Hemorrhoidectomy
Definition
A hemorrhoidectomy is the surgical removal of a hemorrhoid, which is an enlarged, swollen and inflamed cluster
Purpose
The primary purpose of a hemorrhoidectomy is to relieve the symptoms associated with hemorrhoids that have not responded to more conservative treatments. These symptoms commonly include bleeding and pain. In some cases the hemorrhoid may protrude from the patient's anus. Less commonly, the patient may notice a discharge of mucus or have the feeling that they have not completely emptied the bowel after defecating. Hemorrhoids are usually treated with dietary and medical measures before surgery is recommended because they are not dangerous, and are only rarely a medical emergency. Many people have hemorrhoids that do not produce any symptoms at all.
As of 2003, inpatient hemorrhoidectomies are performed significantly less frequently than they were as recently as the 1970s. In 1974, there were 117 hospital hemorrhoidectomies performed per 100,000 people in the general United States population; this figure declined to 37 per 100,000 by 1987.
Demographics
Hemorrhoids are a fairly common problem among adults in the United States and Canada; it is estimated that ten million people in North America, or about 4% of the adult population, have hemorrhoids. About a third of these people seek medical treatment in an average year; nearly 1.5 million prescriptions are filled annually for medications to relieve the discomfort of hemorrhoids. Most patients with symptomatic hemorrhoids are between the ages of 45 and 65.
Risk factors for the development of symptomatic hemorrhoids include the following:
- hormonal changes associated with pregnancy and childbirth
- normal aging
- not getting enough fiber in the diet
- chronic diarrhea
- anal intercourse
- constipation resulting from medications, dehydration, or other causes
- sitting too long on the toilet
Hemorrhoids are categorized as either external or internal hemorrhoids. External hemorrhoids develop under the skin surrounding the anus; they may cause pain and bleeding when the vein in the hemorrhoid forms a clot. This is known as a thrombosed hemorrhoid. In addition, the piece of skin, known as a skin tag, that is left behind when a thrombosed hemorrhoid heals often causes problems for the patient's hygiene. Internal hemorrhoids develop inside the anus. They can cause pain when they prolapse (fall down toward the outside of the body) and cause the anal sphincter to go into spasm. They may bleed or release mucus that can cause irritation of the skin surrounding the anus. Lastly, internal hemorrhoids may become incarcerated or strangulated.
Description
There are several types of surgical procedures that can reduce hemorrhoids. Most surgical procedures in current use can be performed on an outpatient level or office visit under local anesthesia.
Rubber band ligation is a technique that works well with internal hemorrhoids that protrude outward with bowel movements. A small rubber band is tied over the hemorrhoid, which cuts off the blood supply. The hemorrhoid and the rubber band will fall off within a few days and the wound will usually heal in a period of one to two weeks. The procedure causes mild discomfort and bleeding. Another procedure, sclerotherapy, utilizes a chemical solution that is injected around the blood vessel to shrink the hemorrhoid. A third effective method is infrared coagulation, which uses a special device to shrink hemorrhoidal tissue by heating. Both injection and coagulation techniques can be effectively used to treat bleeding hemorrhoids that do not protrude. Some surgeons use a combination of rubber band ligation, sclerotherapy, and infrared coagulation; this combination has been reported to have a success rate of 90.5%.
Surgical resection (removal) of hemorrhoids is reserved for patients who do not respond to more conservative therapies and who have severe problems with external hemorrhoids or skin tags. Hemorrhoidectomies done with a laser do not appear to yield better results than those done with a scalpel. Both types of surgical resection can be performed with the patient under local anesthesia.
Diagnosis/Preparation
Diagnosis
Most patients with hemorrhoids are diagnosed because they notice blood on their toilet paper or in the toilet bowl after a bowel movement and consult their doctor. It is important for patients to visit the doctor whenever they notice bleeding from the rectum, because it may be a symptom of colorectal cancer or other serious disease of the digestive tract. In addition, such other symptoms in the anorectal region as itching, irritation, and pain may be caused by abscesses, fissures in the skin, bacterial infections, fistulae, and other disorders as well as hemorrhoids. The doctor will perform a digital examination of the patient's rectum in order to rule out these other possible causes.
