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
Fiber, water, stool softner...nothing seems to be making the BM easy...it's a sharp pain which I need to bear every morning...I am sad, worried and cursing my self for opting this surgery...any advise??!!
Try to avoid painkillers, because every painkiller has either paracetamol or ibuprofen or diclofenac, etc. and these cause severe bleeding and constipation in many people. U might want to stop the painkillers for 3-4 days (and bear the pain until then) but then u will see for yourself that bleeding reduces and STOPS. Do not take too much chemical laxatives as they can also cause swelling in rectum and bleeding and also swelling of lips,throat, etc. and cause more problems for BM since your bowel start depending upon them for making BM. You must must eat only boiled vegetables and fruits like dry figs, raddish, and try adding a little olive oil in ur diet as it helps to cleanse bowel easily. VERY IMPORTANT: Use KALONJI Oil with REAL PURE honey about 2 teaspoons daily (english name is Nigella sativa) it is the wonder herb known to Arabs and Indians to heal and finish any disease on earth. It has been used since times when there was no science of surgery more than thousands of years ago ! The difference will be visible usually within 3-4 days.
May GOD help reduce the sufferings of the sick
So best of luck everyone and take the responsibility yourself and the time to RESEARCH all options before you commit to surgery.
Blessings
Things that works for me:
- warm water applied (sits bath or standing in the bathtub with removable shower head) while urinating and after BM.
- clean the wound with warm water after BM to prevent from other infection.
- eat high fiber veggies/fruits for the 2 weeks.
- stay away from high protein meat (Dark meat, beef, ...)
- apply Vaseline at the anus before/after each BM. This helps stools for the ease of passage.
BTW. I was scheduling for 1week off as instructed by the doctor. However, I just extended for another week.
Good luck everyone!
please listen to me when i say this is a painful painful surgery. granted im almost only a week in, but people aren't kidding when they say they question living, and the pain is excrutiating. im not trying to scare anyone, just prepare you. try your best to remain in the hospital under their care for as long as possible, they have stronger pain meds that might help you get through the first extreme days. before the surgery, start a higher fiber liquid diet. prepare meals for your family ahead of time, and have someone there to take care of you while youre down.
im hoping tomorrow will be better, im so tired of hurting.
take care and i hope you all have an amazing day and feel wonderful very soon.
Have Been Living with this Pile for 2 Years.. took all kinds of Harbs..Tablets and Injections None seemed to work.. I had an Option for An Operation but when i taught about the Pain involved after the Operation i could'nt take the chance Not Until i found Out the Easy way to Kill and Stop the Pain.. First.. I stopped drinking or eaten anything that contains Sugar like Minerals... Alcoholic drinks... I had to stop Smoking as well... I eat More of Protain than Cabonhydrate foods.. Eat fruits and Drink lots of water... What gave me the total relief is Simple to get and Cheap to buy.. I Make Sure every Night Before i sleep i took 2 tablets of Bixacodine.. And i use blood capsules which contains Ginseng.. I took the Ginseng Blood capsule 1 3 times every Day.. 1 Morning 1 afternoon and 1 at Night hour.. Do this for 2 weeks and you will get your total relief of Pains... Make Sure you Avoid intake of Alcohol or Minerals.. If you want to get total relief of your Pile.. Thanks and God Bless..
Kelvin Dike
i just wanted to pop back in here to give an update on my recovery (had surgery 5/8/2012). things are going really well now. infact ive reached the 'itchy' phase, there isn't any real pain, just soreness and my rump itches, which means it is healing.
infact the pain is at such a low level im not taking any pain meds at all right now and haven't since yesterday. i still have not sat down as i don't feel my backside is ready for that yet. i also have moved back to super soft food like mashed potatoes for the mean time. i am trying to up my fiber intake by nibbling on 1/4 cup of fiber one cereal through today so it will go easy on my system.
i also went to the doctor yesterday and he said all was healing perfectly and tissue was still swollen. he said there will still be pain but each day i should continue to improve.
my bowel movements still hurt like heck, but the massive pain lasts for a short time then retreats some. This started yesterday, afterwards, I climb into the shower and use the shower stream to cleanse the area and direct warm water to that area. This helps soothe the pain some.
again, i will say the surgery is very painful, but i am total proof that it DOES get better. just try to stay on your stomach/side as much as possible. Soak in a CLEAN tub of warm water frequently (also make sure your feet are clean before getting in there), use a sitz bath that fits on the toilet to help with your bowel movements. It sounds totally gross, but it lessens the pain and lets things move a lot easier. Viva paper towels are super soft and assorbant as well as sturdy which helps with blotting dampness away from delecate areas, ive found they are softer than terry cloth washclothes. Whenever you can sleep- DO IT. Heck if you are able to, another idea would be to remain bottomless (without under garments)as much as possible to allow for air circulation.
