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Common Procedures and Treatments

Anorectal Procedures

Most common anorectal procedures, instructions and postoperative care in this section you will find more specific information. Do not forget to refer to the UNIVERSAL INSTRUCTIONS for more generic but important information as well. If after visiting this section you still have questions, please do not hesitate to contact us at 214.824.1730.

There are multiple procedures but many of those have things in common. We'll address specific differences when each procedure is briefly discussed.

• Common Anorectal Procedures
• What to expect?
• Postoperative pain and its control
• Bleeding
• What to look for Diet and Bowel Function
• Wound Care
• Activity
• Follow-up

Common Anorectal Procedures:

Hemorrhoidectomy:

Elimination of the Hemorrhoidal cushions by excising, ligating, cauterizing or interrupting the blood supply to them PPH.

Fistulectomy:

Excising the communication between the inside of the rectum and the outside skin, most are simple or superficial but in some instances they may require complex procedures such as flaps, plugs or seton placement. They can recur, may need several interventions but this is the exception.

Fissurectomy, sphincterotomy:

In most instances acute fissures heal with conservative measures, chronic fissures have less likelihood of healing. Non-healing chronic fissures may require surgery which involves excising the ulcer, and cutting the internal anal sphincter, this is known as Fissurectomy with sphincterotomy. This can be associated with incontinence therefore every attempt would be made to promote healing conservatively. In other special circumstances, the patient may require a skin flap to cover the defect, the purpose is to avoid cutting the muscle, stretching the anal canal and covering the defect, this is known as anoplasty.

Sphincteroplasty:

When there has been a disruption of the anorectal muscle sphincter the patient can experience anal or fecal incontinence. This sometime can be repaired. The main issue after this procedure is delayed wound healing.   

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What to expect?

Most individuals go home the same day after the procedure. Although uncommon, the most frequently seen problem after anorectal surgery is bleeding, pain and less often infection.  In very rare instances, fecal incontinence can be seen, this is multi factorial and it depends on the type of surgery done, especially if there is muscle involvement or work done to it during the surgical procedure. Another side effect is urinary retention or inability to empty the bladder. If warm sitz baths do not relief this symptom, you may need a temporary placement of a urinary catheter in the nearest Emergency Care Unit; this will remain in place for only few days.

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Postoperative pain and its control.

Most of the time a combination of warm sitz baths with ice packing alleviate the discomfort. These two measures are the ones that provide the most relief. Pain medication will be prescribed but it is impossible to eliminate the pain completely. In general the patient will have intense pain after their first bowel movement; it reaches its maximum by the 3rd postoperative day and then becomes less intense as time goes by. The length of this period is procedure dependent and varies greatly from patient to patient. The patient should notify us if there is increasing, unrelenting or constant pain despite pain medications and other measures to control it.

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Bleeding?

The patient should expect a small amount of bleeding with bowel movements until the wound is completely healed. Profuse bleeding can be noted 7 to 10 days after the surgery; this is when the stitches are starting to disolve. Spotting or small amounts of bleeding for prolonged period of time is typically due to granulation tissue, this could require treatments with silver nitrate. You may also see yellow/green drainage also until the wound heals completely, this is NOT a sign of infection. 

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What to look for:

If you have any of the following signs or symptoms you must call.

Difficulty urinating, passing gas or bowel movements, profuse or significant bleeding, excessive swelling, redness, fever, chills, malaise.

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Diet and Bowel Function:

In general a good fiber diet is very important in allowing postoperative wounds to heal properly.  Dilating the anal canal with the bulking effect of fiber enables the wound to heal without abnormal narrowing, which is one of the risks of PPH procedures. Too much fiber however is not better because of its potential of abdominal distention, and even constipating effects. In this web site homepage under the section of health and nutrition you will find instructions for a high fiber diet. If you have not had a bowel movement after the procedure you may take a mild stool softener such as docusate (2 PO tid) or one ounce of Milk of Magnesia. If this fails, please contact us to avoid a fecal impaction.

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Activity:

Common sense will be a good guide as to how much activity to should be doing during the first couple weeks after your procedure. It is important to be active, out of bed for short periods of time. You should also spend some time resting. Avoid heavy lifting or straining because this will cause the wound to be more painful. Some patients feel very good soon after surgery and initiate activity sooner, only to regret it at the end of the day or the following day. Be cautious! Avoid driving for several days until you feel well, especially if you're taking pain medications.

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Wound Care:

Your wound will heal gradually over a period of one to six weeks depending on the type of surgery performed. Some bleeding (mostly with a bowel movement) and drainage is expected.  If sutures are used in your surgery they dissolved between seven to 10 days after your surgery at which time patients may experience increased bleeding but only for a shorter time. This usually results and wound separation but this is normal and expected.

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Follow up:

You will need to be seen in seven to 10 days after surgery please call the office to set up a follow-up appointment of some as possible. If you are experiencing significant problems please not hesitate to call the office.

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