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Sorry for the long post! After yeas of dealing with hemorrhoids (mostly internal, stage 2 at worst) I started to look at options for getting them fixed. I went online and read about all the options and finally settled on THD. as someone who only had a few instances of extreme hemorrhoid pain over the years, I was more looking for a quick fix to eliminate the need for constant use of creams and wet-wipes after a BM. I was in constant fear of running out of or forgetting my prep h at home and suffering with the soreness and blood the rest of the day. I found a surgeon who does THD in my area, scheduled a week off work and went under the knife on Wednesday (7/10) first thing in the morning. When I came out of surgery, I was in agony. I was expecting moderate discomfort but was under the impression that pain wasn't a part of THD. The nurses and I quickly realized that the spinal had worn off extremely fast (I was able to stand and walk within 5 minutes of coming out of the general anesthesia...) and I started begging for pain medicine. I was given a Norco tablet, but was refused IV narcotics due to the anesthesia. I was eventually given some IV Toradol and between that and the Norco kicking in I started to get the pain under control. It took me several hours to be able to urinate despite a full bag of lactated ringer's and three large glasses to drink. Once I was finally able to urinate I was discharged with a script for Norco 10/325 and told to eat high fiber foods and take a stool softener 3x daily. I got home and napped for a bit, and went to CVS to get my pain pills. I picked up a fiber drink mix and a bottle of non-stimulant stool softeners and went back home. I started on alieve and continued the Norco. At times I had to double up 20mg at a time do deal with the pain. I've been doing the psylum husk and stool softeners 3x daily since then. I was told id be back to normal in no time, and I could resume a normal diet as long as I kept up with the fiber and stool softeners. I would have restricted myself to clear liquids if only I had known.... The next day was pretty good. I was very active, pain under control, and was able to help move from my old apartment to my new one. My family did most of the work but I was able to walk freely. Every four-six hours I would start to get some discomfort ... But a sitz bath and some prep h had me right as rain for several hours. Day 3 was pretty much the same, I was thinking man this THD is all they say and more! I was able to snap a few pics of my anus and it was tight and clean! Just like it is supposed to look like! I was very excited. Sometime after dinner I had the urge to defecate. I spent a couple hours on the toilet and in the sitz bath... Producing only blood and mucus. The pain was unbearable. I was sweating, crying, panting, light headed and bleeding profusely. I came close to blacking out several times. Eventually I forced my body to stop trying by wadding up some paper towel and placing it over my anus, and sitting on it for a while. The pressure caused the urge to defecate to pass, and I did my final fiber/stool softener stop for the night and added a full dose of miralax to it. I went to sleep. this morning, I awoke with the urge, and immediately took 2x Norco and my alieve. I waited as long as I could before getting on the toilet, hoping for the pain meds to kick in. I spent another three hours screaming and crying, only producing two lumps of feces the size of a small grape. I stopped the BM in the same way as last night. I administered a fleet enema, and was still unable to pass anything bigger than a grape. after I recovered from that I tried a glycerin suppository, which I held for about 15 minutes. I passed the remainder or the suppository but minimal stool. I called the answering service for the doctor, and to my surprise I received a call from the surgeon himself a short time later. We talked for a bit, and he told me I could go to the ER if i felt it was necessary, but it is normal to have difficulty passing stool after hemorrhoid surgery and to try to be patient. He called in a refill for my Norco (120 pills with a refill, thank god I appreciated that he took care of me and trusted I wasn't trying to scam pain meds!!) and also, at my suggestion gave me a small script for xanax .5mg 10 pills. I've read on here that the anxiety and anticipation of the pain makes it harder to go, and also that the xanax helps to relax the sphincter. My mom filled those scripts for me, and as she was leaving I felt the urge. I ran to the bathroom and popped a xanax. I struggled for a half hour, again only blood, and hit another xanax. After sobbing and screaming, I stopped the BM with the paper trick and went to the ER. the ER doctor examined my rectum digitally, and stated my stools were soft. The exam hurt excruciatingly. I was given a tube of 5% lidocane and instructed to administer a generous helping 15 minutes before trying to pass stool. I made one more attempt at the ER before being discharged, and while the pain was lessened somewhat I was still unable to pass stool. I gave up after about 15 minutes. There was much much more blood this time, either from the lidocane or the digital exam. I had one more hour or so attempt after I got home and I've been sitting here the last few hours. The area around my anus was beginning get raw and bleed itself, so I've called it quits. Every hour or so I get overcome with the urge to run to the bathroom, but I sit very still, breathe slowly, and suppress it. I'm at my wits end. The stool is soft, why can't I pass it? I should note I've even tried going in the sitz bath and have been unable to. Tried squatting and going on the floor. I just need a break from the pain. I'm hoping I can sleep and try again in the morning. I've gone to a fruit and soft food diet (yogurt, soup, etc).... Although the thought of eating anything and adding to my bowels is terrifying. -Evan

