Most anorectal surgical procedures are done in same-day surgery. A few more extensive procedures require hospitalization for one to three days. Your ability to tolerate the pain postoperatively and your doctor's concern about your wounds determine the time of discharge.

• After Discharge
• Causes For Concern

After Discharge

1. Bleeding – small amounts of blood during bowel movements or noticed in undergarments.
   
   
2. Drainage / discharge – most often a thin yellow fluid – not always accompanying bowel movements.
   
   
3. Anal itching and soreness.
   
   
4. Painful bowel movements and irregular bowel habits.

Pain / Prescriptions
Following any surgeries you will experience some degree of pain and discharges from the wound(s). Contact your doctor if the pain is getting worse despite pain meds and rest, or if the pain is associated with fever and/or bloody or purulent (thick yellow) discharge. Prescriptions may be filled Monday through Friday, 9 am to 5 pm. Because proper office records must be kept, refills cannot be issued on weekends or holidays. Please follow all medication instructions as noted on the label.

Bowel Care
Keep your stool soft with the use of fiber supplement such as Konsyl, Citrucel or Metamucil. Take one tablespoon in a glass of water, once to twice per day... You will find shaking rather than stirring the fiber mixture will make these fiber products more palatable. Ease your defecation with mineral oil like product such as Kondremul or Colace. If you experience diarrhea or more than three bowel movement per day, you may stop the stool lubricant. If you have no bowel movement for more that 24 hrs, use some Milk of Magnesia (MOM), 1 tablespoon three times a day.

Care of the Anorectum
Following bowel movements, wet cotton or Kleenex should be used for cleaning by blotting, not whipping dry. Sitz baths (warm water basin) used twice daily and after bowel movements will ease anal discomfort and help clean the anal area after bowel movement (BM). Do not soak in the bath for more than 15 minutes. You may use skin protectant cream/ointment three times per day to protect the perianal skin without concerns to the wound. A wisp of cotton or cotton ball will help keep the area dry and prevent irritation from discharge. Change frequently as needed. Do not sit on “donuts” after anorectal surgery because they can increase pressure and pain in the anorectum.

Bowel Function
Bowel movements after anorectal surgery are usually associated with moderate to severe discomfort. Constipation and diarrhea make the pain much worse and must be avoided. The trauma to the anal wounds caused by hard bowel movements will slow down the healing process.

Constipation
You should be sure to have a bowel movement at least every other day. If two days pass without one, take an ounce of milk of magnesia; if there is no result, repeat this dose in six hours. You can also use an over-the-counter phosphate enema or tap water enema.

Diarrhea
Diarrhea, usually caused by overuse of laxatives, is also a concern if you have more than three watery bowel movements during a 24-hour period. If diarrhea occurs, stop taking milk of magnesia or other laxatives. Continue the bulk-forming agents. If the diarrhea persists, call your physician.

Bathing
After bowel movements, use a wet wash cloth, toilet paper, cotton, or perianal pads (Tucks, Preparation H pads) to clean yourself. If possible, take a sitz bath or tub bath immediately. Baths should last at least 10 to 15 minutes with the water as warm as you can comfortably tolerate. Try to take at least three baths (or showers with a hand-held sprayer) a day.

Discharge/Infection
Some bloody discharge after bowel movements is normal for at least two to four weeks after rectal surgery. If you have profuse, continuing bleeding, call your doctor immediately. Postoperative infection around the rectal opening is surprisingly uncommon despite the obvious contamination by stool. This is probably because of the very excellent blood supply to the area.

Urination
If you have trouble urinating, do so while sitting in a warm tub of water, or run the water faucet while sitting on the toilet. If the problem is severe or persistent, your doctor may prescribe oral bladder stimulants.

Diet
Eat a high-fiber general diet, including plenty of fruits and vegetables. Try to drink at least six to eight glasses of water or juice per day to help keep the stool soft.

Resume your usual diet unless instructed by your doctor. You may follow the diet recommended by the dietician or enterostomal therapist (ET). Drink plenty of fluids (8 glasses per day) and eat plenty of fruits, vegetables, and cereals to help prevent constipation.

Activity
On discharge there are generally no restrictions on walking, climbing stairs, or riding in a car. After some procedures you will be asked to avoid strenuous activity or heavy lifting for 7 to 14 days.

Stair climbing, walking, driving, and sex may be resumed consistent with your comfort. You should not drive if taking narcotic pain medication. Intense physical activity should be restricted for approximately two weeks.

Follow Up Appointments
After discharge please call our office to schedule a post operative visit.

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Causes for Concern

Contact Your Doctor
If any of the following occur, please call our office ( 503-222-1615 )

• Passage of large blood clots
• Have severe hemorrhage not stopped by holding pressure
• Difficulty urinating
• Fever greater than 101 degrees
• Worsening pain not relieved by pain medications
• Problems with the incision(s), including increasing pain, swelling, redness, or drainage
• Severe constipation (no bowel movement for three days)
• Diarrhea (more than three watery stools within 24 hours)
• Severe bleeding
• Nausea or vomiting
• Chills

The Colon and Rectal Clinic
511 SW 10th Ave. Suite 714
Portland, OR 97205
Phone:(503) 222-1615
Exchange:  503-294-1927(after hours emergencies)

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