Swelling and Pain After Hemorrhoidectomy Surgery

Well said...it is true...fear can make pain worse so being prepared is best. For me the pain wasn't burning so much as it was radiating pain along my pelvic floor. It felt like ripping radiating pain...kinda like child birth. If you've been on stool softeners prior that will be great. The dressing isn't soft so that kinda hurt to pass but I highly recommend the hot/warm sitz bath to soak your bum in right after. I was actually trying to get the bath ready and just poop in the water but I didn't manage it in time. When you are swollen, you don't really feel the urge until it is almost too late. The water will be your best friend. After my first BM, I had a hard time getting up off the toilet but knew I needed to get my butt in the water so I mustered up strength and pushed off the counter in the bathroom to get upright. If you have someone to help you that first few, that would be great.... But having said all that and so much earlier, everyone experiences things differently....just like childbirth...everyone's story is different. I did know there were different procedures but I assumed that they did use stitches on me. I am in Canada so I've never heard of the Mulligan procedure? Are you from the UK Ocean Archer?

The milligan-morgan (open) hemorrhoidectomy is not common in North America, but some general surgeons still do it here. My surgeon (Indiana) said he doesn't think any colorectal surgeons still does that in the US.

I pretty much lived in bathtub the first week. I had the sitz basin all prepared, but like Soar said, when the BM comes on, there's not much warning, and you can't really stop it. So my first BM happened inside my bathtub. I guess it was good I wasn't constipated lol, but while it wasn't diarrhea, there was no form to it, so it quickly dissolved and spread throughout the tub.

The pain seemed to stop my motor functions. I wanted to climb out and escape my own sh*t, but I couldn't, or maybe I didn't really want to get my anus out of the warm water. Dignity takes a back seat to pain, but it really wasn't that bad. I'm 4 weeks out now, and can look back at that moment with a smile on my face. Actually I remember joking with my friends about it on Facebook just a few hours after the incident. The thing to remember is pain is only temporary. I just repeated that to myself after every BM the first week. It really seemed to help.

Soar--I did also feel a ripping sensation around the pelvic floor area, and I had to convince myself that nothing was actually tearing/ripping there. But the intensity of the burn on the anus kind of overshadowed that. I just found out a couple of days ago during my 4-week checkup that the surgeon also removed 2 externals. I originally thought only the 3 internals got snipped. Maybe one type of pain was from the internals and the other from the externals? I'm not really sure.

ocean_breeze,

Have you been able to significantly soften your stool yet? If what you're taking now isn't getting them super soft, you'll be in even worse shape after the narcotics. What does eating high fiber mean exactly? Please note the differences between soluble and insoluble fiber. Soluble lowers cholesterol and is great for your heart, but does nothing for your intestines. Insoluble is the kind that's going to help your BMs, but not all insoluble fiber is created equally. 6 grams of psyllium husk (grain used in metamucil) has a much higher osmotic potential than 6 grams of cellulose (vegetables). Take a teaspoon of Metamucil in the morning and one at night. Also, eat a bowl of Fiber One (the plain kind that's loaded with fiber from bran). Plain Fiber One is tough to swallow, so I mix it with some other high-sugar cereal to help flavor it. If that's not enough, increase your Metamucil dosage and add some Miralax to your diet as well.

Starting your psylliuim husk and bran diet now still won't be too late. It'll give your body enough time to adjust to the excess gas that this will cause. Passing gas during the first week post-op is not pleasant. It's nothing like a BM, but best kept to a minimum if possible.

A few other things:

1. Get your prescriptions filled the day before surgery (if your doc will allow it). You'll be pumped full of drugs leaving the hospital, but it's still no fun having to wait for meds. Some pharmacies can take hours to fill a narcotics script.

2. Ask your doc for some cyclobenzaprene. It's a muscle relaxant that doesn't have the potential for addiction like Valium. It didn't do anything for my pain, but it lessened the anxiety of the BMs and also helped me sleep at night.

3. Get some ketorolac (brand name Toradol) from your doc. NSAIDs worked better for this type of pain (for me) than narcotics. ketorolac is the strongest NSAID. It's a max 5 day supply, but that should get you through the worst of it. Then you still have the OTC NSAIDs like ibuprophen, naproxen, and aspirin to fall back on.