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Well, I woke up and the urge hit. I ran and slammed my 20mg of Norco, a .5mg xanax, and an alieve. I went to the bathroom, and to my surprise was able to hold the urge pretty well. Noticed for the first time since the surgery my underwear were soiled overnight, even though I cleaned up with a sits bath before bed. I applied some lidocane to the diaper rash, and when that settled down I was able to administer two good sized doses to the anal canal.

 

 

 I'm currently sitting, holding it in trying to make sure the lidocane kicks in, and then I'm going to go in there and drop some nukes in the toilet! Positive attitude, right??  Will report back!

 

- Evan

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OP back. It took a couple more days, and another trip to the ER (who investigated much more thoroughly) but nature eventually took its course. I can honestly say once it came it wasn't as bad as I had feared. The pain is visceral... but once feces started moving the knowledge that the ordeal was nearly over made it less intense. I've had several BMs today, and while all were painful, being able to "go" is definitely relief in and of itself. The worst of it now is a very painful rash I've developed from all the moisture down there. The surgeon took a look today and reassured me it isn't a new hemorrhoid or fissure, just a rash. I'm trying some hydrocortisone ointment on it now. I'm on the road to recovery, I hope! To everyone going through this: be patient, your body will "work things out" on its own and the memory of straining on the toilet will be a distant memory once you hear the first "splash!"
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Op can we get an update?
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Hey, it's the OP here. I'm sorry for not keeping everyone updated -- but I figure I'll record what happened for posterity and hopefully help others in the process.

After the events above, I continued to have somewhat painful BMs for the next couple weeks.  However, every so often, I would have bouts of extreme constipation and the resulting BM would be very bad -- almost taking me back to square one pain wise.

Eventually I learned that the healing process had changed the shape of my anus -- My stools, when they were soft, would come out in the shape of a ribbon.  If they were more of a normal consistency they would be difficult to pass, causing pain and bleeding, but coming out round.  Usually the first stool would be round and hard, and then I'd have 'normal' ribbon shaped stools after that.

After a few months, my rectum had stretched out sufficiently that I was having regular round stools pretty much all the time, with minimal pain.

-- However --

The process of all the difficult BMs over a period of three months had left me with three new external hemorrhoids, and at least one internal.  I was worse than I had ever been, even before the surgery.  I was entirely dependent on prep-h and witch hazel wipes to function as a human, and had to apply it after each and every BM -- no exceptions.   After a month or so of that, the skin around my anus started to break down, and I developed 10-15 "sores/ulcers" from skin that was continually saturated with moisture.  This necessitated more cream to dull the pain.  Vicious cycle sort of thing.

I made an appointment to follow up with my surgeon, and started using my own special blend of butt-cream, that I created a long time ago to improve my hems before a vacation.  Not for long term use, but, helpful:

  1. prep-h (pain relief kind)
  2. antibacterial ointment (neosoporin)
  3. anti-fungal ointment (azole-based)
  4. hydro-cortisone cream
  5. zinc-oxide based diaper rash ointment

If you decide to use that -- be extremely careful with it.  Prolonged use of steroid creams on the skin causes it to thin -- and this will greatly exasperate your issues.  Use for a few days, max.

My sores had already cleared considerably by the time I saw the surgeon -- he was amazed at the before and after (I showed him a picture I had taken two days before).  Based on my history, we decided to do a repeat surgery scheduled for yesterday.  We given that there had already been one THD attempt -- I told the doctor that if he didn't find Doppler signals to correspond to the new hems to go ahead and excise them with a traditional surgery.

