Abscess Drainage


Discharge Instructions Following Drainage of Perirectal Abscess

An abscess around the anus develops as a result of an infection in glands within the anal canal. Although this infection usually does not become serious, occasionally it may reach the deeper tissues surrounding the anus. This results in the formation of a painful collection of fluid and pus. An incision and drainage of the infected fluid can relieve this pain. The wound that is made is left open to allow any residual pus to drain. Sometimes a dressing is placed in the wound as well.

Following the drainage of an abscess, there is approximately a 50-50 chance for the further development of a fistula. A fistula is a tunnel beneath the skin that starts at the gland which caused the infection and runs to the area of the abscess and then out onto the anal skin. This causes persistent drainage. A fistula may result in the development of further abscesses in the future. It is therefore imperative that patients follow up with their surgeon following drainage of their abscess.

HOME CARE:

A dressing has been placed over the wound. This should be left in place until you take your first tub bath (sitz bath). This may be in the evening or next morning following your surgery. Your surgeon will tell you the timing. At whichever time you are directed, the outer dressing should be removed. There is usually a dressing in the wound and this should be soaked and then pulled out while sitting in a tub of very warm water. You should then continue to take sitz baths with warm water three times a day for 10-15 minutes.

Your wound may continue to drain a large amount over the next several days as the infection slowly heals. Wear a gauze dressing to the wound to protect your clothing. You may also use a sanitary napkin for further protection of your clothing. You may notice bloody discharge for the next four to seven days.

Patients have much less pain after the surgery than they had prior to the surgery. However, depending on the size of the abscess there may be residual discomfort for a few days. Pain should slowly decrease. After a few days if there is a change in course and pain begins to intensify call the office. You will be given a prescription for pain medication. Follow the directions given by your doctor for taking this medication. After a day or two, if the pain is subsiding try to use just plain Tylenol to ease residual discomfort. To avoid upset stomach, take your pain medication as prescribed with food in your stomach.

Take these drugs exactly as directed. Never take more than the recommended dose, and do not take the drugs more often than directed. If the drugs do not seem to be working, call the office for advice. Do not share these or any other prescription drugs with others because the drug may have a completely different effect on the person for whom it was not prescribed.

Some people experience drowsiness, dizziness, lightheadedness, or a false sense of well-being after taking opioid analgesics. Anyone who takes these drugs should not drive, use machines, or do anything else that might be dangerous until they know how the drug affects them. Nausea and vomiting are common side effects, especially when first beginning to take the medicine. If these symptoms do not go away after the first few doses, check with the physician who prescribed the medicine.

Side effects may include: dizziness, lightheadedness, nausea, sedation, vomiting, if these side effects occur, it may help if you lie down after taking the medication.

  • Avoid strenuous activity for 1 week after your procedure.
  • Take sitz baths (sit for 15-20 minutes in warm water) three times a day and after each bowel movement for the first few days.
  • Don’t worry if you have some bleeding, discharge, or itching during your recovery. This is normal.
  • Avoid constipation.
    • Take Benefiber or other psyllium product (Metamucil, Citrucel, Konsyl, etc) one teaspoon twice a day. Take a stool softener such as Colace or Surfak twice a day as well.
    • If you have not had a bowel movement by the morning of the fourth day following surgery, take 2 fleet enemas, 1 hour apart (lubricate the tip of the enema well with Vaseline and insert gently). If no result, drink one bottle of citrate of magnesium, which can be purchased at any pharmacy. Following the first bowel movement, you should have a bowel movement at least every other day. If 2 days pass without a bowel movement, take an ounce of milk of magnesia. Repeat in 6 hours if no result.
    • The use of dry toilet tissue should be avoided. After bowel movements use a wet Kleenex, cotton or Tuck’s pads to clean yourself, or if possible, take a warm bath.
    • If you were given a prescription for an ointment, apply this two or three times a day at the edge of the anal opening.
  • Eat a regular diet including plenty of fresh fruit and vegetables. Drink 6-8 glasses of water a day.
  • Call the office if your temperature is greater than 101 degrees. Follow-Up Make a follow-up appointment as directed by our staff. The first follow up is usually 2 weeks following surgery.

