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