Following the digital examination, the doctor will use an anoscope or sigmoidoscope in order to view the inside of the rectum and the lower part of the large intestine to check for internal hemorrhoids. The patient may be given a barium enema if the doctor suspects cancer of the colon; otherwise, imaging studies are not routinely performed in diagnosing hemorrhoids. In some cases, a laboratory test called a stool guaiac may be used to detect the presence of blood in stools.
Preparation
Patients who are scheduled for a surgical hemorrhoidectomy are given a sedative intravenously before the procedure. They are also given small-volume saline enemas to cleanse the rectal area and lower part of the large intestine. This preparation provides the surgeon with a clean operating field.
Aftercare
Patients may experience pain after surgery as the anus tightens and relaxes. The doctor may prescribe narcotics to relieve the pain. The patient should take stool softeners and attempt to avoid straining during both defecation and urination. Soaking in a warm bath can be comforting and may provide symptomatic relief. The total recovery period following a surgical hemorrhoidectomy is about two weeks.
Risks
As with other surgeries involving the use of a local anesthetic, risks associated with a hemorrhoidectomy include infection, bleeding, and an allergic reaction to the anesthetic. Risks that are specific to a hemorroidectomy include stenosis (narrowing) of the anus; recurrence of the hemorrhoid; fistula formation; and nonhealing wounds.
Normal results
Hemorrhoidectomies have a high rate of success; most patients have an uncomplicated recovery with no recurrence of the hemorrhoids. Complete recovery is typically expected with a maximum period of two weeks.
Morbidity and mortality rates
Rubber band ligation has a 30–50% recurrence rate within five to 10 years of the procedure whereas surgical resection of hemorrhoids has only a 5% recurrence rate. Well-trained surgeons report complications in fewer than 5% of their patients; these complications may include anal stenosis, recurrence of the hemorrhoid, fistula formation, bleeding, infection, and urinary retention.
Alternatives
Doctors recommend conservative therapies as the first line of treatment for either internal or external hemorrhoids. A nonsurgical treatment protocol generally includes drinking plenty of liquids; eating foods that are rich in fiber; sitting in a plain warm water bath for five to 10 minutes; applying anesthetic creams or witch hazel compresses; and using psyllium or other stool bulking agents. In patients with mild symptoms, these measures will usually decrease swelling and pain in about two to seven days. The amount of fiber in the diet can be increased by eating five servings of fruit and vegetables each day; replacing white bread with whole-grain bread and cereals; and eating raw rather than cooked vegetables.
Resources
BOOKS
"Hemorrhoids." Section 3, Chapter 35 in The Merck Manual of Diagnosis and Therapy , edited by Mark H. Beers, MD, and Robert Berkow, MD. Whitehouse Station, NJ: Merck Research Laboratories, 1999.
PERIODICALS
Accarpio, G., F. Ballari, R. Puglisi, et al. "Outpatient Treatment of Hemorrhoids with a Combined Technique: Results in 7850 Cases." Techniques in Coloproctology 6 (December 2002): 195-196.
Peng, B. C., D. G. Jayne, and Y. H. Ho. "Randomized Trial of Rubber Band Ligation Vs. Stapled Hemorrhoidectomy for Prolapsed Piles." Diseases of the Colon and Rectum 46 (March 2003): 291-297.
Thornton, Scott, MD. "Hemorrhoids." eMedicine , July 16, 2002 [June 29, 2003]. http://www.emedicine.com/med/topic2821.htm .
ORGANIZATIONS
American Gastroenterological Association. 4930 Del Ray Avenue, Bethesda, MD 20814. (301) 654-2055; Fax: (301) 652-3890. http://www.gastro.org .
American Society of Colon and Rectal Surgeons. 85 W. Algonquin Road, Suite 550, Arlington Heights, IL 60005. http://www.fascrs.org .
National Digestive Diseases Information Clearinghouse (NIDDC). 2 Information Way, Bethesda, MD 20892-3570. http://www.niddk.nih.gov .
OTHER
National Digestive Diseases Information Clearinghouse (NDDIC). Hemorrhoids . Bethesda, MD: NDDIC, 2002. NIH Publication No. 02-3021. http://www.niddk.nih.gov/health/digest/pubs/hems/hemords.htm .
Laith Farid Gulli, M.D.,M.S.
Bilal Nasser, M.D.,M.S.
Nicole Mallory, M.S.,PA-C
WHO PERFORMS THE PROCEDURE AND WHERE IS IT PERFORMED?
