Hemorrhoidectomy Post-op Instructions

You have had surgery to excise hemorrhoids. This can be one to three columns of hemorrhoids excised.

The hemorrhoidal tissue has been excised both inside and outside the anus. The incisions have been closed with an absorbable suture that will not need to be removed. It is expected that the wounds will open up to some degree over the first few days after surgery. It is important to frequently shower or bathe in order to clean the area of the expected drainage, and to dry the perianal area well after each cleaning. I recommend showering or soaking in a tub after having a bowel movement, instead of using toilet paper. You may also use a witch hazel cleaning solution that can be purchased at a drug store. After about a week, when it is more comfortable, I recommend using Preparation H flushable wipes to clean after BMs.

The expectation is that you will go home the day of surgery. After going home, there is not a need for a special diet. There are no foods that are off limits, but I recommend eating lightly for the next 3 days. Avoid foods that would make you constipated. Eat plenty of fiber.

Pain after this surgery is variable, depending on multiple factors, but probably most related to the number of hemorrhoidal columns excised. Local anesthetic is injected at the time of surgery, so that pain is not initially too bad, but when this wears off, the pain can be severe. The pain improves quickly over the first few days after surgery. When you are discharged, you will be given a prescription for pain medication to use as needed. This is usually Norco (Acetaminophen/Hydrocodone). Use this sparingly, as it can cause constipation.
It is common to have some degree of pain for up to 2 weeks.

You should be up and around soon after surgery. When you go home it is important to walk often. You can climb stairs and be active, just avoid any significant lifting (greater than 15 lbs) for 2 weeks.

Issues you may have:
Constipation can occur in the post-operative period, usually due to pain medication use. I recommend using a gentle laxative like Milk of Magnesia.
Urinary retention, especially in older men, who already have an enlarged prostate. We try to make sure that you are able to void prior to leaving the ambulatory surgery unit after surgery. If you already have voiding issues (a weak stream, getting up more than once per night to void) it is important that I know pre-op so that I can prescribe medicine that may make post-op urinary retention less likely. If, after going home, you are unable to void, or find yourself voiding a very small amount every hour, you may be in urinary retention. You should call the office, and if it is after hours, you may be directed to the ER to have a urinary catheter placed.

Swelling will occur, and be significant. This can be relieved to some degree by ice packs. It is not uncommon for patients to feel that a hemorrhoid is still there, but this is usually just inflammation that will resolve with time.
Bleeding can occur. This is expected to some degree. Call the office if you are having bowel movements composed of only blood.
Call the office if you have Pain that is worsening and or associated with a fever (temperature equal or greater than 101). It is normal to have some pain, and even a low grade fever can be common. Take the pain medication, or tylenol. Be careful not to combine prescribed pain medication that contains tylenol, and OTC tylenol, or at least be sure not to take more than 4000mg in a day.
Wound infection after hemorrhoidectomy is very rare. But if there is increasing redness, tenderness or drainage from the incision site, call the office.