Instructions For All Patients Undergoing Anorectal Surgery

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PREOPERATIVE PREPARATION FOR ANORECTAL SURGERY

PAUL E. SAVOCA, MD, FACS, FASCRS

To diminish risk of bleeding please stop all aspirin; motrin; advil; coumadin; plavix; and all non prescription dietary supplements one (1) week prior to and after the procedure

1. The office may ask you to have blood tests done several days before your procedure. This is important to ensure that everything is optimal for your anesthetic. Occasionally, no blood testing is needed.
2. We ask that you do not eat or drink anything after midnight on the evening prior to your operation. Food or liquid in the stomach may cause problems with the anesthetic or force your surgery to be postponed.
3. We ask that you take two (2) Fleet’s enemas approximately 1 hour before you leave to go to the hospital on the morning of your procedure. This helps clear the rectal area of fecal material and allows for a safer and more comfortable operative procedure. Please read the instructions on the box prior to administering the enemas. Call the office if you have any questions.
4. There are several items available in any drug store which you may find helpful to obtain and have at home for use after surgery:

  • 4×4 gauze or other absorbent pads
  • Stool bulking agent (Benefiber, Metamucil, Fibercon, Citrucel, etc)
  • Stool softener (Colace, Surfak, etc)
  • Any medications for which you were given a prescription

5. Following these recommendations will facilitate the operative procedure and postoperative recovery.
6. Call the office if you have any questions or go to www.paulsavocamd.com

POSTOPERATIVE INSTRUCTIONS FOR PATIENTS UNDERGOING ANORECTAL SURGERY

1. The following prescriptions may be sent home with you:

  • Pain reliever with instructions.
  • Topical ointment (ie, Analpram, Anusol, etc) apply externally after each bath or bowel movement.
  • A cotton dressing may also be applied.
  • You should also purchase Benefiber or other psyllium product (Metamucil, Konsyl, Citrucel,etc.). Take 1 teaspoon twice a day in a large glass of water or juice. Decrease the amount if bloating or excess gas occurs.

2. Postoperative office visits are essential to monitor healing of your incision. Call the office to schedule your first appointment as instructed. This is generally 3 weeks following surgery.
3. Tub baths, comfortably warm, should be taken three times a day for 15 to 20 minutes especially after bowel movements.
4. Some bloody discharge, especially after bowel movements, can be expected. If there is prolonged or profuse bleeding with passage of clots, call the office at once. There may be gelfoam packing which will slough and dissolve on its own.
5. Bowel movements after rectal surgery are usually associated with some discomfort. This will improve as healing occurs. If you have not moved your bowels by the morning of the 4th day following surgery, take 2 Fleets enemas, 1 hour apart (lubricate well with Vaseline and insert gently). If no result, drink one bottle of citrate of magnesia. 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.
6. The use of dry toilet tissue should be avoided. After bowel movements, use wet Kleenex, cotton or Tuck’s pads to clean yourself, or if possible, take a warm tub bath.
7. A regular diet, including plenty of fresh fruit and vegetables, is recommended. Try to drink 6 to 8 glasses of water per day.
8. No strenuous exercise or heavy lifting should be attempted until healing is well underway. Climbing stairs, walking and car driving may be done in moderation. Car driving should be avoided for 7 days.
9. Call for temperature greater than 101 degrees.
10. If unable to urinate – try soaking in warm tub and urinate in the water. If still unable to urinate, call the office.

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

Abscess/fistula Surgery Postop Instructions

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DISCHARGE INSTRUCTIONS AFTER FISTULOTOMY

PAUL E. SAVOCA, MD, FACS, FASCRS

An anal fistula is an abnormal channel or tunnel-like chronic infection that starts inside the anus and ends outside on the skin around the anus. Its development is usually the result of a previous anal infection or abscess. About 50% of people with an anal abscess end up with a fistula. Most fistulas are short and superficial and are best treated by simply opening the entire tunnel and leaving it open to heal in gradually. Occasionally a patient can have a complex fistula with multiple tracts or the tunnel may traverse a considerable amount of the sphincter muscle. For this reason the surgical treatment has to be individualized for each particular patient depending on the location and anatomy of the fistula. Frequently, the surgeon cannot guarantee exactly what will need to be done until the examination that is done under anesthesia at the time of the surgery. It is important to realize that the operative procedure can change depending on what is found at the time of the surgery. At times a fistula will require more than one surgery to cure.