A board certified general surgeon who has completed one additional year of advanced training in colon and rectal surgery performs the procedure. Specialists typically pass a board certification examination in the diagnosis and surgical treatment of diseases in the colon and rectum, and are certified by the American Board of Colon and Rectal Surgeons. Most hemorrhoidectomies can be performed in the surgeon's office, an outpatient clinic, or an ambulatory surgery center.
QUESTIONS TO ASK THE DOCTOR
- How many of your patients recover from hemorrhoids without undergoing surgery?
- How many hemorrhoidectomies have you performed?
- How many of your patients have reported complications from surgical resection of their hemorrhoids?
- What are the chances that the hemorrhoids will recur?
GOOD LUCK!!
Main recurrence off pain is from BMs (of course) but the pain meds (mine is Percocet) all bind the bowels, making it a catch-22. Today I'm biting the bullet and doing straight Tylenol. I find humor helpful. For instance I'm using pantie liners for pads and my wife had to explain to me that the sticky side goes on the underwear (I'm going to tell ALL my guy friends now).
Thanks
work i will never ever go through this procedure again,its worse than child birth.
good luck to all that choose this procedure,ITS PAINFUL.
Unfortunately the bleeding has started again and I seem to have painful lumps on the outside now. Not happy as I really don't want to go through this again.
I would appear to be one of the lucky ones who has had minimal, manageable (Vicodin) pain after surgery and very little problem with BM. I would emphasise what others write - I believe that the warm sitz baths and stool softeners are a must and really help speed the healing process along.
Patience is needed. I am nearly 5 weeks out and still have some leakage, but the pain now is only the itch and discomfort of (hopefully) healing surgery.
Please be aware of how serious this op is but also please take heart from the people who have come through without the dire results that some of these posts predict.
To ALL people here...this IS the most painful surgery I have EVER been through!
As one person stated,he questioned living it's self,that the pain level IS absolutly unbareable.I will tell you,he is NOT alone when saying that.
I am in the same boat as you are. I had the procedure done 3 weeks and 1 day ago. BMs are incredibly painful. It feels as though I am tearing apart. I have tried soaking several times a day over the last 3 weeks, using many different types of prescription creams and ointments and nothing has relieved the pain. I am at the point of holding in my BMs as I just can not deal with the pain. Hopefully someone has some advise that will help with this pain. It is by far the most painful procedure I have ever been through. I wish I had never done it.
If you really suffer and I mean that utterly miserable day after day soreness and pain that Hemorrhoids causes then I guess I'd say have the surgery. What you must remember is that pain is different for everyone. But I do think that the sites that say all should be well after 2 weeks are being hopeful at best. I'd double that at least. And dont go to gym for a while. Just take a gentle walk instead for a month or so. Best of luckj to anyone considering it.
I prepared for surgery just as I did for my first colonoscopy with a liquid diet the day before surgery and a complete purge using two 10oz bottles of magnesium citrate (one at noon, one at dinner 4pm). The next morning, one hour before heading to the hospital for surgery, I gave myself a Fleet enema. The surgeon didn't require this complete purge. My theory was that doing so would delay my first BM giving the surgical wound more time to settle down, and it would also ensure that no latent hard stuff would come down the tract and hurt me.
Surgery went well (I'm taking the doctor's word for that). The most pain I experienced in the hospital was when the IV sealed off and the liquid pain meds created a burning bubble under my skin. I was in the hospital for about 30 hours. The surgeon doesn't like to let his patients go home the same day -- and I'm glad about that.
I've been very strict about my high fiber diet (almost exclusively All Bran and Quick Oats) and lots of fluids -- about 32 oz (5 parts Gatorade, 1 part Cranberry juice for taste) every 4 hours since surgery. I've been taking 1 percocet every 3 hours and only some Ibuprofen periodically, and Colace twice daily.
Today (4 days after surgery) I had my first BM and immediately ramped up on the percocet. It was painful, but not like most descriptions on this and other forums. Just a bit of moaning, no howling or need to jump in the tub, etc. However, I'm now taking 1 percocet and 2 Ibuprofen every 2 hours. My stool was soft, but I've added Metamucil to the mix going forward -- it can't hurt. I've already had 4 significant BMs today. I quickly learned to not fight the BM. That is, most of my BM pain is in starting and stopping. So, once it starts, I keep the abdominal pressure on so that the flow will continue as long as possible, hopefully completing the BM in a single flow. That has worked very well since I tried it on the 2nd BM.
