Swelling and Pain After Hemorrhoidectomy Surgery

Breezie,

No wonder you have been beside yourself! You had waited all weekend to see the surgeon on Monday and then he couldn't see you! I can understand if he wasn't in on that day, but changing your Tuesday appointment to Thursday seems heartless, considering your condition and your obvious distress. I can't understand why they didn't fit you in, even if they were fully booked, as post-op surgery complications should be a priority.

But thank goodness you got straight into the ER and a female doctor who sounds like she was competent, even if she wouldn't give you the cream you need. And at least you have a diagnosis confirmed, and the cream prescribed by your regular doctor. It's really unusual how different that cream is treated in the US and Australia. As I told you, here it is available over the counter, and I thought it was expensive at $32 for a small sized tube. But the price there is unbelievable. Thank goodness you are subsidided by your insurance. Otherwise I would definitely have to send you some in the post (with the hot water bottle, ha ha).

My doctor told me it takes 4 weeks to work, but as you know, I did start to feel better within a couple of days, so I really hope it has this effect for you as well. You have been through SO much suffering Breezie and you are SO brave. Unless you have been through this, no one could understand how hard it is. You have had much more than your share of pain over the last couple of months. You have to believe it will get better, but you are just not there yet.

I can understand how you are limiting your food intake to avoid too many BMs. 1-2 a day is surely enough, and more than this at the moment will just cause you more pain. And you are so sensible with eating nutritious high-fibre food when you do eat.

We must both be "slow healers". Of course, the reason is the muscle spasm, cutting off the blood supply, because without this, you can't heal. At least it's not an intrinsic weakness in us - that we can't heal. I'm sure our immune systems are doing their best at the moment, and the ER doctor did say your hem site was healing. You probably don't have more hems though - how could you at the moment...you haven't strained or done anything to create new ones. Perhaps she was referring to the site of the original ones?

Did either of the doctors offer you any stronger pain relief? I think it is warranted considering how much pain you are in. My surgeon was going to write me a script for Endone last week (a narcotic analgesic) which I declined because I still had some left from my surgery time, and I don't take them anyway. But he thought it was definitely warranted after he examined me. Perhaps you need something stronger, and just increase your laxatives to compensate?

Well, Breezie, remember that I am thinking of you with much compassion and empathy. I am really wishing you a recovery that comes without any further delay. You must be such a strong person to get through this, as it is such a terrible ordeal. Hang in there my friend. Hopefully the worst is over for you and you will have some relief soon.

Hi Aussie.

I also don't understand why they offered me an appointment tomorrow and then called to change it. Part of me wonders if they don't feel that this fissure is "related" to the hem surgery? I hope not because it definitely seems related to me, and I have not been released from his care for this surgery. I really don't know, but I am very upset about it. I have asked my husband to go with me to the appt on Thursday afternoon for moral support. I plan to share with the doctor, in a respectful way, what this experience has been like. I hope he is not dismissive and takes me seriously. I'm sure to them a fissure isn't that big of a deal, but the pain with this has been just terrible.

I also don't understand the differences for approaches to medication. I also had thought about how easily you could get the ointment there and send it over. LOL But I wouldn't have felt right asking it of you. I was just feeling very desperate this morning. I also hope it starts to work soon, within a few days. The worst pain is coming from the spasms. I do have some sharp pains on and off during the day, but they don't feel as delibitating. They may also just be from the spasms as well, come to think of it.

The reducing of food intake seems to be having an effect on the number and size of BM's so far. I only went once today so far which is a record since having surgery! It's only 8  pm, so I never rule anything out until I am asleep. I haven't had to wake up in the night for a BM in a little over a week. I still have a lot of anxiety about this and probably will for some time. It's hard to imagine having a "normal" diet ever again or not having my rear end be the focus of all my thoughts and energy, but I am so hoping I will get there. I don't think I've been doing the food reduction thing long enough to tell if it will make a big difference, but today is day 2 and so far it is working. I hope it helps.