Above all, try your best to relax and heal. Watch movies, read books, craft, write, whatever you enjoy. Keeping your mind occupied helps manage the pain as well. There are tons of movie sites online like netflix, amazon video and crackle. heck there is even YouTube to watch.
Take care all and I hope you all feel wonderful.
I will post again when i am able to sit again and the pain is completely gone so everyone can get an idea of healing periods and if i come up with other ideas to help out.
~Mindy
Many thanks for sharing your thoughts and experiences. No two individuals are the same and the amount of surgery varies of course from one person to another. Add to that, that a lot of people who go through the procedure without too much hassle will not have any horror stories to share here. So it's very difficult to know what a typical experience is. So please do not rely on this forum on trying to decide whether you should have the op or not. Know that the op should be fine and the post op recovery WILL be painful, and for some folk the worst pain they've experienced. But, no pain, no gain. and returning to work with a week off may be possible for smaller ops, but not for external piles imho.
So recovery tips in summary, from my experience:
1. Lots of fluid. This helps to avoid constipation.
2. Macrogol based stool softeners/osmotic laxatives (such as Movicol) which ensure that water is absorbed into the stools making them softer and easier to pass.
3. High fibre diet (I'm UK based and so I'm allowed to spell it like that!!) and reduce unnecessary solids that won't easily digest. Try more soups and less red meat, say. Remember, if you need to go less frequently for a BM you are increasing chances of healing between BMs AND thereby causing yourself less agony!
4. Consider soluble fibre supplements such as Benefiber powder, which is tasteless and totally soluble
5. Take prescribed analgesics (painkillers) round the clock and don't come off them too early. If you have had general anaesthetic, you will be benefiting from that initially which masks the true pain to come. Some of these drugs add to constipation and you may be tempted to leave them for that reason - forget that, you need them. The additional fibre should counterbalance that.
6. Using warm water to clean and relax muscles can help
7. Some people find a prescribed ointment called Diltiazem aids in the healing process. You should enquire about this from your doctor/surgeon
8. I was advised to walk, but was told this was to assist in avoiding constipation. I would say to rest and allow the wound to heal. As Mindy says, rest and allow the wound to heal. If you have an open wound from external piles, they are VERY raw at first, so gentle cleaning and air to breathe are good for them. If you have underwear that hospitals provide, you will see they are net/meshed based and allow good air flow whilst providing support. These are very useful.
Why does nobody get told all this good stuff BEFORE they have the surgery?!!
Best wishes all!
Shaf
I'm back for an update. If you look up a few posts, you will see I had my procedure done on 5/8/2012. Well, I want to let you know, I am sitting down on my chair now, it is a little uncomfortable but it works. I started driving again yesterday. Up until then it was a lot of pain when I tried. Also, bowel movements are almost completely pain-free.
I can do pretty much what I want now I believe. Granted, I am not going to over-do it because I don't want any pain again, but I am feeling quite well.
BTW- I did find out I had a prolapsed hemorrhoid and a few others.
Grace: About the swelling, I went through that as well. My doctor said it is normal and that area will be swollen for awhile. I was so scared the hemorrhoids had returned because of the swelling, but they didn't and everything is fine now. Hope you get well soon.
Alright, I am off of here. Take care all and I hope you all have speedy recoveries, feel amazing and no longer have to bow down to these pains in the rear.
~Mindy
Regard
Cindy
I have both internal and external. She said she would be using a "pain balloon" for afterwards to help with the pain. Apparently it is a catherer that goes on either side of the anus and when you are in pain you push a button and it injects pain medicine right to the source. It lasts for 4 days. Has anyone ever heard of this?! I can't find anything about it.
I just had a PPH surgery yesterday (9/13) for my stage 4 hemorrhoids. There was some discomfort for about 45 mins to an hour after the procedure. I could have left the hospital two hours after I woke up, but they wanted me to stay, just in case.
So, I left the hospital at around noon today - about 18 hours after the surgery, and went to a nice place for lunch.
