of fruit

Snacks: Fruit.... agiain try not to overfill

Tea: Omelette with Roasted Veg, fruit salad with cream and a square of 80% Cocoa Chocolate (gotta keep the iron intake high for any blood loss :)) You could also try scrambled eggs with Veg or Jacket Potato. Remember, small servings)

Supper: Fresh Orange with 15ml Lactulose and a cup of Decaffeinated Tea

Day 3-4: Same as above but start introducing 1 Glass of Movicol (This will help you bowel to start working again and encourage a BM) NO MEAT until after the first BM. I also tried Hob Nobs when I was deperate for something sweet (they are a high fibre biscuit!!)

I remained on this diet until Day 7 when I was regularly having a BM. Then you can up the serving size and broaden the range to include meats.. don't shock your system though take it slowly.

 

Pain Plan

The pain you can suffer with this operation is very severe due to the fact that this area of your body has the most nerve endings! I can honestly say that when I had my banding done (and I wasn't prepared with pain relief), it was worse than giving birth. The key is being proactive and seeing your G.P BEFORE the surgery. Talk to them about a pain relief plan and get all drugs prescribed and ready for when you come home. Your surgeon will only want to prescribe paracetemol due to the constipating effects of codeine; with a balanced HIGH fibre diet and supplements this is easily balanced out. The pain I experienced was like someone taking a blow torch to the inside of my bum and then deciding to whack it every minute or so with a baseball bat. Hence, the need to be prepared... So from reading a post by an American Doctor I came up with the following:

Remember the key: In the first few days religiously take your medication before pain sets in. Don't contemplate missing a dose. You will regret it. My mum is a nurse so I stopped with her for the first two weeks and she kept a pain relief diary so that we didn't overdose.

 

Days 2-4: Up to eight paracetemol a day every 4 hours (set your alarm at night) and Ibuprofen every four hours. 1 Dihydrocodeine every 6 hours. For breakthrough pain I took Oramorph (liquid morphine) at a rate of no more than 10ml an hour. 

During the first 24 hours you may not feel much pain due to the Anaesthetic but as soon as you feel the first hint of pain start on your meds. My worst pain was during days 3 & 4 when all the bruising and swelling was coming out. 

 

Days 5-10: Up to eight paracetemol a day every 4 hours and Ibuprofen every four hours. 1 Dihydrocodeine every 6 hours. You may only need some Oramorph when you have been for a BM.

 

Day 10 onwards becomes much easier. I stuck with the Ibuprofen and Paracetemol and only took the Dihydrocodeine when needed. Since day 14 I have only had to take Ibuprofen for the swelling as I am not in much pain at all now.

 

Support Network

You will need a 'Bum Buddy'. In the first 4 days I could'nt even walk to the toilet by myself. Infact we hired a Kermode which proved invaluable. I had trouble going for a wee due to the pain so I was up and down to the loo a lot. My mum was fantastic, she helped me to the toilet, ran me baths, prepared my food, made sure the children were dropped off at Nursery and friends (you will need to get help with the kids - peace and quiet for recovery). What ever you do make sure you have planned a support network and help with the house, kids, husband, dog etc etc. Print the plan off for everyone and make sure that they realise that this is going to be like a major operation due to the pain levels and debilitating effect on your bowel function. You will need FULL support for at least two weeks. I am 18 days post Op and still resting!

Preparation List

  • Foods: All Bran, Weetabix, Fruits, Tinnned fruit (for ease), cream, Green Tea, Decaffeinated Tea/ Coffee, Lots of Soups, Cream & Brown sugar (nice on All bran), vegetables.
  • Supplements: 2 bottles of Lactulose, High Strength Aloe Vera Capsules, Butchers Broom Tablets (order well in advance), Movicol. These can all be bought on Amazon
  • Medical Items: Sensitive Baby Wipes (for when you can wipe; you will not want toilet paper!), Preparation H wipes (sterile and soothing to finish off with), Kermode (can hire from Red Cross shops), Padded Raised Toilet seat (Amazon), small stool (helps when on the loo or Kermode, when the legs are raised its easier for a BM), Knickers you can throw away after, Panty Liners (for any mucous / blood in the first week). Sitz Bath (from Amazon), Salt for the bath.
  • Drugs: Oramorph (I really had to push my G.P for the Oramorph and promised to use it only as a break through pain relief.). Dihydrcodeine. Paracetemol and Ibuprofen (in copious amounts). You need to persuade your GP that you understand the need for a high Fibre intake to offset the effect of constipating Opiates.
  • Other Items: Laptop: (join Netflix for free and watch TV in bed to pass time) I couldn't even concentrate to read in the first week. Books to read for when you feel up to it. A V pillow for sitting up in bed. An extra pillow for sleeping (put in between legs to relieve pressure on your bottom)
  • A BUM BUDDY (you will need them 24 hours a day for the first 4-7 days)

Recovery

Be prepared your recovery will be HARD WORK and you will have to build yourself back up again. Everyone is right that you will only feel slightly human after 14 days. In the first few days be prepared that you will revert to being a toddler... you will need help with everything as you will be in pain, spaced out, and unable to go to the toilet. Be prepared to take a bath up to three or four times a day, have your bum looked at by your BUM BUDDY (they need to make sure its not getting infected), have tantrums, and feel massively depressed. This is all very normal but none of explained by the NHS!!!

