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Wasn't sure where to posy my Hemorrhoidectomy experience, so I am hoping this is the right topic area as I am new to the site.  This is a post to hopefully help others going through recovery from surgery.  If my experience can help in some way, I will have reached the goal of my post.

I am a 42 year old male who had been suffering with internal and external for over 25 years.  The worst aspect of this problem was not really knowing when a BM was over, so I spent a lot of time on the toilet, which only make the problem worse. 

The more I research now, the more I think there is a big genetic factor to hemorrhoids.  My mother and her siblings had them, as did her father.  All of us are of different weights, lifestyles, and health, so I believe the usual advice of lose weight, exercise, and add more fiber to your diet may not completely resolve or reverse the problem for some people.  Given my genetic history, I believe that no matter what my weight, exercise level, and dietary habits had been, I'd have hemorrhoids.

In any case, I had lived with hemorrhoids for over 25 years, and only once did the condition get so bad that I went to a Proctologist for help in 1993.  He started with banding, which didn't work, was quite painful, and so he ended up removing a prolapsed hemorrhoid during an office visit.  Since he refused to give me constipating pain medications, the pain was unbelievable.  Recovery only took a few days, but that was only one of many hemorrhoids and I would continue to live with them until I chose to remove them all on 2012-02-14.

The decision to go ahead with full blown hemorrhoid surgery came from a new symptom.  Last summer I started to experience about 60 minutes of clear / brownish discharge after a BM.  This became a lifestyle nightmare .  After some Internet research, I found a very highly rated rectal surgeon at a prestigious Boston hospital.  One office visit and we both decided that a full Hemorrhoidectomy was the right choice for me.

I knew going into this that recovery might be very painful, but I wasn't sure how long it would take to heal.  TIP: If the surgeon gives you recovery estimates of 3 to 10 days, ignore this.  Tell your employer that you'll be completely out of work for two weeks.  Add a few more weeks for dealing with discharge and minor pain with a BM.  These things won't stop you from going back to work, but two weeks off is a minimum.  You'll have to factor in things that can't easily be done at work like changing gauze or maxi pads and sitz baths.

Surgery took about two hours.  The surgeon came to see me pre-op but explained that he wouldn't see me again until about 3 to 4 weeks after surgery during an office visit that I should schedule, and that the nurses would handle my aftercare and aftercare documentation.  That sounded reasonable.  After surgery, I didn't feel much pain and I stared taking the Percocet they gave me. 

The main problem I encountered after surgery was passing urine.  I left surgery at about 4 PM and I didn't pass enough urine to get permission to be discharged until just before 10 PM.  It was the strangest sensation.  It felt like I had to go, but something was blocking the flow.  With a lot of relaxation, I was able to produce enough to get the okay from the nurses for discharge, but just after they threatened to catheterize me.  Thank goodness this didn't happen because a catheter is a aftercare burden.

I followed the aftercare instructions to the letter, taking Psyllium fiber 3X a day, and doing sitz baths.  By day 2 I could not produce a BM and I was feeling backed up.  I immediately stopped the Percocet and started Milk of Magnesia per the aftercare instructions.  Nothing happened and all the while I was feeling more and more backed up.  Three days after surgery and I was desperate for a BM.  I paged the surgeon in desperation and he told me to take a dose of Citrate of Magnesium, and if that didn't work, as a last resort, do an enema.  He also said that I had "a lot of hemorrhoids" and "you have to have a BM". 

The first statement was significant because this guy had been performing this surgery for 35 years, so for him to say that indicated I was a mess back there.  The next statement about having to have a BM was a bit of a "no duh" moment.  It wasn't like I didn't want to go.  In fact, at that point, I was willing to do ANYTHING to go.  I understood what he meant though - not pooping can lead to hospitalization and even death if not resolved.  That was his way of reminding me of this.