No one offered me anything stronger for pain relief, but I really don't want anything. I still have some narcotics left from my surgery that I could use. They just made me feel so bad then and also cause constipation that it just isn't worth it to me to try. I am too afraid of the side effects.

I just hope this fissure heals well, heals completely, and heals as soon as it can. I think I worry that it will come back or something. I also hope the worst is over and I will feel better soon. And I hope you continue to heal and recover completely. It would be good to be able to share good news about our days instead of all the pain!

Thank you for your kind comments. I don't feel very brave, but seeing you put that in writing did make me feel better. This is indeed a very difficult journey. I was crying when talking to the ER doc, and she was very understanding. I know it sounds terrible, but I often have experienced that female doctors are just more understanding overall. At least that has been my experience. I told her that I know it's not the worst thing someone could go through, and she said "but it has been really hard for you and that is what matters."

I hope I will be able to get the nitroglycerin by 10 or 11 tomorrow and start using it. I hope by Thursday when I see the surgeon I will actually be able to tell him I am having improvement!

May you continue to heal and feel well.

I got the nitroglycerin ointment this morning. It is a 0.4% mixture. I did get a headache almost immediately after using it, and it is bothersome so far. At this point, I would put up with a headache to have some improvement. I am also having a little itching down there, but I can't tell if it's the ointment or just itching from everything else. So, I put a little tiny bit on my arm and marked it with a pen so I can see where I put it - I figure if I am allergic to anything in it (like the lanolin), maybe it would show up on my arm and I would know. Does that sound reasonable?  I just have so many allergies and sensitivities to things. The last thing I need is an allergic reaction or contact dermatitis down there.

The pharmacist went over how to use the ointment, which was helpful. It also helped me know I need to buy some vinyl gloves for application. Using my finger was somewhat painful, but I'm not sure if a q-tip would be okay? I don't know if the cotton tip might cause some problems or not.

I also got a hot water bottle!!! The little pharmacy where I got the ointment had one - just one - left. So I am sitting on it right now, giving it a try. Sitting doesn't feel good but the moist heat feels better than the microwave bean bag thing I was trying to use before. This feels like a gentler heat.

I am just hoping this works, with no reactions, and with healing!!! I would love to go see the surgeon on Thursday and have him tell me it looks like it is healing. I would also love to experience a reduction in spasms.

Hope you are having a good day!!!!

Yay!! So glad you got the ointment. Fingers crossed for you that it works! At least having a headache is a sign that it has been absorbed, so it should be doing its job. My ointment is only 0.2%, so that might be why it is available over the counter here. I found the headaches were not too bad and I stopped getting them after a few days. But perhaps that is because my ointment was a lower strength as well.

AND you got the hot water bottle! I hope it helps you after all the build-up I have given it. I still use mine daily. That one was obviously meant for you, as it was the last one in the shop.

Hopefully you don't have any allergies to anything in the ointment. The arm test should tell you, but be careful not to over-apply it, as you may get too big a dose. My surgeon told me to use 1 cm (about half an inch) of ointment and to use it externally only, as it is still easily absorbed. So I would suggest if it is difficult or painful to put it inside, just use it superficially.

I think I am continuing to improve each day. Not quite there yet, but definitely better than this time last week, both pain-wise and also in feelings of general well-being. I can honestly say I don't feel unwell anymore, which I did for so long. I am looking forward to hearing you say the same soon!

I have been a bit busy at work this morning, hence my delayed post. I hope you are still awake to read it, so you know I am still thinking of you and hoping for your recovery from this agony.

Hi Aussie! I was just thinking about you and then saw this post. It is always good to hear from you. I am glad you are continuing to feel better!  I hope every day brings improvement until you soon get to the point where you no longer even think about any of this! I hope that for both of us!