I'll be sticking to my diet of high fiber and lots of liquid until the BMs are essentially painfree. I'm guessing that may take another week.
Stitches are still there and I am still seeing bright, red blood.
My advice is that everyone take a long, hard look at their situation
before deciding to go with the surgery.
I have a very complicated situation because I also suffer from
severe migraines, lupus and fibromyalgia. As a result, I was kept
in the hospital 6 full days after surgery because it triggered a
horrible migraine. (I've put off the surgery to try all those other
alternative treatments for 3 years so my doctors and I did not enter
this surgery lightly.) I was given a DHE-45 treatment to ease the
migraine but was also given Vicodin (Norco) and Dilaudid while I
was in the hospital to ease the pain I felt ALL over my body including
the surgery site.
They sent me home with no painkillers for the first 24 hours due
to a mix-up, but every since then, I have been in pain at the surgery site
which keeps triggering my migraines. Ended up in the ER last week where, after
requesting the standard urine sample, the doctor on call tells me
there was blood in the urine, but don't worry because it was probably
just a hemorrhoid! I gave him the dirtiest look possible and calmly
explained to him that a hemorrhoidectomy is what I had JUST had so
the thought of another one being the cause of blood in my urine was
NOT what I wanted to hear.
Maybe things would have been different if I had gone home with the
painkillers as planned, but I can say that I truly still feel pain
and I will return to the surgeon on what will be exactly 1 month
feeling pretty much the same way I felt a few days after the surgery.
I just pray that it doesn't take much longer to heal.
1. drink lots and lots of water.
2. eliminate caffeine from your diet. I can't stress this enough. no coffee, no power drinks...
3. eliminate orange juice from your diet and replace with grapefruit juice w/2tbs olive oil
4. take psyllium fiber pills 2-3 times a day. No one gets enough fiber, even vegetarians
5. same as oj, tomatoes are acidic and should be avoided.
6. eat yogurt for healthy bacteria in your digestive system.
If all this fails, rubber band ligation is still way less painful than the roidectomy.
I'll post tomorrow how I feel before my gig.
1. drink lots and lots of water.
2. eliminate caffeine from your diet. I can't stress this enough. no coffee, no power drinks...
3. eliminate orange juice from your diet and replace with grapefruit juice w/2tbs olive oil
4. take psyllium fiber pills 2-3 times a day. No one gets enough fiber, even vegetarians
5. same as oj, tomatoes are acidic and should be avoided.
6. eat yogurt for healthy bacteria in your digestive system.
If all this fails, rubber band ligation is still way less painful than the roidectomy.
I'll post tomorrow how I feel before my gig.
HEMORRHOIDECTOMY SURGERY WAS WAY MORE ABOVE and BEYOND MORE PAINFUL THAN ANY OF THOSE SURGERIES!
Sitting is almost next to impossible, standing feels like to much pressure , laying on his side on an air matress helps some. BM's still extremely painful, and bleeding with clots. He'll be on the toilet and need to get in the tub immediately to wash off. Takes Hydrocodone , stool softners, metamucil, milk of magnesia, prune juice. He keeps a log on the counter to keep track of everything. When we left the Hospital that same day of the surgery, was given an appointment for a 2 week post op check (June 1) We have been back to the Doctor office 4 times now, with questions and concerns. Swelling, burning, bleeding, and what the hec are those new skin tags about ? ! Tags are so big they look like he was made a vagina ! Doctor says expect the bleeding yet for up to 2 more weeks. Return to work, MAYBE next week ! ? No after instructions came with the surgery, day by day basis, I guess ! The peeing was hard for the first 4 days, now it has finally got better. That leads us to believe the REAR will get better too ! We did not go on line, to search hemorrhoidectomy till AFTER the surgery. So reading these posts has helped us know that my husband is NOT the only one that is miserable. However, if we had read the posts and searched about the actual procedure, it may not have changed his mind, because the years of trying to push his grade 4 roids back in, were extremely painful, and bothersome , He still thinks he would have went ahead with the surgery. Hopefully in time, he will be able to tell you that he is glad he had it done, and all will be good. Until then THANKS for sharing ! If you are reading this, and deciding to have the surgery, YES it will be painful, but plan to allow at LEAST 3 - 4 weeks away from work, and healing slowly !! The bathtub is his best friend yet,He even is able to doze in the tub. We wish you all the BEST !