From the Clinical Staff to All Surgical Patients:

We are here to help you with any pre-operative and post operative questions you might have. We know this is new to you and any surgery can be frightening. We are here to help you through it.

Please keep the following in mind when you call:

  1. Please leave a short message as to the nature of your call. Someone will usually get back with you as soon as possible. Remember if you are having a life threatening emergency, CALL 911. If you call after 4 PM you will receive a call back shortly after the office opens at 9 AM.
  2. Please call the office where you are seen as that location will have your medical record which will make it much easier to answer any medical questions that you have.
  3. Medication refills: Please allow 48 hours for refills. Make sure you leave the following information:
    • YOUR NAME – WITH SPELLING DATE OF BIRTH YOUR BEST CONTACT TELEPHONE NUMBER THE PHARMACY TELEPHONE NUMBER (VERIFY THAT IT IS OPEN) THE NAME OF THE MEDICATION FOR REFILL

Thrombosed Hemorrhoid Removal


Instructions Following Removal of Thrombosed External Hemorrhoids or Anal Skin Tags

1. A thrombosed hemorrhoid is the rupture of a varicose vein on the outside of the anus with accumulation of blood beneath the skin. What has been done today is removal of the clot and the skin over it in order to drain it and prevent recurrence.
2. A simple dressing has been placed over the wound. Remove it after arriving home just prior to soaking in a warm bath.
3. No strenuous exercise should be performed for the next 24-48 hours to prevent bleeding
4. There will be pain when the local anesthetic wears off. Tylenol, anesthetic ointment and warm tub baths will usually treat this. If they do not, fill the prescription you were given.
5. It will take approximately 10-14 days for the skin to heal. Do not be alarmed if minor bleeding discharge or itching occurs, this is normal.
6. Eat a fiber rich diet and drink 6 to 8 glasses of water every day to avoid constipation. You may also use a bulking agent such as metamucil if desired.
7. Anal hygiene is important. Wash or sit in the tub after bowel movements and gently cleanse the area with a wet wipe or moistened cotton. Anesthetic ointment or vaseline may be applied after bowel movements if desired.

CONTACT THE OFFICE IF:

  • You have pain that is not controlled with your prescription.
  • You are unable to urinate
  • You have continuous bleeding with passage of clots.
  • You have temperature above 101° F

Hemorrhoid Banding


Hemorrhoid Banding

  1. Hemorrhoids
    These are veins in the anus and lower rectum that become enlarged. The most common symptoms are rectal bleeding, itching, and sometimes pain. Hemorrhoids might come out with straining or having a bowel movement, and they can sometimes be pushed back in. There are internal and external hemorrhoids. Only internal hemorrhoids can be treated with banding. In this procedure, a rubber band is placed around the hemorrhoid tissue, strangulating the hemorrhoid which then falls off.
  2. After Each Treatment
    You may feel a dull ache for 36-48 hours following your treatment. The feeling may be noted as soon as the band is applied. The band may make you feel as if you need to have a bowel movement. Try not to move you bowels for two hours after the procedure to avoid pushing the band off the hemorrhoid. In 24-48 hours, the hemorrhoid caught in the rubber band will be completely destroyed. For discomfort, most people require tylenol, some require mild narcotics . Taking warm baths for 15-20 minutes will usually relieve the discomfort. If discomfort is severe or if there is fever of 101 degrees or more and there is difficulty urinating call the doctor immediately.
  3. Diet
    No special diet is necessary. It is important to keep your bowel movements soft and regular. Metamucil or similar fiber supplement should be taken once or twice a day. If necessary a stool softener can also be used.
  4. Activity
    You may continue your normal physical activities. You will be able to drive your car immediately after the treatment.
  5. Precautions
    The hemorrhoid will usually drop off within one week. You will usually not know this except occasionally some bleeding will occur at this time. Call the office should continuous bleeding with passage of clots should occur. It is important to remember that 2-4 treatments are usually required and that bleeding and protrusion can persist until all hemorrhoids have been treated. Swelling of the external skin can sometimes occur after the procedure, warm baths and hydrocortisone ointment can help this. If the swelling persists and the pain is intense, call the office.
  6. Follow-Up Treatment
    Generally, 2-4 treatments are required to eradicate all internal hemorrhoids. One treatment only is given at a time to minimize pain and complications.
  • SEEK IMMEDIATE MEDICAL CARE IF
  • There is intense pain with inability to urinate
  • Fever greater than 100.5°F (38.1 ° C).
  • Bleeding that does not stop