It is a mystery to me the difference in dosage and strength of the ointment. Mine is the 0.4% and I am to use 1 inch and insert it rectally. It was somewhat uncomfortable doing that and trying to spread it around – if you can imagine – but I tried to be very gentle and not do more than I felt I could. I kept telling myself that it would help with the spasms and would be worth it.

I called the pharmacist about some redness on my arm where I had put a little bit, and she said that was just a sign that it was pulling blood to that area and working.  She encouraged me to keep using it and that it should greatly help my condition. That put my mind at ease that the redness was normal. And it soon faded anyway. The headache lasted about 8 hours and has mostly faded; I can just still tell it is there. I know when I use the ointment again tonight I will get another headache, and I hope I can sleep. It is a pretty bad headache. Not the worst I’ve ever had, but enough to make it hard to rest. We’ll see! 

I wonder what the surgeon will think of me getting this from my primary care doc. His nurse did suggest that I try that, but he still may not be happy about it if it goes against what he would do. But I guess I will find that out on Thursday.  I also want to ask him about the fissure. I worry about whether it will heal completely and never come back. I’ve read stories about chronic fissures that don’t heal. It has me freaked out all anew. When it comes to this part of my body, it doesn’t take much to worry me anymore. I never would have thought I would be so traumatized by this, or be so fearful about this area of my body. I think the mental healing may take longer than the physical.

I’ve used the hot water bottle twice today. I still can’t sit for very long, but the warmth did feel good. I wish I could get the water a little hotter. I run the tap water as hot as it can get. The packaging said not to use boiling water, so I didn’t. I will let you know how it works for me. At the very least, I will have it for winter when I need some extra warmth on a chilly day or night! 

I continue to think of you often and send positive prayers and thoughts your way as well. It really comforts me to know you are there as well.

Yes that does make sense about the redness. The medication dilates the blood vessels, so of course it would cause redness, I hadn't thought of that before. It does sound like our regimes are quite different. Perhaps because you have got a fissure, whereas mine is just unhealed hem wound - although the surgeon did say it was acting like a fissure ( I guess in terms of pain?). Anyway, I'm sure it will work.

I can't see why your surgeon should be upset about you getting this cream from your primary care doctor. Your first option was to see the surgeon, and you have been trying to do this now for almost a week, but they could not give you the appointment you needed so badly. You had no alternative but to see someone else, and the surgeon's own staff even suggested this. If he is not happy, that's his problem!

I use boiling water in the hot water bottle. Mine has a woollen cover on it, but otherwise it would need a towel wrapped around it, so that it doesn't burn. It's a miracle that I haven't bursted it yet - with the number of times I have filled it with boiling water and put my body weight on it! I am careful not to overfill it, and I squeeze out any excess air before I screw the lid in. And I try not to put all my weight on it, but it must be a pretty tough little bottle! The instructions not to use boiling water are probably just in case of litigation - they don't want you to sue the manufacturer if you burn yourself.

You are right about the mental healing required, as well as the physical healing. The whole experience of post-operative recovery (and the time leading up to our operations) is debillitating and traumatic. But it is amazing when your body starts to heal, how the mental anguish also improves. I have noticed a big improvement in my mood the last week, as I have started feeling better. And the times that I am pain-free, I can't imagine exactly how bad the pain was a few weeks ago (not that I want to re-live it). A bit like childbirth I guess! You will recover soon too and this time will become a terrible memory. I don't think either of us will have this operation again in a hurry. Hope you sleep soundly tonight.

This will be a short reply as I am on my cell and for some reason it doesn't show what I am typiing as I type! I did the 2nd dose tonight. It is a bit painnful to insert my finger and try t rub it around. I hope I don't cause harm! Maybe tomorrow I won't try to do more than insert it. Yikes! My hubby said "well your poop comes out so I don't think your finger will do any harm!" Hope he's right! This would all be less stressful if the surgeon would just have seen me! Now I'm worried I will hurt myself! Sorry for the typos!