Bathing: Always keep the area clean and patted dry after a BM.

Going to the toilet: You may spend along time waiting to both wee and poo. Get the comfy padded seat. Prepare for tears and pacing, lots of Sitz baths to relax the muscles (hence letting you push). YOU WILL GET THROUGH IT. Keep up with the meds and they will make it bearable. You will feel alot of pressure down below. (This is another good reason for any children to be taken care of as they don;t want to see mummy go through this).

 

Result

As I explained I am now 18 days post op and I felt the compulsion to start a new thread online as I hadn't read many threads from the UK with people referring to the Pain Relief available over here. I can now walk around with no problem and go for a BM without pain and without the need of a bath. I am back at home and can do jobs around the house. I still have a sleep every day and let my husband do the bedtime routine with the kids. I fully intend to take the four weeks of work, I don't want to regress and go through this again.

My only worry now is that I am still very swollen. There are not many threads after two weeks and not much talk of how long swelling takes to reduce. I live in hope! My wound is still slightly open and producing sticky pus but I pat this dry and use Prep H wipes after I have been for a BM. I have no pain when going for a BM.

This has been one of the toughest years of my life. I hope it has made me stronger. Yes it was worth it as I have no pain now. I imagine I will have some rather large skin tags as I ended up having three large rascals cut out!!

 

Good luck to you all and please don't hesiate in asking anything you wish to know pre or post op.

 

Warmest Regards,

Post op Pam!!

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Just wanted to chime in with my experience after having a hemorrhoidectomy.  First off, I am a Marine living in Japan who has suffered from hemorrhoids since 2007.  I have had about 8 episodes over the course of six years that led me to seek out a permanent fix as over the counter medicine and diet tweaks did not do the trick.  I was not at the point where surgery was mandatory, but I was at the point where I would have very painful flare ups, including excessive bleeding and almost always anal discharge after bowel movements.  I find it hard to believe that many of the general public live with similar pain/discomfort but that is apparently the case. I had a surgery on 7 November 2013, and it is now Christmas and I think I am now 98 percent healed. When having the initial evaluation for surgery I was told that I would have to stay in the hospital for about a week, and would be fully recovered in two weeks.  The later of the two was completely incorrect, but I did only stay in the hospital for about 5 days (including one day of pre-surgery prep).  This is standard in Japan, but differs from the the U.S. in that this is an out patient surgery.  What also differs in Japan is the choice of pain medication.  I was essentially given ibuprofen for pain post-surgery which made the whole ordeal quite a bit worse than it had to be, but that is a Japanese custom with medication.  So, after being discharged from the hospital I was given no advice for treatment, probably because of a rather large language barrier, but I can attest that I was certainly not 100% on the two week marker.  I went back to work on day 7 post surgery, which proved to be a painful adventure but I got through it with the provided medication.  What others considering surgery can expect:Weeks 1 and 2:  Quite a bit of pain no matter what you're doing, and even more during BM's and post BM.  You can subdue the pain with with hot baths (the only thing that provided real relief), but who has time to spend hours in a bath?  I also was discharging some very odorous fluids during this period which I soaked up using small amounts of pre-cut gauze (changing 3 to 4 times daily)Weeks 3 and 4:  Less pain, but still a noticeable discomfort and discharge. Bowle movements will still be considerably uncomfortable/painful. Ensure you are sticking to a stool softener or heavy fiber diet to avoid hard stool.Weeks 5 and 6:  BM's are bearable, but you will still not be totally healed.  Plan on having something to soak up secretions at all times to avoid odorous discharges.  Week 7: I am almost totally healed and I'm completely happy with the results of the surgery.  Although I was rather skeptical about the procedure during the past 7 weeks, I can say that I have had no problems with BM's this week (no bleeding, secretions, or post BM pain), which is a huge improvement from my pre-surgery condition.  I would recommend this procedure, but certainly plan at least 3 weeks of vacation to be smart.  Don't try to tough it out like I did, as this is a crazy painful procedure.  Good luck...  Adam

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Any one heard if Exparel is available in Australia its  a new drug for pain after rectal surgery.

Its given via injection around the anus and  is supposed to numb the area for around 3 days.

The writer said that it costs around $260 for the one treatment.

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Wonderful post, Pam! I'm 5 weeks post-op and I followed nearly all of the recommendations that you've listed here and I came out of it very well! I totally agree about staying ahead of the pain. The first few days I set my alarm as a reminder to take a pill during the nights.

I would add that you shouldn't spend too much time pushing when sitting on the loo since this can aggravate the wounds. Another point concerns the continual cleaning and disinfection of the sitz pan and the bath tub before and after each use. One article I read recommended washing your hands, face and feet before going for a soak, the reasoning being that you want to keep the area free of any germs and infections. For this reason I mainly stuck to showers with a hand held water nozzle and I used a hair dryer afterwards to remove the moisture. I'm almost at the point of being comfortable wiping normally after a BM but I'll continue patting the area clean followed by a sitz bath afterwards for a few weeks. The last thing I want to do is aggravate the area.

I also had lumps and swelling where the stitches were that felt worse to the touch than how they actually appeared when I looked in a mirror. They went away on me, almost overnight, at about weeks 2 or 3. I now have what feels like thick hard skin where they were but when I look in a mirror it looks fairly flat with the surrounding areas. My surgeon said that the skin will eventually soften over time. I hope this helps!
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