Infrared Hemorrhoid Treatment


After Procedure Instructions

This method of hemorrhoid treatment is the application of heat to the tissue surrounding the hemorrhoid veins causing coagulation or clotting of these veins and reduction in the swelling of these tissues.
After the treatment

Some mild discomfort may be experienced after the procedure. It should resolve within 48 hours. Usually no pain medication is required but if necessary warm baths and/or plain tylenol will suffice. If the pain is severe or associated with fever of 101 degrees or more, contact the office.

Some mild bleeding may be experienced for several days following the procedure. Avoid aspirin, ibuprofen, coumadin, plavix or other blood thinners or vitamins and supplements such as vitamin E. If continuous bleeding or passage of clots occurs, Go to the nearest emergency room immediately.

Avoid strenuous activity for 24-48 hours after treatment

Infection after IRC is rare but if sever pain and fever occur, contact the office

Eating a high fiber diet and plenty of fluids will avoid constipation which can increase pain after the procedure.

IRC is an effective treatment of hemorrhoids but commonly multiple applications are required during follow-up visits to eradicate the bleeding.

Pruritis Ani (anal itching) Treatment


Anal Pruritis

Anal pruritis (itching) is often due to increased moisture of the skin around the anus. This results in itching and scratching. This causes further skin damage. Hemorrhoids, infections, and other anal diseases may lead to itching. There may be no clear cause. Poor local hygiene will usually cause itching. Perfumed soaps and sprays can also lead to anal irritation. Dietary factors such as caffeine (coffee, black teas, colas), beer, milk products, chocolate, nuts, citrus fruits, tomatoes, spicy seasonings, jalapeno peppers and salsa may cause problems. In many cases no specific underlying cause can be identified.

The following is a list of DO’s and Don’t’s to help relieve anal itching

DO’s:
DO use plain white Kleenex or a moist cotton washcloth to wipe after bowel movements DO take warm tub baths 2-3 times daily especially after bowel movements
DO place several cotton balls gently between the buttocks to absorb excess moisture especially if ou perspire.
DO use bulk: 100% bran (up to 1/3 cup daily), whole grains or metamucil (1 teaspoon in a glass of water or juice twice daily). Decrease your fiber intake if you become bloated or have excess gas.
Do watch your diet and eliminate foods that seem to make the condition worse.
DO take medications as prescribed
DO wear all-cotton underwear
DO return to the office as scheduled

DON’TS
DON’T scratch or rub the anal area, wipe gently or pat dry.
DON’T use scented, colored or floral pattern toilet tissue
DON’T use harsh or scented soaps
DON’T use cleansing pads containing alcohol, avoid wet wipes in general
DON’T drink coffee, tea, alcoholic beverages or cola
DON’T eat spices, peppers, tomatoes or nuts. When your symptoms improve you may be able to resume eating some of these foods.

REMEMBER: Itching will not stop immediately,have patience

The following is a good barrier cream to be used at night in those suffering from pruritis

BUTT PASTE RECIPE
1 oz DESITIN OINTMENT
1 oz ZINC OXIDE OINTMENT
3 oz BETADINE OINTMENT
15 gm A&D OINTMENT
MIX TOGETHER IS A SEALED CONTAINER.

GOOD FOR 60 DAYS

Anal Fissure Treatment (non surgical)


Anal Fissure

An anal fissure often begins with sharp pain. This is usually following a bowel movement. It often causes bright red blood stained stools. It is the most common cause of rectal bleeding. One common cause of this is passage of a large, hard stool. It can also be caused by having frequent diarrheal stools. Anal fissures that occur for a longtime (chronic) may require surgery.

CAUSES

  • Passing large, hard stools.
  • Frequent diarrheal stools.
  • Constipation.