If you are worried or it is painful, perhaps just use it around the anal opening, but not inside. That is what my surgeon advised me and he said it is still absorbed. He clearly told me not to use it inside (although the product information says to use it internally, so don't worry that this is a problem). Mine works this way, and it is half the strength of yours, and I only use half as much.

I think I will stick with using the ointment outside until I can see the surgeon. I may put a little bit on the tip of a q-tip and gently put a little inside, but I don’t want to keep putting my finger in there. I don’t know what is going on in there exactly until the surgeon takes a look and I definitely don’t want to cause any problems.

I wonder if your surgeon said your unhealed wound was acting like a fissure due to location and/or possibly the effect of the spasms preventing it from healing? That would make sense to me.

It is encouraging to hear about your experience with mental well-being improving as your physical health improves. That gave me hope. I am really glad that you are continuing to improve.

I can’t say I notice a difference this morning, but I know it will probably take a little while for it to work fully. The prescription I got was for twice a day for 3 weeks. The spasms this morning after a BM are still very powerful and lasting, and they are also spreading to the pelvic area. I did notice a little improvement in pressure this morning, I think. It made me realize just how much pressure there has been in that area all this time. This pressure and the spasms have been there since surgery, and I honestly feel they contributed to the fissure developing.

I had a small epiphany that I think I will share with the surgeon tomorrow; it is related to why my fear and panic is so escalated with this process. It came to me in the wee hours of the morning when I couldn’t sleep. I did fall asleep okay last night, even with the headache. But sometimes when I wake up at 3:30 or 4:00 to take the Tylenol and advil I can’t go back to sleep, and that happened again last night. So I just lay there tossing and turning and worrying. I am going to share the epiphany with you in the private message function on this board, if that is okay, as I don’t want the whole world to know about it. I’m just interested in what your thoughts are on sharing this with a doctor.  The private message function is located under our profiles.

I guess it is already about 8 pm your time, so I hope you had a good day at work and get a good night’s rest! 

Hi Aussie. I have a quick question for you - do you try to apply the ointment in the morning before a BM? Today I waited until afterwards - a few hours later. I just wonder if it makes a difference.

Hope you are having a great day! We have been having really gorgeous weather here, and I really miss being out and about in it! It's supposed to get super hot the next week or so, and I won't miss being out in that!

Hi Breezie,

I tend to apply it very early in the morning so that I can lie down for the recommended 30 minutes afterwards. So this is before a BM, probably at least an hour before. But when I use it in the evening, I don't usually have a BM then. The product information doesn't mention when to use in relation to a BM, so maybe its not important, unless you use it just before, and it gets removed!

Lucky you having warm weather. Sydney is very cold at the moment, maybe not as cold as your Winters get, but still cold! Warm weather seems to lift your spirits, so try and get out and take advantage of it!

I replied to your private message, so hope you got it. cheers, Aussie.

Hi Aussie!

I sent you a private message as well. Thanks so much for your help!

Most mornings I still have to go pretty soon after waking up, so maybe I should wait until after I go before applying the ointment. I don’t want it to get removed too soon!  I was just thinking that maybe if I could possibly get it applied before I had a BM, then maybe it would be more effective at reducing the spasms. I don’t know if it makes much difference. I noticed this afternoon (about 3 hours after using the ointment), I had a BM. The initial spasm was pretty bad, but the intensity didn’t last as long as usual – at least it seemed that way to me.

The weather here is supposed to get up to the high 90’s, possibly even 100, the next several days. We usually have a good bit of humidity too, which makes it miserable. I prefer nice balmy 70’s weather. :)

Take care, and thanks again. I’ll let you know how it goes tomorrow!

Hi Aussie. I sent you a private message with an update.

Hi there. I sent you a message. Do I need to post this or do you get a notice if there's a message?

Aussie. We had a very bad storm last night. Trees down in our yard no power. I will try to update soon. Ioo degrees and no ac. Still having pain but holding on. Hope u are well.