I could have ridden a bicycle home from the hospital.
No pain,no discomfort, no bleeding, no weirdness, I feel just great.
I am a 50 y.o male, I just wish I had not put this thing off for so long.
I am not using any pain meds. The only problem I experienced was discovering how sensitive my system is to stool softeners. I had to go to the bathroom four times last night, so no more of that stuff, either.
I drove to the grocery store today, and took care of some household chores - just another uneventful, ordinary day.
I live in Istanbul, Turkey. I had my procedure done at Acıbadem Kadıkoy Hospital, by Nihat Yavuz.
I must say the difference in my quality of life has been immediate.
Not sure why they send you home same day. Pain killers only take the sharpest part of the edge off. I hope this is worth it when all is said and done, because right now, I'm pretty damn miserable. Impressive level of pain. I'd read some of the stories online, but I figured those were abnormal results...after all, I'm relatively healthy otherwise, I thought. Under 40, decent shape, good diet, above average tolerance for pain...boy was I wrong.
Night of the op, I thought my colon was going to explode. Couldn't pass gas or work up to a BM. I'm sore and bruised like the most popular boy at the prison prom. Spent most of today in hot bath water. That helps, but I can't sleep there. As disgusting as it is, I was finally able to have a BM while in the tub. But hell, at least it relieved a bit of the pressure. Was slightly less painful than the unpassable gas, but not by much. I now know what the phrase "tore him a new ass hole" would feel like, i think. And I could do without such terrible knowledge. Certainly broke new ground in the area of disgusting things my wife has had to help me with. Good thing we left the "...or worse" clause in the vows.
Just called doc requesting stronger meds...Percocet 5/325 were the initial scrip, doc just said I can take 2 at once, so hope that makes it better. Or at least leaves me unconscious for a few hours.
But yeah...painful is sort of an understatement.
surgeon has mentioned wanting to give me Botox injections to loosen scar tissue up and make things easier? I have also read quite a bit about dilating your rectum yourself to make the bowel movement process easier? Any suggestions??
The next morning I decided to drive myself 5 hours home, on the way the surgeon called and asked if I could be at the hospital at 115pm...I was half way home so I said sure! When I got there he took a look and said...WOW that is huge! Again thanks doc, he said it was an external thermbosed hemorrhoid about the side of a large grape. He asked me if I wanted to do it right there under local anth or schedule something else. I said this thing hurts, lets get it done! I was cautioned that the shots wouldn't be pleasant...it wasn't bad. They gave me 3 injections, one in the cheek, one next to the hemorrhoid, and one it it. After about a minute I couldn't feel a thing. The doc cut the clot out and the top of the hemorrhoid out...packed me up with gauze and taped me up. Only took about 15 minutes...I drove myself home and picked up one of those sitz baths. Got home around 4pm...when the shots wore off I had pain, but it wasn't anything worse than prior to surgery. I used the sitz before I went to bed...that helped. I took some advil that night and the next day. I have been taking stool softners and some fiber.
Instead of using the sitz, I have been using my jettub every morning after my BM, and than once when I get home from work, and once before bed. I went to work the day after the surgery ***note that was probably stupid*** but I figured it didn't hurt worse than prior to, and I went fishing so.
I used 3 x 3 gauze pads until Thursday for minor bleeding control, I also took some advil a few times. By today (Saturday day 5 after surgery) I was back in the woods hunting...climbing into my tree stand wasn't too bad, and I stayed there for 3 hours.
I don't know if it because where my hemorrhoid was located, my age (32), fitness, or just dumb luck but this wasn't too bad. Yes it hurts like a you know what but I got to say, much better at anypoint after than before. Honestly, I'm glad I didn't read this or I wouldn't have went for the surgery and that would have been a huge mistake.
Right now as I sit here, I couldn't tell you I feel anything wrong at day 6 after surgery. BM's don't really hurt much at all...(never did, even the first one after the surgery).
I missed one day of work..the day of the surgery, and that was because I was on vacation anyways.
Here are my experiences, and hopefully they can help someone. I had hemmoroidectomy & sphincterotomy exactly 2 months back to this date. The recovery has been very slow. I am still in pain after each BM every day. For the past week or so the pain is a bit bearable...it's about a 5 on a sclae of 1 - 10. My pathology indicated that there were 8 small to medium hemmoroids (internal as well as external) were removed covering an area of 3cm X 4cm.