SYMPTOMS

  • Bright red, blood stained stools.
  • Rectal bleeding.

HOME CARE INSTRUCTIONS

  • If constipation is the cause of the rectal fissure, it may be necessary to add a bulk-forming laxative. A diet high in fruits, whole grains, and vegetables will also help.
  • Take warm sitz baths for 15 minutes 4 times per day may.
  • Increase your fluid intake.
  • Only take over-the-counter or prescription medicines for pain, discomfort, or fever as directed by your caregiver. Do not take aspirin as this may increase the tendency for bleeding.
  • Avoid constipating foods such as bananas and cheese.
  • Using medications prescribed by your physician results in healing in most cases within 4-6 weeks. If medical treatment is unsuccessful and/or pain is debilitating, outpatient surgery to be required.

SEEK MEDICAL CARE IF:

Rectal bleeding continues, changes in intensity, or becomes more severe.

MAKE SURE YOU:

  • Understand these instructions.
  • Will watch your condition.
  • Will get help right away if you are not doing well or get worse.

Pelvic Floor Testing


Patient Instructions for Anorectal Physiology (ARP) Testing

Preparation for the Procedure

ENEMA PREP

  1. We ask that you take two (2) Fleet’s enemas before you leave to go to the office on the day of your procedure. These are available in any pharmacy. You should use the Fleet’s saline enema in the green box or the generic equivalent not the oil enema in the orange box. This helps clear the rectal area of fecal material and allows for a safer and more comfortable procedure.
  2. Please take the first enema two (2) hours prior to leaving the house and the second enema one (1) hour prior to leaving the house. Please read the instructions on the box prior to administering the enemas for safe and correct use. If done incorrectly the procedure may need to be repeated and require repeating the prep.
  3. Call the office if you have any questions.

ARP testing consists of several tests some or all of which may be recommended by your physician depending on your symptoms.

Anal Manometry
Anal manometry is performed to evaluate patients with constipation and/or fecal incontinence. Anal manometry measures pressures of the anal sphincter muscles and the sensation in the rectum. The test takes approximately 30 minutes. A nurse will review the procedure with you, take a brief health history and answer any questions you may have. The person then lies on his left side. A small, flexible tube, about the size of a thermometer, is inserted into the rectum.. During the test the nurse asks the person to squeeze or relax the anal muscle. The anal sphincter muscle pressures are measured during each of these maneuvers. To squeeze, the person tightens the sphincter muscles as if trying to prevent anything from coming out. The doctor may perform two other tests. First, an anal EMG which is a test to evaluate the nerve supply to the anal muscle. In addition an ultrasound of the anal sphincter may be performed. After the examination, you may drive yourself home, eat and go about your normal activities.

Anal Sphincter EMG (Electromyography)
EMG measures the electrical activity in the pelvic floor (puborectalis) muscle. In constipated patients, an EMG is performed using postage stamp sized skin sensor applied near the anal opening. The patient relaxes squeezes and pushes. A computer records sphincter muscle electrical activity. Anal sphincter electromyography confirms the proper muscle contractions during squeeze and muscle relaxation during push. In people with non-relaxing puborectalis, the tracing of electrical activity gets bigger, instead of smaller, during a push. Normal anal EMG activity with low anal squeeze pressures on manometry may indicate a torn sphincter muscle that could be repaired.

In incontinent patients, the nerve that controls the sphincter muscle may have been damaged. In order to test for this, a fine sensor attached to the tip of the gloved examining finger of the physician is inserted into the anal canal. A gentle electrical impulse is delivered which most patients cannot feel. The time it takes for the muscle to respond is recorded and the procedure repeated on the other side.

Rectal Ultrasound
This painless exam involves inserting a small probe into the anal canal and using sound waves, a picture of the anal sphincter is generated. This reveals any potential abnormalities or injury in the muscle.

Risks:
Anorectal manometry is a safe, low risk procedure and is unlikely to cause any pain. Complications can occur, but are rare: it is possible that a perforation (tearing) or bleeding of the intestinal wall could occur. Equipment failure is extremely unlikely, but does remain a remote possibility.