The Citrate of Magnesium did nothing for me.  I kept searching the Internet to see how others dealt with this issue.  I read a lot of recovering addicts have this problem due to all of the opiate narcotics they take, and found that some drug recovery doctors believe that Colace is better than Psyllium to head off and resolve Percocet constipation.  I also learned that Mineral Oil Enema was the best way to try to remove impacted stool before a trip back to the hospital.

My surgeon did say enema, but he didn't say what kind of enema, so based on the info I saw online, I asked my wife to try and find me a mineral oil enema.  Thank goodness I made that choice because I believe that I wouldn't have gotten the same great results if I had decided to do a saline enema.

My wife returned 20 minutes later with two mineral oil enemas which were buy one get one free at CVS.  They were not Fleet, but CVS brand.  It didn't matter.  I was at the end of my rope.

TIP: Make sure you do the enema in an empty bathtub that is close to a toilet.  Put down old beach towels from the bathtub to the toilet.  You don't want to get mineral oil all over the bathroom tile or grout.  It won't come out and will stain.  I did the enema according to the instructions and got up from my side to all fours and let whatever oil that didn't already squirt back out of me "soak in" for about 5 minutes.

I was numb back there and didn't really feel pressure to go, but I decided I have to do this, and carefully got out of the tub without slipping, walked to the toilet over the beach towels and sat there.  After about a minute there was pain and this urge to push even though I didn't want to.  I didn't want to rupture anything, but then it felt like I was involuntarily squeezing a bag of cement through a garden hose.  Severe pain and then then wham! - a mass of stool the likes I never saw before in my life passed through me into the toilet.  The pain was there but the pressure might have been even worse.  I was afraid that I'd look down to find parts of me in the toilet.  Surprisingly, there was no blood - only poop.  I left like a new person and carefully ran to the sower to wash the mineral oil off.

Later I cleaned the tub and the toilet so my wife didn't go flying off of the toilet seat when next she used it!

Later that night I had two more effortless BMs with some residual rectal pain, but they were fast and I spent no more than 20 seconds on the toilet.  First time I can remember sitting, going, and being done with it.  Fantastic!!

From that point forward I came up with a strict daily regimen that I created based on research.  This has been working for me ever since.  This may not work for everyone, so take this only as an example of what works very well for me.

  • Psyllium Fiber (Metamucil or generic) 3X a day in 10 oz. of OJ and Cranberry mixed with a drink mixer.
  • With the above drink take:
  • 1 Colace capsule 3X a day
  • 1 300mg capsule Fish Oil 3X day
  • 1 Pro-biotic capsule with all of this in the morning.

This combination has been miraculous for me.  I go and I have no problems.  I should have started this BEFORE the surgery and maybe I wouldn't have had the issues as badly with the Percocet.

It has been 18 days since the surgery and I am still getting anal discharge.  I deal with this with a 3X4 Johnson & Johnson Non-stick gauze, which I replace 3X a day.  I stopped wearing maxi pads last week as the bleeding is less than before.  This gives me hope that the discharge will stop at some point.  The discharge is the only thing keeping me from a 100% recovery right now.

I still do sitz baths - at least one a day.  I can't recommend them enough.  Because I use a tub (not the basin-thingy attached to the toilet) it is a nice relaxing esperience and helps clean any discharge and sooth any itching from the anal hair growing back.  (They shave you down back there for surgery.)

Feel free to ask me anything about my experience.  I am one patient who WOULD do it again and wished I hadn't waited so long.

Take care and good luck to all thinking about this surgery or going through recovery.
K

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Wow...Thank you for your info. I'm a 41yo female reaching the end of my rope and trying to find the guts to do this. I know it is necessary, and a permanent solution. Thank you for your honest feedback. I'm scared but I am ready. Just looking for all the guidance I can find (and some POSITIVE feedback as so much is so not so!)
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Hi mjs124,

If you're suffering with internal and external hemorrhoids, I highly recommend surgery, but make sure you do a lot of research in picking a surgeon and choose the surgeon wisely as I believe I did. Choose a surgeon who specializes in this surgery and has performed it successfully for more than ten years.