4. Get Flomax from your doc. This doesn't apply to Ocean_Breeze or any female patients, but it's a must for males. My surgeon's nurse refused to let me speak to surgeon about such trivial matters like urinary retention. She insisted it's the swelling that was preventing urination and flomax wouldn't help. Every time I called, she told me to call the ER to get a catheter. In my hemorrhoidectomy journal I think I said urinary retention was almost as bad as the BM pain, but now in retrospect, I think it was worse. Catheterization probably wouldn't have been that bad, but I think it was the fear of the unknown that traumatized me. Every pee stream took an agonizing hour or more to get going. Sometimes I'd strain so much trying to pee that it actually caused a BM to happen. Finally after 3 days of phone calls, the nurse relented and put my call through to the surgeon, who promptly prescribed Flomax. He even told me it wasn't uncommon for him to prescribe it to his male patients to relax the urethra (well, if that's the case, then why the roadblock from the nurse!?) It was a godsend. Women aren't supposed to use this due to potential birth defects, but if you're no longer at childbearing age, you might want to talk to your doc about it. Then again, women don't seem to have as much trouble with urethra hypertrophy as men after hemorrhoidectomies.

5. Get a sitz bath. I prefer to take a full bath, but sitz baths are convenient for BMs. That's right, poop right into the sitz basin. Then muster up enough will-power to walk over to the bath tub and submerge yourself. I needed to have my butt in water for at least an hour after BMs, and it's just not practical (or healthy) to sit on a sitz bowl for an extended period of time.

6. Expect pain. It's normal. Don't freak out and think something horribly wrong is going on. Yes, you're pumped full of drugs, and you're still in pain. The drugs didn't decrease the severity of my post-BM pain. They only helped to lessen the duration of the first-stage pain. Of course, the drugs helped to take away the all-round post-surgery soreness throughout the day, so you definitely still need those.

I read a lot where mothers compare this pain to childbirth, and so many say "at least I have my kids to show for the pain".  It's almost like hemorrhoidectomy pain is all for nothing. How about getting your life back? Isn't that worth something? Don't chicken out. Get your life back, and tell us how it went!

I was having some bleeding, so the surgeon wanted to be sure it wasn't anything else. I also had a colonoscopy about 4 years ago and there was a benign polyp, so they wanted to be sure there weren't more. They did find that I have diverticulosis throughout my colon, so that just supports my shift to a high fiber, high water diet. The downside is that my hems are a little flared up today.

Oh dear...you poor thing. My mom has diverticulosis and has had some bad flare ups with that. She has problems with her intestines and needs to make sure she has a high fibre diet. She doesn't eat seeds and such that can get trapped in the pockets. Do the drs. recommend that your hemmies recover from flare up before surgery? Last night I was out with friends and had a few jalapeno peppers with my nachos. ooh I just realized this morning why last nights bm was burning afterwards for a while (the skin on my butt cheeks) , so maybe avoid spicy foods too. When are you scheduled for surgery? Hope you find some relief soon. Is the bleeding from the hemmies or from diverticulosis?

I don't think I have any symptoms with the diverticulosis. It's just good to know so it reinforces the high fiber and lots of water diet. The dr didn't say anything about the flare up. I don't think I can way for it to completely go away because it's not, and it's been 2 weeks already. The surgery is scheduled for Wednesday.

Last week, I had the flare up of external and internal and the severe contact dermatitis reaction to the cream, and it was excrutiating. I'm sort of thinking post-surgery might be like that - swelling, raw, sore, I survived that. It was bad pain, but at least with the surgery I will know there is a purpose!

Thanks for continuing to check in and post!

oceanarcher, Thanks for your posts!  I am definitely taking all of the suggestions into account. Just FYI, I am a female, age 40, and live in the US.  The surgeon is doing the Ferguson method (using stitches) and quite frankly, I would rather have that than any other. I am not a candidate for THD or staple because of both the external and internal hems. I have one external that has been flaring up bad for 2 weeks plus, as well as an external skin tag that is not painful but is hard to keep clean. I think there is at least one internal hem. When I have flare ups, especially the one most recently, I have terribly sharp pain, swelling, aching, burning and stinging, some bleeding, and itching..... So I do think getting the surgery is going to be necessary. I appreciate your analogy to getting out of prison. For almost 3 weeks my quality of life has been reduced just with this flare up. It's Mother's Day weekend and I'm spending today in my nightgown laying down most of the day because of the flare up. Not fun!!!! I'm hoping to be feeling up to going out to eat tomorrow with my family and maybe see the Avengers! 

