What is post anorectal surgery care?
The day of your operation is critical to treat your condition. But equally as important is your recovery from anorectal and proctologic surgery. Dr. Maher Abbas will provide you with world class surgical expertise. He is committed to guiding your recovery in order to achieve a superior outcome. The majority of patients have an uneventful steady recovery but on occasions a few bumps may be encountered during your healing journey. The following instructions are helpful to guide your postoperative journey. If these instructions need to be customized to you, Dr. Maher Abbas and his team will discuss them with you.
By the time you leave the hospital you should be able to take short walks. The 1st week you will often feel like resting and taking naps because of decreased energy level. Your body needs time to heal. No vigorous physical activity that increases friction in the buttocks area (such as aerobic exercise, bicycle riding, jogging, weight or heavy lifting, straining) for 2 weeks and until the area feels comfortable. Do not drive while you are taking pain medications.
By the time of your discharge, you will either be on a full liquid or regular diet. Avoid spicy food or citrus containing food such as lemons and oranges for 2 weeks. Avoid constipating food and if you eat red meat, pasta, or white bread, take smaller portions. Follow the sections on Post Surgery Diet and Constipation. Use fiber supplementation and/or the laxative you are prescribed. Ideally you need to have passage of stool within 48 hours of surgery. Do not avoid defecation or hold on stool as it will become harder to pass and more painful.
You can resume your home medications unless instructed otherwise. If you are on any blood thinner, ask Dr. Maher Abbas for specific instructions. Take medications as prescribed. If mild ache or discomfort, take 1 to 2 tablets of Tylenol [paracetamol 500 mg] every six hours as needed [can take up to 6 tablets per day]. If you are prescribed a non-steroidal anti-inflammatory medication (NSAID) such as Voltaren, Advil, Aleve, Ibuprofen, always take it with food. Do not exceed the prescribed dose or frequency. Sometimes you will be prescribed an anti-acid medication to protect your stomach (such as Gaviscon, Zantac, Pepcid, Tagamet, Nexium, Prilosec, Pantazol). If other pain medications, antibiotics, or vein shrinking medications such as Daflon are prescribed, take them as directed. Drink plenty of water with medications.
If you are sexually active, ask Dr. Maher Abbas to clarify when you can resume sexual activity.
Signs to watch for
If any of the following symptoms occurs, immediately notify the office during regular working hours and seek emergency room care or come to the clinic as instructed. After hours, you can reach Dr. Maher Abbas and/or his nurse directly through cell phone or WhatsApp or come immediately to the emergency room to get triaged if unable to reach them. The following are the symptoms to watch for:
- Blood in the urine, painful urination, or inability to urinate
- Continuous bleeding from the anus or passage of multiple blood clots
- Diarrhea or loose stools that do not improve as you advance your diet
- Excessive pus drainage (milky thick smelly secretions) from the anus
- Headache that does not go away after a spinal anesthetic
- Painful defecation that does not improve with time
- Painful swelling of the anal area that progresses
- Pelvic pain that radiates to the back, legs, or rectum
- Persistent nausea, vomiting, or inability to take oral hydration
- Recurrent fever (Temperature >38 ° Celsius, >100.4 ° Fahrenheit)
- Shortness of breath, chest pain, or racing heart beats (palpitations)
- Swelling in the legs
If you are discharged with a seton string in the anus or a soft Penrose drain [Figure 1 and Figure 2], wash the area with soap and water at least twice daily or after bowel movement and cover with a dry dressing. If a seton is present, often it will remain for a minimum of 6 weeks or longer. A Penrose drain is typically removed within 2 weeks following your operation. If you have surgery for a large abscess (an infection with a cavity) a mushroom catheter [Figure 3] may be left inside the cavity wound to allow proper drainage. Unless instructed otherwise, gently irrigate the catheter with 50 milliliters of warm water and liquid soap unless instructed to use other type of solutions. The catheter is typically removed within 2 weeks of surgery. There is no need to record the output of this catheter.
Time Off Work
Depending on the type of your operation and nature of your employment, you will need 1 to 2 weeks off work. For major anorectal operations, 4 weeks maybe recommended. Dr. Maher Abbas and his team will provide you with the appropriate sick leave certificate.
Proper wound care is an essential part of your recovery. Unless instructed otherwise, adhere to the following instructions:
- In most cases of anal surgery, a tampon soaked in antibiotics ointment is left inside the anus. Do not attempt to remove it as it will come out the 1st time you have a bowel movement
- Remove the external dressing within 12 to 24 hours after surgery when you are ready for your 1st sitz bath [see the section on Sitz Bath]
- You can shower within 24 hours of your operation
- Wash the anus and any external anal wounds after each bowel movement. Pat dry the area (do not rub or wipe) and if you are prescribed an antibiotic ointment, apply a small amount to the wound and cover with dry gauze
- If a wound packing is left inside the wound, it should be removed the following morning. If need to repack the area, you will be instructed. Otherwise wash and cover as instructed in #4. Do not digitate [put the finger inside the anus] if there are anal wounds internally
- If you are prescribed an analgesic ointment such as Xylocaine 2% or Emla 5%, you can use as needed for pain (before and/or after moving your bowels) but do not exceed 6 applications a day
Usually a routine follow-up visit will be arranged within 5 to 10 days of discharge. Additional follow-up visits will be arranged based on your needs. However, should you have a concern about your recovery, you can call the office at any time. If biopsies or a specimen were taken during your hospitalization, the results will become available within 1 to 2 weeks.
Any questions? Contact Dr. Maher A. Abbas’ office nurse here.