Everything has worked out very well for me post surgery and it's really a new lifestyle. No more bleeding or discharge, no more bulges coming out of my backside.

I've eliminated the fish oil due to the massive heartburn it was giving me and dropped the colase based on the surgeon's post-op recommendations, but I still take the Metamucil fiber in water two to three times a day. This has kept me regular. I know that hemorrhoids can come back and I am working hard in trying to stop that from happening. If you're a healthy adult who can handle surgery, I would highly recommend going through with it. It is widely known that women have a better pain threshold than men and I think you'll handle any pain like a pro. Go easy on the pain meds because they will constipate you. Start the fiber therapy right now. Work your way up to 3 doses of Metamucil asap. This will help to ensure you can poop post-op.

Make sure you ask for time off if you work. If you're a stay-at-home mom, get your partner to handle everything you usually handle while you recover. You'll have to focus on your recovery 100%.

Good luck. Please let me know if you do go through with surgery and let me know how it turns out.

-k
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Hi K -

Surgery is scheduled for September 24th. I have a great surgeon - the head of colonrectal surgery at one of the largest hospital networks here. He actually performed this surgery on my Mom probably 10 years ago. And though I know it was a permanent cure for her, I lost her 7 years ago so she isn't here for me to get all the details from re: her experience! UGH! I've been doing fiber/fruit smoothies everyday and metamucil 1x a day and have gotten myself in a "good place" w/ 1 easy bm/day, albeit a slow and lengthy experience followed by sitz bath, etc. and putting them "back in". I so look forward to a quick BM like you mention in your post! My biggest concern is achieving the proper balance while using pain meds. Did you continue using the Percocet while doing your colace/metamucil therapy? I am not working and have a wonderful husband for support so I am free & clear to focus on nothing but my recovery. Wish I could do this sooner but have a big family reunion in FL in 10 days so thus the delay. Thanks for your help coaching me through this.

M
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Hi M,

Very good to hear that you scheduled the surgery because after going through with it, I think it's the best treatment for very bad hemorrhoids.

As far as the pain meds are concerned, I didn't take any regular fiber before surgery (see my first post) and I seriously regret that I didn't get up to 3X Metamucil a day before treatment. The reason is that the pain meds backed me up so badly post op, it took several days to have a BM - and this was only accomplished with the aide of a mineral oil enema - very messy indeed. Not being able to go #2 was the worst feeling in the world - I wanted to die. Thank goodness for the mineral oil enema, because I'm pretty sure I would have had to go back to the hospital for impacted bowel if that didn't work. I'm guessing that was what it feels like to have a baby - lots of stretching and pain and then it leaves you. I don't want to get graphic, but this is reality. Re-read my first post.

Getting up to 3X doses of Metamucil a day should only take a week, and it's the best thing I ever did since then. After doing a lot of research after the surgery when I couldn't have a BM (desperate for any advice), I saw that I should have started fiber therapy way before the surgery so that when I took pain meds, I would have had less of a problem with my first post-op BM. I think because of the constipation, I was only on pain meds for a little less than 48 hours after surgery. If I had to do it all over again, I would have skipped as many doses of pain meds as possible and started fiber much further out before surgery.

Easy on the smoothies if they contain dairy because dairy can bind and so can honey and other sugars. Again, the very best fiber is Metamucil or generic psyllium fiber powder in water (not OJ - too much acid and sugar) 3X a day. I can't stress this enough and neither could my surgeon.

Use J&J non-stick 3X4 inch pads for any discharge. Don't freak out if the discharge continues for more than a month. It clears up when all of the sutures heal and that can take 6 to 8 weeks depending how bad your condition was. Your surgeon will tell you how far the healing has come during your first post-op office visit with him. Right after surgery you might need maxi pads along with the non-stick pads depending on the amount of bleeding and discharge you're experiencing.

Sitz baths 3X a day are a must as well while you're healing. Warm water only, no Epsom salts or soap. This will speed up the healing process.

