Instructions related to AnoRectal Surgery

 

 

Instructions for before Ano-Rectal Surgery

Your surgery will be cancelled by the anesthesiologist if you eat or drink after midnight before surgery.

You may take your regular medications with a sip of water early in the morning.

You may brush your teeth and gargle the morning of the surgery.

Do not take any aspirin or blood thinning drugs for 1 week prior to surgery.

Report to the surgery facility at which you have been scheduled about 1 hour prior to the time of your surgery.  Confirm this time with the day surgery clerk the day before your surgery.

Administer a Fleet (green and white box) enema an hour prior to checking into the day surgery unit.

Void urine just before your surgery.

Bring a friend or relative with you to drive you home after the procedure.

 

Instructions for after Ano-Rectal Surgery

Getting home
On discharge from the day surgery facility, you must be driven home. 

During the surgery a long acting local anesthetic was administered around the anal area; this should keep you comfortable for 4-8 hours.  When you arrive home you may have a light meal and take a nap.  Before the anesthetic wears off take a Percocet tablet to keep you comfortable.  This may be supplemented with an Aleve pill if you are in a lot of pain.  In the evening, sit for 15-20 minutes in a tub of hot water (sitz bath) after taking off the dressings.  Blow dry the anal area, pull a strip of Salon Care cotton rope and place it over the anus between your buttock cheeks.

For the first 24 hours after surgery you may alternate sitz baths with application of cold packs (place crushed ice in a Ziploc bag)

You may notice a residue from the adhesive tape on your buttocks.  This is best removed with nail polish remover (acetone).

Pain
Expect to experience a significant amount of pain after anorectal surgery.  You have been provided with a medication to control this.   Percocet is a very strong pain killer and should be taken one tablet every 6 hours as needed for the first 3-4 days.  Do not exceed 6 pills during a 24 hour period.  It may produce nausea, confusion and constipation. Take an Aleve every 6 hours alond with Percocet if you are in significant discomfort.  Do not take aspirin for 10 days after your surgery as this impairs clotting of blood and may result in serious hemorrhage.

You will find that sitting is your  most uncomfortable position.  Spend most of your time lying on your side or standing.  If you have to sit for a long period you may wish to use a soft pillow.  Do not to use a rubber ring as this pulls the buttocks apart and puts tension on the operated site.
 
Sitz baths
Sit in a tub of hot water for 10-15 minutes after each bowel movement and every 4 hours or as often as convenient.  You will soon find that this is one of the most effective means of relieving pain.

Diet
As far as possible, eat a diet that is high in fiber.  Make sure you drink at least 6 glasses of fluid per day.  Avoid spicy, highly seasoned foods and alcohol as they can produce considerable anal burning.  Avoid dairy products especially cheese as they tend to be constipating. 

Each evening, mix a teaspoon of Konsyl or Hydrocil in a glass of clear juice such as apple or cranberry and drink it as soon as possible.  If allowed to stand this mixture will thicken and be unpleasant to swallow.  Drink a glass of water after you have taken the Konsyl/Hydrocil.

Bowel movements
You should have your first bowel movement within the first 2 days after surgery.  I usually leave a strip of very fine gauze in the rectum and this will pass with the first bowel movement.  Do not hesitate to push or strain during your first bowel movement. Wipe with Sofkins/Diaparene and blow dry if necessary.  For the first few weeks after your operation you may notice impaired control of your anal sphincter.  This will gradually improve as your wounds heal.

If you have not moved your bowels at the end of this period, take 1 bottle (300 cc.) of Mag Citrate along with one or two Dulcolax tablets (available over the counter at your drug store).  This will produce some cramps and result in a bowel movement within 8 hours.  If necessary you may administer a Fleets Mineral Oil enema (also non-prescription) to soften the stools and lubricate their passage.  Call the office if you have not had a bowel movement in spite of these measures.

Voiding urine
You may notice a little difficulty voiding urine at first.  Keep your fluid intake as low as possible until you void urine.  If you are unable to void, take a sitz bath, relax and void into the bath.  Do not be alarmed if your urine has a greenish tinge.  This is from the local anesthetic and will clear in a few hours.

Bleeding
A small amount of blood with bowel movements is not unusual for a few weeks after your surgery.  You may notice an increase in the amount of bleeding about a week after surgery.  This is because the scabs that were produced at the time of surgery are being dissolved by the body and are being replaced by new tissues.  Please call the office if you consider this bleeding excessive.

Drainage
You will notice a greenish- yellow drainage for 3-6 weeks following your surgery.  Use a strip of cotton rope to absorb this drainage and prevent your clothes from being soiled.  Change this every 4 hours.   Prior to applying the cotton rope,  wash the anal area with water or wipe with Sofkins/Diaparene, blow dry if necessary.  Use a kotex pad if the drainage is excessive.

Return to work
This will depend on the nature of your surgery and the amount of pain you are experiencing.  Dr. Aquino will discuss this with you during your first post operative office visit.  He would like to see you in the office about 10 days after your surgery.  Call for an appointment.

Please make sure you have the following kit-
Prescriptions for Percocet 
Over the counter Motrin/Aleve etc.
Salon Care 100% cotton rope from Sally’s Beauty Brands
Konsyl or Hydrocil
Baby wipes