During a simple fistulotomy the tract is opened and left to heal. Sutures are sometimes used to narrow the wound but not close it completely. If it is decided that the fistula is too deep or in a bad position to open it completely, a small drain- called a seton – may be inserted. Your surgeon will explain how this will be managed in the future.

Discharge Instructions:
Following your fistulotomy, you may experience some mild to moderate pain or discomfort in your rectal area. You may also experience constipation, difficulty urinating, and possibly some rectal bleeding. The following are some general guidelines for proper care after your procedure.

Home Care:
A small amount of bleeding is common following rectal surgery. A sanitary napkin or gauze may be worn over the anal opening to keep the underclothing clean. When there is no longer any bleeding or discharge, there is no need to keep the pad in place. If there is prolonged or profuse bleeding with passage of clots, call the office at once.

Difficulty urinating after fistulotomy is unusual, but can occur due to spasm of the urinary sphincter resulting from pain due to the surgery. Getting the pain under control and relaxing the sphincter usually allows for the urine to pass. Take the pain medication you were prescribed and do warm sitz baths – either in a bath tub or sitz basin. While soaking, attempt to relax the bladder and urinate into the water. If you are unable to urinate in the first eight hours after your surgery, notify the doctor’s office. After hours, go to the nearest emergency room or urgent care center. A bladder catheter will be placed and remain in place for 2 days, you may call the office to have the catheter removed. Once you have started to urinate, drink plenty of water and fruit juices (such as prune juice) after your surgery.

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.
  • If you were given a topical ointment, place this over the anal skin and a little into the anal canal 2-3 times a day.
  • 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 3 weeks following surgery, but if a seton was placed the surgeon may want to see you sooner.

Hemorrhoid Surgery Postop Instructions

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Discharge Instructions for Hemorrhoid Surgery

PAUL E. SAVOCA, MD, FACS, FASCRS

You had surgery to remove hemorrhoids (also called a hemorrhoidectomy). Hemorrhoids are swollen (enlarged, dilated) veins inside and outside the anus. Hemorrhoids are usually caused by increased pressure, such as straining when constipated or pressure during pregnancy. Hemorrhoids may cause pain, bleeding, blood clots, and itching. Complete recovery from hemorrhoid surgery typically takes about 4 weeks.

Following your hemorrhoidectomy, you will experience pain or discomfort in your rectal area. You may also experience constipation, difficulty urinating, and possibly some rectal bleeding. The following are some general guidelines for proper care after your procedure.

Home Care
A small amount of bleeding is common following rectal surgery. A sanitary napkin or gauze may be worn over the anal opening to keep the underclothing clean. If there is prolonged or profuse bleeding with passage of clots, call the office at once. In some patients a packing will have been placed in the anus at the end of the surgery. This will dissolve and pass with the first bowel movement.

Difficulty urinating after hemorrhoidectomy is usually due to spasm of the urinary sphincter resulting from pain due to the surgery. Getting the pain under control and relaxing the sphincter usually allows for the urine to pass. Take the pain medication you were prescribed and do warm sitz baths – either in a bath tub or sitz basin. While soaking, attempt to relax the bladder and urinate into the water. If you are unable to urinate in the first eight hours after your surgery, notify the doctor’s office. After hours, go to the nearest emergency room or urgent care center. A bladder catheter will be placed and remain in place for 2 days, you may call the office to have the catheter removed. Once you have started to urinate, drink plenty of water and fruit juices (such as prune juice) after your surgery.

You will be given a prescription for pain medication. Follow the directions given by your doctor for taking this medication. 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. Some people experience drowsiness, dizziness, lightheadedness, or a false sense of well-being after taking these medications. 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 1-2 weeks after your procedure.
  • Ask someone to drive you to appointments until you are able to sit and move comfortably.
  • Take sitz baths (sit for 15-20 minutes in warm water) at least 3 times a day and after each bowel movement.
  • 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.
  • 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 3 weeks following surgery.

Fissure Surgery Postop Instructions

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SPHINCTEROTOMY (Anal Fissure Repair) DISCHARGE INSTRUCTIONS

PAUL E. SAVOCA, MD, FACS, FASCRS

A sphincterotomy is a procedure performed to treat anal fissures. An anal fissure is a split in the lining of the anal canal, possibly resulting from a hard bowel movement. Muscle spasms and subsequent bowel movements prevent healing.

During a sphincterotomy, the outermost part of the internal anal sphincter is cut. This breaks the muscle spasm, improving blood flow to the area of the fissure, resulting in relief of pain and healing of the fissure.

