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Hemorrhoids are swollen veins inside or outside the anus.  They may be caused by increased pressure, such as straining when having a bowel movement or pregnancy.  Hemorrhoids can cause pain, bleeding, clots, and itching.

Buy these a few days before surgery:

  • 1 bottle Magnesium Citrate – 10 oz.

  • 2 sodium phosphate enemas

The Day before Surgery

  • Eat a light breakfast and lunch.  Avoid greasy foods and red meat. 

  • Drink only clear liquids (no pulp, no dairy) after lunch.

    • Water, sparkling water, soda

    • Broth

    • Juice with no pulp (apple, grape)

    • Popsicles- no fruit fiber

    • Gatorade G3 Recover® /silver label Bottle only (+ protein)

    • Jell-O®(no fruit in it) NO Jell-O® cups

    • Coffee or tea, no creamer

    • Gatorade®

    • Crystal Light®

    • Ensure® Active Clear

After lunch, do not eat food; do not drink juice with pulp, dairy products, or alcohol.

_____  2:00 pm drink magnesium citrate 1 bottle.  It is okay to drink this earlier. Drink this once you are home to stay for the day. It tastes best if chilled.  Magnesium citrate may give you loose stools and some cramping.  It could take 30 minutes to 8 hours for results. You may have bowel movements for hours after drinking it.

_____  You may want to give yourself the first of two enemas this evening. Take the second one in the morning, 1 hour before you leave for the   hospital. See below. 

_____   Shower before bed and in the morning              before leaving home.

The day before surgery, clear liquids only after lunch. Nothing to drink the last 4 hours before surgery.  

The Day of Surgery

_____  1½ hours before you leave home, give yourself the first enema. Give yourself the second enema ½ hour later.  Shower. 

After Surgery

Rectal Care

Take a sitz bath at least three to four times a day and after each bowel movement (BM) for several days.  This can be done in two ways.  Sit in bathtub filled with 3-5 inches of warm water. Add nothing to the water. Relax for at least 10-20 minutes. OR you can use a plastic tub that you place on your toilet. Sitz baths help you heal, and lessen the pain of rectal spasms. For comfort, you may want to sit on a towel in your bathtub. Avoid toilet paper. Instead clean the area after a BM by spraying with warm water. We will give you a spray bottle or you may want to use a hand held shower.  Gently pat dry with a baby wipe, (free of perfume, dyes and alcohol).  

You will have yellow-red drainage for at least 7-14 days.  Expect to wear pads (free of perfume and dyes) in (cotton) underwear (best to use fragrance and dye free detergent) to monitor drainage. Change pads every 4 hours or as needed to limit wetness and to help prevent itching in this area. You may see more bloody drainage with increased activity and BMs.  You may have swelling at the anus with tissue protruding from anus.  You may also have lump or skin tags develop around the anus.  This is your body’s reaction to the incisions made at surgery. These lumps will shrink as recovery occurs.  

Activity

  • Plan for rest during the day.  Expect to be up and around doing light duties each day to keep up your strength. 

  • Chang position often for comfort.

  • Do not drive while taking narcotic pain pills.

  • Sex may be resumed when it is okayed by your doctor.

  • Check with your doctor before you return to work.  Your recovery time may be longer if your job involves lifting or sitting.

Pain 

After surgery, you will have pain.  With banding, expect to have rectal pressure. At first, you will feel numb in your rectal area. You may be able to get home with no narcotic pain pills.  Once you are home, you may want to take a dose of pain pills before you lay down for your nap. You do not want pain to wake you up. If it does you may have waited too long. You will need to take your narcotic pain pills before you have pain and schedule them for at least the first 1-2 days.  

The person staying with you overnight will need to set an alarm and check on you during the night. It is very important that the pain does not wake you up. Schedule your pain pills. Always take them with a small snack. Stay ahead of the pain for the first few days. On the pain scale 0-10, 10 is the worst, expect that your pain will be at 5-6 out of 10. This is a reasonable pain goal. Do not drink alcohol, drive a car, or use heavy machines while you are taking pain pills.

This is a common course of pain after this surgery: 

  • The first 5 days you will have a lot of pain.

  • Expect to have pain with your first BM. Do not hold off on having a BM. Follow the urge to go when you feel it. 

  • If you had banding, the bands fall off day 3-10.  Expect that you will bleed and have more pain.  You may need narcotic pain pills again.

  • If you have stitches, they dissolve in 10-14 days.  You will bleed and have more pain.  You may need narcotic pain pills again.

  • After 5 days you may have less pain.  It is normal to see blood on your stool for weeks after surgery.

Avoid Constipation

Buy the stool softener, docusate sodium.  Take at least 2 each day. Take these as long as you use the narcotic pain pills and until you have your first BM. This will help stool pass more easily.  Follow package directions. 

Buy a bulk fiber laxative, such as Metamucil®. If taken every day, it can prevent hard stools. Take it at least once a day, at the same time every day. Follow package directions.  Do not start until after you have had your first bowel movement.  

Drink at least 8 glasses (8 ounces each) of fluid each day to stay well hydrated. This helps you heal faster, helps your pain pills work better and can help prevent constipation. Drink enough fluid so that the color of your urine is light yellow or clear. 

Diet 

You may want to eat a soft or liquid diet until you have your first BM.  Once you have your first bowel movement, you may want to add other foods to your diet.   Avoid spicy and acidic foods as you heal. 

When to Call the Doctor

  • Large amounts of bright red blood from the rectal area that does not stop with firm pressure to the rectal area for 10 minutes

  • Temperature greater than 100.4° F,  take your temperature daily for one week

  • Foul-smelling drainage

  • Excess swelling in the rectal area

  • Problems passing urine

Phone Numbers

Digestive Health Center: (608) 890-5000.

After hours, weekends or holidays this number will be answered by the paging operator.  Ask for the doctor on call or ask for Dr. Harms, Heise, Kennedy, Foley or Carchman.  Leave your name and phone number with area code. The doctor will call you back.

If you live out of the area, call (855) 342-9900.