We just saw your post from July 5. We wrote the 5/27/11 post above yours. My husband wanted to let you know that he is getting better each day now. He is completely mobile again. Now, he has No regrets for doing the surgery. He felt like minimum of 3 weeks off, was best. His were inside and outside, Light bleeding, and stitches were still falling out at 5 weeks. He still takes stool softners regularly. It is REALLY a slow recovery. Take Care, and Best Wishes.
thank you
For most of the last 4 days, I've been either on the toilet, in the bathtub, or trying to sleep off the pain. I work from home, and I've been completely unable to work - that's quite a statement.
I've had frequent BMs - similar to what one commenter mentioned - small BM, clean up, and an uncontrollable urge would hit for another one...repeat the pattern over a couple of days. I've been yelling in pain during and after the BMs. I've cried as well - not a tear or two, but boo-hooing for several minutes.
I realize some folks have relatively minimal pain and recovery pretty quickly, but there are enough folks who have a much rougher go of it. I wish my doc would have have a LOT stronger words about the recovery when I was discussing the treatment options.
BTW, I did try infrared coagulation, but after treatment 2, I was in more pain than when I started. My doc said I was one of the few that IRC just wouldn't work for and that traditional surgery was my only course of action.
If you are researching this surgery, budget 2 weeks MINIMUM of down time - no work, no social engagements, nothing more physical than a very gentle walk. My employer is very upset with me because I did not set expectations what my actual recovery has been.
My surgery went pretty good, didn't feel the pain during the surgery because they put me to sleep.
After the surgery is when all hell broke loose , whenever I had the BM, it was excruciatingly painful.Urinating was tough the first couple of days.
This week's home recovery has been a challange.I have been taking two Percocet tablets every four hours for pain med's, I was still suffering with the pain during the BM.The bleeding and the swelling was pretty much common after the surgery.The sitz bath helps ease the pain, but doesn't get rid of it.I believe it is best to stay with liquids till this trauma is over, avoid taking solid foods till the first three weeks go by if possible.And stick with dietary fiber rich foods , fruits and vegetables to prevent hoids from coming back.
Close to my 6 weeks and all good.
On my first visit / exam with you , you had little bedside manner, but I have had good doctors that did not have this at first. This is not a big factor for me. During my visit, with you, I asked and you recommended a hemorrhoidectomy and said it was the only procedure for the size of my piles.
In asking you about time to plan for recovery, you seemed reluctant to state how long recovery would be. So, I asked, "5 days?, 5 to 7?" You suggested that was about right. So, my planning with work was to be ready to miss 1 week of work. I was optimistic as every surgery in the past the recovery has always been way quicker than expected. I am very well aware of pain and recovery from surgery. I can handle pain, expected pain, but guessed meds for 5 days or so would be enough.
You told me it was "the most painful surgery of all that you do", WHEN, *** AFTER *** I had the surgery. No, you are not alone, just read a forum like this one. Here is my biggest point, you need to raise above that level. You need to be the stand up physician that does not end up with someone like me that, if I had been briefed correctly, I would have likely chosen not to have the procedure done.
My other complaints include:
The very slim, written, post-surgery instructions you provide cover most, but some human overview of the pain meds and such should not be assumed. Most recoveries are not anywhere as complex. One lays around, washes in whatever way possible and takes pills as needed. Here, bowel movements create unbearable pain. Pill management is much more difficult. Baths are needed after every BM. Lidocain 5% ointment that I got by calling your line from another Doctor, (Chung?) ended up being very helpful.
While squirming in pain frequently and fearing bowel movements like torture, I looked on the web and found that most discussions of this procedure leave the patients wondering what kind of Docs like you that tell us 5 - 7 days for recovery. I think if you were honest and said 2 - 4 weeks, you might lose some patients, perhaps that is your alterior motive. During the call with Dr. Chung, he said he gets his patients to plan 3 weeks off of work. You could have spoke up if you thought I was in denial about 5 - 7 days, but you said that is about right.
In a few minutes you could have explained how to adjust stool softeners and made sure I had some 5% lidocain cream. On my first visit from pain about 5 days after surgery, you handed me a tube of 2% lidocain cream. WTF! - you had to know that 5% was available and could easily have written me a prescription. Seems to me that patient comfort should be higher on your list.