Discharge instructions

Following your sphincterotomy, you may experience some mild to moderate pain or discomfort in your rectal area. You may also experience constipation, difficulty urinating, and possibly some rectal bleeding. The following are some general guidelines for proper care after your procedure.

Home Care

A small amount of bleeding is common following rectal surgery. A sanitary napkin or gauze may be worn over the anal opening to keep the underclothing clean. When there is no longer any bleeding or discharge, there is no need to keep the pad in place. If there is prolonged or profuse bleeding with passage of clots, call the office at once.

Difficulty urinating after sphincterotomy is unusual but can occur due to spasm of the urinary sphincter resulting from pain due to the surgery. Getting the pain under control and relaxing the sphincter usually allows for the urine to pass. Take the pain medication you were prescribed and do warm sitz baths – either in a bath tub or sitz basin. While soaking, attempt to relax the bladder and urinate into the water. If you are unable to urinate in the first eight hours after your surgery, notify the doctor’s office. After hours, go to the nearest emergency room or urgent care center. A bladder catheter will be placed and remain in place for 2 days, you may call the office to have the catheter removed. Once you have started to urinate, drink plenty of water and fruit juices (such as prune juice) after your surgery.

Some patients have less pain after the surgery than they had prior to the surgery, but this is difficult to predict. 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 Appointment a follow-up appointment as directed by our staff. The first follow up is usually 3 weeks following surgery.

Pilonidal Surgery Postop Instructions

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Discharge Instructions for Pilonidal Cystectomy

PAUL E. SAVOCA, MD, FACS, FASCRS

You have had a pilonidal cyst removed. Depending on the surgeon’s preference, the incision may be down the middle of the buttock crease or off to the side an inch or so. There may be some stitches placed as well. In most cases the majority of the wound is left open to heal in gradually. Caring for this open wound properly is essential for wound healing and to decrease recurrence of the cyst. Because of the difficulty seeing the wound, it is best to have assistance from a spouse, parent or sympathetic friend in changing the dressing.

  • You will be given a prescription for pain medication. Follow the directions given by your doctor for taking this medication. 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, consult your physician.
  • 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 prescription pain medications. 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.
  • Don’t drive while you are taking narcotic pain medication.
  • Don’t lift anything heavier than 15 pounds until your doctor says it’s okay.
  • Don’t mow the lawn, use a vacuum cleaner, or do other strenuous activities until your doctor says it’s okay.
  • You may walk indoors, outdoors, up and down stairs.
  • Expect to be off from work/school for at least one to two weeks following this surgery. Your surgeon will give you more guidance on return to normal activities.
  • Avoid constipation:
    • Eat fruits, vegetables, and whole grains.
    • Drink 6–8 glasses of water a day, unless otherwise instructed.
    • Use a fiber supplement and a stool softener twice a day. This is particularly true while taking narcotic pain medications.

Wound Care: For comfort take pain medication prior to dressing change.
The basic principle is to shower the wound twice a day and reinsert a fresh gauze in the wound after each shower.

  • Leave the dressing from surgery in place until the day after surgery.
  • The morning after surgery, remove the tape and outer dressing from the wound, getting in the shower and allow the rest of the dressing that is packed in the wound to be soaked with water and then pull it out. Unfortunately, this does hurt a bit.
  • When the dressing is removed, you may see a small amount of bleeding. This is normal.
  • Vigorously irrigate your wound in the shower for 5-10 minutes, using a hand-held shower head, it you have one. Aim showerhead directly at the wound. Bending forward helps open the wound. Let the water clean the area thoroughly.
  • Wrap a thin, clean wash cloth or 4×4 plain cotton gauze around your finger and clean gently, but thoroughly, the inner surface of the wound, removing any surface covering to expose clean, healthy pink tissue. Don’t scrub.
  • After shower, pat the skin around the wound edges dry.
  • The repacking of the wound is what usually requires help from another person. Wash hands. You may use gloves, but this is not necessary.
  • Moisten a fresh 4×4 inch plain cotton gauze with tap water. Squeeze out excess water.(The dressing should be damp, not wet).
  • Pack the wound gently but not tightly with the moist gauze. Use a Q-tip or your finger to ensure that the gauze reaches the bottom of the wound and place it so that all inner wound surfaces are in contact with the moist gauze.
  • Cover with a dry outer dressing and secure with tape or elastic bandage.
  • Dispose of the old dressing in plastic trash bag with twist tie.
  • As your wound heals, it will close from the bottom and sides, and you will need less and less gauze to pack it.
  • Shave the skin at least 2 inches around the wound at least once weekly. Use adhesive tape to pick up loose hair.

