Archive for: Office Procedure Instructions

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

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

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