After all the horror stories I read, I figured it made sense to add my own experience to show that this procedure can go well and be relatively pain free. I had several grade 3-4 internal friends. I started by taking stool softeners (reduced dosage) 2 days prior--not sure if this helped, but it didn't hurt. Took the enema on day of surgery and had movement after 3 minutes--nothing else came out and I was a little nervous it hadn't worked, but didn't need to worry. During surgery I was under a local anaesthetic, although I was asleep. The anaesthesiologist suggested this had fewer bad side effects than the full dose and to me it felt the same, except that I started on the table on my stomach. No complaints. After 90 minutes or so I woke up in recovery and started to feel a growing discomfort that turned into pain. Not unexpected and the nurse gave me some IV happy drugs. After 10-15 minutes she gave me another half dose (I wanted to try a lower dose) and then 5 minutes later the 2nd half. Out came the IV and I went home with a prescription for Norco--just the 7.5 version. No pain during trip home. I started taking sitz baths (just hot water) every 2-3 hours on the first day, took ONE norco every 4-6 hours and the ibuprofen (400mg... less than the 600 prescribed) inbetween. The pain was mildly discomforting--never anything worse than I'd had during bad flare-ups. Urination didn't happen that day--I ignored the "go to ER after 6-8 hours" advice and next morning had no problems. I'd been drinking plenty and although urination was hard (sometimes taking a hot shower helped) it was okay. I can see that some may have more problems here. The first bowel movement... not a lot of fun, but I was taking my stool softeners (colace, metamucil, milk of magnesia (all in slightly lower doses as I wasn't taking full norco dose either). Felt sore / raw and painful. Honestly I thought I'd embedded one of the staples in my anus, and not much came out. But... every bowel movement has been easier since. I had a bath waiting for me and I also use a squirt bottle (from my wife's delivery) to clean. The warm squirt water is highly recommended. I pat dry with TP. My main problem the first two days was nausea--I threw up my fiber meds on day of surgery and got a prescription for something (can't remember name) that totally wipes out nausea. Urination isn't perfect yet and I can't tell difference between gas / bowel movements, but the pain is so much better than I feared. I've started using hydrocortizone cream for itching, but itching means healing... I would recommend this surgery--I used Dr. Murday in Salt Lake's St. Marks hospital. Going back to work tomorrow--still taking pain meds (2-3 / day) but after 4.5 days this is partially a crutch. I take one - two baths a day, much reduced fiber supplements, still plenty of fruit juice / liquids / fruit / vegetables, but more or less normal eating. Still use panty liners, but never had much bleeding--almost none to be honest. This is not the horror surgery if you get the right surgeon.