Follow up appointments are essential to ensure the wound is healing normally. The doctor will tell you how soon they need to see you back for the first follow up appointment.
When to Call Your Doctor:

Call the office if you have any of the following:

  • Excessive Bleeding
  • Increasing pain
  • Increased redness or drainage of the incision
  • Fever 100.5°F, or higher

Anal Warts (Condyloma) Removal Postop Instructions

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DISCHARGE INSTRUCTIONS AFTER REMOVAL OF CONDYLOMA

PAUL E. SAVOCA, MD, FACS, FASCRS

Anal warts, also known as condyloma, are growths found on the skin around the anus (rectal opening) and sometimes in the anal canal.

Anal warts are caused by the human papilloma virus, which is usually transmitted through sexual contact but not necessarily through anal intercourse. The same type of warts may occur on the penis, scrotum, vagina or labia. The time from exposure to the virus and growth of the warts is commonly from one to six months, but it can be longer. During that time the virus remains in the tissues but is inactive. There are many types of human papilloma virus; some cause warts on the hands and feet and others cause genital and anal warts.
When the warts are just on the outer skin they may be able to be treated with a variety of medications applied in the office or at home. However, once the warts extend into the anal canal they need to be removed surgically. In most cases, a single treatment will not cure anal warts. Close follow-up is critical because the virus may continue to be present and cause new anal warts to form. Even after there are no visible warts, the virus may remain in the tissue. Small warts that reappear are easily treated in the office. Follow-up visits are necessary even after there are no visible warts. Visits may be necessary for up to six months. There is a possibility of serious problems if the warts are left untreated. On rare occasions, these warts can become cancerous, so it is important to keep the follow-up appointments the doctor suggests.

During the operation you have undergone the warts have been removed and the underlying surface has been burned slightly to eradicate the virus in the area.

Home Care

  • A small amount of bleeding is common following rectal surgery. A sanitary napkin or gauze may be worn over the anal opening to keep the underclothing clean. If there is prolonged or profuse bleeding with passage of clots, call the office at once.
  • You will be given a prescription for pain medication. Follow the directions given by your doctor for taking this medication. 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.

  • If you were given a topical ointment place a thin layer over the anal wounds after baths and bowel movements.
  • Avoid strenuous activity for 1-2 weeks after your procedure.
  • Ask someone to drive you to appointments until you are able to sit and move comfortably.
  • Take sitz baths (sit for 15-20 minutes in warm water) at least 3 times a day and after each bowel movement.
  • 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.
  • 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.

Perineal (Trans-anal) Repair Of Rectal Prolapse

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Discharge Instructions for Perineal Repair of Rectal Prolapse

PAUL E. SAVOCA, MD, FACS, FASCRS

You had surgery to remove a rectal prolapse through the anus (this is often referred to as a Delorme or Altmeier Procedure). Complete recovery from hemorrhoid surgery typically takes about 4 weeks. Following your surgery, you will experience pain or discomfort in your rectal area. You may also experience constipation, difficulty urinating, and possibly some rectal bleeding. The following are some general guidelines for proper care after your procedure.

Home Care

  • A small amount of bleeding is common following rectal surgery. A sanitary napkin or gauze may be worn over the anal opening to keep the underclothing clean. If there is prolonged or profuse bleeding with passage of clots, call the office at once. In some patients a packing will have been placed in the anus at the end of the surgery. This will dissolve and pass with the first bowel movement.
  • Difficulty urinating after rectal surgery is usually due to spasm of the urinary sphincter resulting from pain due to the surgery. Getting the pain under control and relaxing the sphincter usually allows for the urine to pass. Take the pain medication you were prescribed and do warm sitz baths – either in a bath tub or sitz basin. While soaking, attempt to relax the bladder and urinate into the water. If you are unable to urinate in the first eight hours after your surgery, notify the doctor’s office. After hours, go to the nearest emergency room or urgent care center. A bladder catheter will be placed and remain in place for 2 days, you may call the office to have the catheter removed. Once you have started to urinate, drink plenty of water and fruit juices (such as prune juice) after your surgery.
  • You will be given a prescription for pain medication. Follow the directions given by your doctor for taking this medication. 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.