Best of luck and let me know how it turns out. Keep your chin up. I know you'll be okay.

K
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Just wanted to put my 2 cents in.  I only had a few days to prepare for the surgery.  2 nights before I took the max dose of laxative (Perdiem, a senna based), as well as the max dose of Colace.  This resulted in a huge cleansing poop the day before surgery.  3 days prior I started taking 3 TBS of Olive Oil in the am and 3 TBS in the pm, mixed in a cup of broth to make it palatable.  People say you can use mineral oil and that's OK too.  I just liked the Olive Oil b/c it's natural,  I had it at home already and it actually mixes with your food, which the mineral oil does not.  That makes the poop itself soft.  I did not start Metamucil until I came home from surgery.  This regimen prevented any constipation.  I'm 2 weeks out, I still take 1 Senekot, which has half the senna of the Perdiem, plus a little stool softener in it.  All of my BM's have been soft and I believe this has helped with healing.  I have a more thorough post made Aug 3 on my positive surgery experience.  I will add, ask for and get a rectal pain pump.  It is inserted just after the surgery and lasts 5-7 days.  It made a huge difference for me.  Unlike previous posters, I took the max prescribed amount of Percosets for at least the first 4 days.  Because I had everything soft in there before and was religious about the stool softeners, laxatives and fiber, I had no real problems.  I also used a mineral oil enema for the first big BM which was 2 days after surgery, just to lube things and get things going, but I never had a real solid or hard BM.  Good luck.  It's 2 weeks out and I am so glad I did this.  I feel better now that I have in years, in terms of my posterior. 

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mjs124,

How did your surgery turn out?  If it was Sept., you're probably all healed by now and back in action.  Let us know.

K

 

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Hi K -

Everything is great! The surgery was just uneventful - bms were scary at first but with the sitz baths all was fine. I was prepared for the worst but I never had ANY bleeding and only slight oozing for the first 2 weeks. I laid low for one week, taking some pain meds and eating clean but by week 2 was back to my normal routine - I even played 18 holes of golf 10 days after surgery!! I would say now at 7 weeks I'm 98%, just have a small amount of swelling remaining but life is so much easier! If I knew then what I know now I would have done this 2 years ago. I agree having a very experienced surgeon is the most important part of this process. I feel very fortunate as another person I have cooresponded with on this board is suffering anal stenosis and is facing months more of problems and recovery! Glad all of us here are back on are feet and better than before! Thanks for all your advice and support in this scary adventure!
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mjs124,

That's great! Thanks for sharing.

K
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I'm a 50 year old female with internal and external H's.  I have nerve damage from childbirth and can only go with an enema.  No amount of fiber helps me, at all.  So, I would need to use an enema to go, after surgery, as well, which I didn't know was acceptable.

I'm thinking about doing the Dopler method, as I read that it was a lot less painful, because you are not actually cut. 

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Hi, Komakino, would you mind recommending your surgeon? I am having severe hemorrhoids.
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Paul Clarke Shellito, MD - Mass General Hospital
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Hello,

Please advise if mineral oil was your last resort for BM, because I still can't do it post 5 days of my surgery.  Did it help you for your first BM?  My doctor did not prescribe mineral oil for me but I am in tremondous pain because I can't have a BM.

thanks,

C.T

 

 

 

 

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Are you taking stool softeners and laxatives? My doctor prescribed a stool softener twice a day and lactulose twice a day. I did that for the first month then reduced the lactulose to once a day with a dose of Miralax. I am still taking 2 stool softeners twice a day.
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Any more updates on still having anal discharge or anus never closing fully like it did presurgery? I've heard that the chances are very high in losing that natural closing down there and also never fully healing and,having more pain with BM than before having the surgery. I am on my 11th day and I am very very constipated just as you had described, so I did as you had done. Sent my wife to get me an,enema with mineral oil.....haven't had BM for 3 days now,and have a fever of 99.5.
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