My surgery was out patient surgery and was sent home an hour after the surgery. The surgery itself lasted 45min. I expected horrible pain anyway. First three days I had runs and made things worse. I became very weak and many times I couldnot feel lower part of my body due to pain. The pain level was a 9. There we different types of pains I felt through the next six weeks! Every time I ran my fingers across my lower back, I could feel different pain receptacles produce different pain...some cutting sensation, some stabbing, some throbbing, some ripping and so on. It's more like moving your fingers acorss a "piano of pain".
During first five weeks I only took Ibuprofen and Acetaminophen for pain. I refused to use serious narcotics like Hydrocodone, although my Dr prescribed that just in case. Three weeks back my Dr asked me to not to use even Ibuprofen. He simply asked me to "deal with it" and he expected my body to "get used to it". So no pain meds since. Every day after BM, I would suffer thru the pain from 6:30 am to 3 pm. After two months, I still feel pain after BM. There is a post surgery scar tissue that seem to swell up after BM every day and as along swelling stayed, the pain seem to be a constant issue.
For relief, this is what I did every day. After BM, I have been going for a walk for 30 min to an hour. That seem to relax my muscles and focus on other things than pain. When I get back from walk, I would either take a hot shower or bath. Wipe the area clean and apply Lidocaine ointment. (I think it is a steroid and acts like a local anesthetic) I also used Vaseline after each time I would clean the area. Drink 6 to 10 glasses of water. I ate scrambled eggs or omelette, oatmeal upma (look up on youtube on how to make it), lots of veggies, spinach. Ate a carrot three to four times a day. This gave me enough fiber for my next BM. Refused to eat meat or chicken...for some reason the days when I ate any meat I had painful BMs. But sauteed fish fillet worked very well. I also have been using a hot water bottle when I lay down or sleep at night...which definitely seem to provide a good relief from pain. Most importantly surround yourself with loved ones who are willing to help you when you need them. I owe it my wife and three kids who have been there every time I needed them.
Hopefully I am close to getting my health back and kick this pain to the curb permanently. Good luck with those of you planning this surgery and wish a speedy recovery to those who have already gone thru it.
So far this morning I'm still in quite some pain, but fine enough to write this. I'm not out of the woods yet, but so far i can say that it's not as bad as I had anticipated. If one has had piles that are bad enough and for long enough to need surgery, then one is already well used to pain so it hardly makes a difference.
I kow I will still be in for a few more surprises regarding the healing process. I will concentrate on gettign my liquid diet and papaya. They help soften your stool also. Until i am completely healed, i can say this with finality. Forget what the doctor say -- think about the bad experiences people suffered in getting the procedure done and weigh it against your choice. At the end of the day -- it will be your pain and not the pain of someone who'll say everything is going to be ok.
The flight or fight scenario, in my case the run to the loo option. This was never discussed before surgery which made my recovery slow and painful.
I'm sure there are a lot of people that eat a normal diet that are not constipated but still get hemorroids.
What made my recovery slower than expected was everytime I knew a BM was coming I would tense up. The urge to push was overwhelming to the point I couldn't stop, this of course caused damaged that took extra to heal.
The trick is to eat a high fibre diet, drink plenty of water,ease back on the meds and salt baths.
Oh! the most important thing is to remain calm and in control during the visit to the loo.
Good luck.
I have heard from different people that have gone thought this experience and it varies greatly.
The recovery process/pain will depend on the amount of surgery done.
The first BM after surgery is when you will need to remain calm and in control.
I was talking stool softening medication that helped.
It's day 11 for me and I am returning to work tomorrow, light duties only.
Remember it will only get better from here.
Santo
Anyway the op and post initial op pain is the easy part, the hard and TERRIBLE part of the operation is the BM or lack of it, I managed 3 tiny stools 3 days after op, since then nothing, but I am getting constant urge to go all that comes is wind and fluid, (very little though) I have followed all the advice with fibre diet, drink lots of water, soften stools, etc etc but still can't get BM
and each visit to the toilet is agony that last for hours afterwords, the pain relief available does not work, I tried a tens machine last night and finally managed to sleep a few hours though not totally pain free, I'd say about 30% extra pain relief with the tens, to be honest 10% more is heaven 30% feels like just having the piles back and is bearable.
I have leakage every time I pass wind, and this is so demoralising but very little blood loss and it is diluted.
At this time wishing I'd not had this done, hoping this wish change as the days go by,