I think the past week my stools were a little unpredictable because we are switching to a whole foods, plant-based diet after watching Forks Over Knives. I think the soy-based products are the reason, so I am going to try and avoid them until after the surgery when I am feeling 100% and can play around with them more (what affects me and what doesn't).  Thursday through this morning everything was like water from the colonoscopy prep which has helped cause this flare up, but still not as bad as last week!  I'm eating whole fruits, whole grains, steamed veggies (avoiding raw veggies because they are harder on my system), and some beans (not too many). Lots and lots of water. I take Colace and Benefiber every day and have for years. If I can get out I plan to get some Metamucil to add in for a few days and see how that does. I also have Miralax that I take when needed. I'm trying to stick with what I already take because I know how it works in my system and I already know how to adjust it. I think I'm more worried about the narcotics which I am sure I will need and which I know (from prior experience) are constipating. We are also going to have prune juice and decaf coffee on hand since that is a good way to get things moving if needed. (Learned that after my hubby had surgery in November 2011.)

Also I found a wonderful resource that was recommended to me. I don't think we can post websites, but if you search for "healthy journeys" there is  website with guided imagery resources. Two programs are available for free on pain and successful surgery.  There is a lot of research that shows guided imagery is very effective, especially with pain control.  I think I will buy the surgery one and download it onto my mp3 player and see if the dr will let me listen to it during surgery while I am under. Can't hurt, right?

I'm also already linining up movies in my Netflix queue and HBO queue to watch - including lots of comedies, sci fi, and some action. Last week when I was in a lot of pain, the comedies helped some. I love to read but find it hard to read when I am in a lot of pain, but I have my favorite series ready plus a few others to read when I feel like it. (These are series I own and consider "comfort food" reading.) And of course, I have some of my all-time "comforting" DVDs to fall back on that I watch when I need some comforting, like the Lord of the Rings series, Harry Potter series, and a few others.

Both surgeons I saw said that it is hard to tell how much pain someone will have until afterwards. They said that you can do the same surgery on 10 people and have 10 different experiences. I am hoping that the pain will at least not be worse than the worse flareups I have had. Here's hoping!!!! I'd really like to not have to take narcotics for too long.

I hesitate with both Flexeril and Valium because they both really constipate me, and combined with the narcotics would maybe be more trouble than help. I do have a prescription already for Parafon Forte which is a muscle relaxer not as prone to cause constipation. (I have a history of back issues, thus the experience with all these meds!)  I also think that if Hydrocodone will do the trick, I know how to manage that better than Percocet which I had more problems with after back surgery.  I know Percocet is stronger than Hydrocodone, but if I can just take the edge off, I can make it. :)

I appreciate your comments and posting. You and soar have been so very helpful the past week or so. It really does help to know I am not alone!!!

 

 

ocean_breeze,

I've been reading the posts and want to wish you good luck!! I'm on day 19 (Surgery was 4/24/12) and finally starting to feel almost normal. I agree with a lot of what soar for sure said. You will not regret having the procedure done. Well, you might in the first week and maybe second as I was in such horrible pain. But now that I'm passed the first 2 weeks I do not regret it at all.

Ocean_Breeze,

PainInTheA$$ wrote:

ocean_breeze wrote:

I have had 2 surgical consults this week. Both went very well, and both told me the same thing. I am scheduled for a colonoscopy on Friday and then the hemorroidectomy next Wednesday. I am experiencing a very high level of anxiety. I'm really trying to psych myself out, but it's not helping. I'm most worried about the BM's.  This week I have been eating high fiber, drinking tons of water to try and prepare my body, taking stool softeners, etc and still having some harder BM's.  I am trying to figure out how to get them soft and firm so I know what I need to eat and do next week after surgery. I feel like time is running out to figure it out!

ocean_breeze,
I've been reading the posts and want to wish you good luck!! I'm on day 19 (Surgery was 4/24/12) and finally starting to feel almost normal. I agree with a lot of what soar for sure said. You will not regret having the procedure done. Well, you might in the first week and maybe second as I was in such horrible pain. But now that I'm passed the first 2 weeks I do not regret it at all.

Thanks for the post! By the way, I got a good chuckle out of your user name. :) It really does help to hear about people that are past the worst part - I will try to just keep reminding myself of these messages when I'm going through those first 2 weeks! I am really nervous but trying not to let it control me. I struggle with anxiety anyway, so you can imagine that the days leading up to this surgery are pretty wild!