So, why would I write a letter like this. I wonder myself. I am pissed that you did not care enough to prepare me much better. I feel violated to have gone through so much pain that at minimum, I should have been forewarned would be there. If I was the litigious type, I would think about suing you, but that is not in my makeup. All I really want is for you to learn to be better at your next opportunity. You are a veteran. I am certain your surgical skills are great. Being a Doctor is a magical thing. Your lack of preparation and planning to make this experience as painless and at least to give me realistic expectations of how bad it could be is scandalous. The magic of being a physician is more than the technical side. On the human and forthright side, you need a ton of work. The pain one survives during the recovery is similar to torture. For the better part of the first two weeks, the pain I suffered kept me thinking that this is just wrong.
So, my only hope is that perhaps you can learn from this. That is all.
I now have to figure out for a final follow up if I should go to the other Dr. I mentioned. Dr. Chung, he almost sounded appalled when I described the 5 - 7 day recovery quote. He said he tells his patients to take 3 - 4 weeks off from work. Right on! Dr. Y (my doc) just needs to change his ways.
I am guessing that a doctor like this cannot respond to such an email as I noted above. Lawyers would want to keep any litigious documents to protect, just if there was a suit. I like my take, I just would feel so much better to at least have him acknowledge receipt of the above letter.
The email above was modified a bit, the gist is unchanged. I had to chop it down to under 4000 characters.
Would love any feedback. I chose not to display my email, but hope that I can come back here and see similar takes. As ugly as discussing the procedure, I lose my shame. I have already found two friend/acquaintances that are considering surgery. I think I saved them the torture that most of us have been through.
I now have to figure out for a final follow up if I should go to the other Dr. I mentioned. Dr. Chung, he almost sounded appalled when I described the 5 - 7 day recovery quote. He said he tells his patients to take 3 - 4 weeks off from work. Right on! Dr. Y (my doc) just needs to change his ways.
I am guessing that a doctor like this cannot respond to such an email as I noted above. Lawyers would want to keep any litigious documents to protect, just if there was a suit. I like my take, I just would feel so much better to at least have him acknowledge receipt of the above letter.
The email above was modified a bit, the gist is unchanged. I had to chop it down to under 4000 characters.
Would love any feedback. I chose not to display my email, but hope that I can come back here and see similar takes. As ugly as discussing the procedure, I lose my shame. I have already found two friend/acquaintances that are considering surgery. I think I saved them the torture that most of us have been through.
I had sensational pain and bleeding with uncomfortable slimy mucus at my anus. So my Dr. Said i had 3rd degree haemoriod.
the most painful thing in my life.
Anaestasia on my spinal cord made me feel no pain for op that lasted just 1hr. I heard it was painful but neva knew it was this extent, am 29yrs from Nigeria male, i decided to go for d op 2nd Dec 2011.
I'v been on liquid food, and fibric foods today 9th Dec, i urinated with scary pain d next day after d op and d jerking pain subsides as d day goes by. My ass now looks like a vagina lol with d stitch lumps but will stretch out sooner like my Dr said. Am taking vit c, tramadol, flygil, and oil parafin which seeps frm my ass lol. I am on sit warm salty saturated water bath, am praying to GOD that my 1st toileting not been painful. Am not having any swelling or bleeding. I wil be a lot betta by d Grace of GOD. I persistently confessed +vely to my antisipated 1st BM that it can NEVER pain me and back it up with drinking water, stool softner oil parafin, and eabric fruits am 1wk old after op.our
bodies differs with recovery.
Best wishes!
For those looking at undergoing the procedure, I will offer my advice. Sitz baths are amazing. It's hard to get up and take care of yourself when you feel this bad, but the effort will be rewarded. Do not "chase the pain". Stay on a good medication schedule. Ask your doctor to prescribe Lidocaine 5% ointment. Sit on an ice pack. Try to walk around to get some endorphins and prevent constipation. BMs are incredibly painful, so be prepared to start a Sitz bath right after you go. I use baby wipes instead of toilet paper.
I too, feel that this surgery wasn't explained as thoroughly as I would have liked. However, what's done is done and I'm looking forward to feeling better. On the other hand, I'm highly doubtful that two weeks is a sufficient period of time which to expect to be fully healed.
I welcome someonelse to give me his or her advice. Oh, and to the people on here talking about anal sex--what's WRONG with you? Doesn't your rear hurt enough???
THANK YOU