Since I knew what to expect -- I did some things differently:

  1. Complete colon cleanse with SUPREP vs the Fleet Enemas we had used before hand.
  2. Clear liquid diet two days before the surgery.
  3. Stool softeners two days before the surgery.
  4. Fiber, pain pills, stool softener, water all on hand
  5. No activity right after surgery
  6. before I went under, I requested an IV of torodol (high-power NSAID) be on hand when I was woken 'just in case'
  7. Started Alieve (NSAID) the night I came home to help reduce swelling.  This is tricky because it can worsen bleeding -- but I decided I'd rather have bleeding than swelling.  Definately discuss this with your doctor if you decide to do it.  My research seemed to indicate that Alieve was the least likely of the NSAIDs to cause bleeding.

My after surgery experience was much better.  Just like before, the spinal was already worn off when I woke up from the general -- the doctor actually had to bring me out of the general while I was still in surgery because my blood pressure was too low. I could feel my doctor moving the THD device around for the last 5-10 minutes of the surgery.  I was starting to feel pain towards the end so I asked my anesthesiologist to administer the torodol.  Thank god I made sure it was on hand, because with my low blood pressure, narcotics were out of the picture.  Honestly, that shot made all the difference.  I was "in pain" but it was more of a discomfort than excruciating pain.  The doctor found three additional Doppler signals and didn't end up excising any hems.  He did suture one of them up inside the rectum.

When I came home, I started on the fiber supplements, Alieve, and slamming water like it was my day job.  To be honest, I had planned on avoiding solid food for a couple days -- but since already hadn't eaten in two and a half days -- I couldn't help it.  I had a bowl of Chicken Noodle soup and a footlong subway (on wheat of course).  I have to say, that was the best subway I've ever had, even though I had to leave the bananas peppers off (for obvious reasons).  I went to bed (that was last night).

This morning my cat woke me up at about 4AM wanting food.  I realized that in my rush to get prepared for the post-op recovery, I had forgotten to buy cat food... so I had to make a trip to walmart.  I was hungry so I ended up getting an Egg-White-Delight from McDonalds (5g of fiber at least) and took it with a helping of fiber.  With lunch I took 4 fiber pills with senna extract that my doctor had given me.  I continued slamming water like it was my job.

I have to say that knowing my bowels were COMPLETELY empty from the SUPREP was an amazing relief.  Knowing that the feeling of needing to go was just pressure from swelling makes it a lot easier to ignore.  Spending time on the toilet trying to push out stool that isn't there didn't help last time.  That made what happened next even more surprising:

About six hours after lunch -- when I took those senna laced fiber pills -- I had a very small BM.  It was very soft and just slid out with no pushing.  I've actually had two more, slightly larger BMs since.  I'm not sure if it was the additional fiber or the senna laxative -- but it was amazing.  I'm planning on taking the other set of fiber pills from the sample my doctor gave me tomorrow at lunch.I can't say that this is a good idea for everyone -- I hesitated taking a stimulant laxative.  Also keep in mind that this round of THD was a lot less invasive than the last one (3 vs 7 arteries, 1 vs 2 hems sutured up).  But if you can get the stool out of you while it is still very soft early in the process -- before you have a bunch of pressure built up -- it makes all the difference IMO.

I'll post back in a few days to let you guys know how it went.  At this point last time I was doing "quite well" also -- I didn't start to go down hill until I had to have a BM.  At least that's behind me this time.

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Well, so far so good.  This time around I'm in a lot more pain.. sitting is difficult and walking is more like a penguin waddle -- but I'm passing stools with regularity.  Actually, today, 4 days post-op I've had 4 decently large BMs separated by about 45 minutes.  So it seems like my system is getting flowing again.  I remember having a day like that last time as well -- although it was much later in the process.

Although this morning I've been feeling like I may have over done the fiber a touch the last 4 days :-p

I had to go to the ER last night because of a Spinal Headache.  Worst pain I can imagine -- but they did a blood patch and I was better within an hour.  Pretty amazing.

- Evan

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Evan, hope you re doing better now...how is everitbingg concerning operation? Tnx for your answer
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