Thanks for the positive feedback about my attitude. I have a "fake it until you make it" mentality. If I don't keep focused on the positive, I quickly can become depressed. There is also a lot of empirical evidence out there for mindfulness and the power of our thinking. Not "magical" thinking, but the idea of using guided imagery, positive affirmations, our intention about our thinking, etc. It's a form of cognitive behavioral therapy. Anyway, I try, but I do not always feel positive. I'm sure the days after surgery will be a struggle to stay positive!


I can't see the TV from my bathroom. I do have a laptop computer, and I'm going to try and drag it in with me and put it on a low stool I have so that I can try to watch something to distract me while I'm soaking in the tub. If that doesn't work, I will at least take my cell phone in and look up random things on the internet or something. haha. I'm hoping the laptop works out because that will be most distracting. Listening to music won't help me - when I'm in pain, music just makes me feel more angry. Don't know why!!!


What happened with the cream - My family doctor had prescribed hydrocortisone suppositories. I have used these, as needed, on and off over the years, and they have actually been quite effective. Most of the time I only need 1-3 nights of this and the hems calmed down. This time, the doctor prescribed a different strength and dosage. I don't know why. Anyway, I used this and things just did not calm down - at all. After a week, I woke up one morning with terrible, terrible pain in the anal area. Then they prescribed Nystatin and that made it raw and excrutiating. I didn't realize the Nystatin was making it worse until after a whole day of using it. Then the next day my husband drove me to the doctor and she prescribed Greer's Goo. Went home, put it on, and right away, excrutiating pain. I looked it up, and low and behold, it has Nystatin in it!!! I also did have an internal hem at that point protruding, so that may very well have been part of the pain reaction. I did not know at all about not using creams on an internal hem! Also, the external hem started to get infected and the entire anal area was raw and inflamed from the contact dermatitis. The only thing that helped after that (I found out by experimenting) was using vaseline and a little polymycin ointment.


I also had been taking a blood pressure medication. I experimented with this during that really bad week, and I noticed that when I took the medicine, the hems were horrible that day. When I stopped,they were a little better. My doctor thinks I'm crazy, but I have observed over the years that sometimes medications do make my hems worse. Another medication I had problems with was a birth control pill. I know these are not "normal" side effects of these medications, but I am sensitive to a lot of foods/medications and I do think my reactions are real. I just wish doctors would take me seriously.


I am not looking forward to the 2 weeks post-surgery, but I am looking forward to not having hems anymore. The docs and I also don't know if I had an allergic reaction of some kind to the hydrocortisone suppositories, and that was the mainstay of keeping them under control in the early stages of a flare up all these years. Not sure I can use them anymore or not!

I also want to put this out there, especially for feedback from any females.  I am prone to getting yeast infections. These often spread to my anal area and aggravate the hems.  I have a standing appointment for Boric Acid suppositories that I have to use - they are the only thing that works. I worry a little about getting a yeast infection after surgery from the antibiotics/stress and if this will affect the surgical area. I'm going to try and remember to ask the surgeon about this before surgery if I can, especially to make sure I can use the Boric Acid if needed.  I can tell you, the yeast infections have caused some of the worst symptoms in the hem area that I have had!

Yes, the laptop and I had lots of dates in the tub :)

a) I totally appreciate the idea of taking a written list of questions with me. If nothing else, my husband can use it to ask the dr questions if I'm too out of it!



b) I love the idea of the "hemorrhoidectomy journal" on here. LOL Part of me hesitates because it might scare others, and I don't want to do that. But the other part of me thinks it may help to just have a safe and understanding place to post where others can offer encouragement.



c) It really helps to see you posting "I'm already starting to forget the details." I am looking forward to that day!



I have been saving "fun" websites to my laptop's favorites so I can have something to look at. Some friends from work have also shared fun sites I may want to look at, and I've put them into my favorites list as well. I figure the more sites I have to go look at the better. I do better when I'm distracted as well. I also think comedy will help. I may not laugh but maybe the humor will balance out the pain a little bit.



It is amazing how people at work find out what kind of surgery you are having when you have specifically asked your bosses/close friends not to share it. LOL One positive is that I have had numerous people share stories from their family members that are all glad they had the surgery done. And a few coworkers of mine are suffering from hems, and they appreciate knowing that there is someone else they can talk to. Oh well! It is one of the most common experiences for humankind.