Hemorrhoidectomy

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Postoperative Care

After surgery, the patient is taken to the postanesthesia care unit (PACU). Patients are closely monitored by the nursing staff and remain there until they are stable. The amount of time spent in the PACU depends on the patient's progress and the type of anesthesia received. General anesthesia must wear off and the patient must be awake and coherent before they leave the PACU.

Outpatients are transferred to another room to finish their recovery, and inpatients are taken to their hospital room. The intravenous line remains in until clear liquids are taken and tolerated. This can be almost immediately following surgery, especially if local anesthesia was

used. Sometimes general anesthesia induces nausea, which may delay taking oral fluids. Once clear liquids are tolerated, the diet progresses to solid foods.

Spinal anesthesia usually wears off within a few hours. During the first hour following surgery, patients lie flat on their back to decrease the risk for an anesthesia-induced headache, which can be painful and prolonged. Before being discharged, the patient must regain full sensation in the lower part of the body.

Because of swelling and the dressing, some patients have temporary difficulty urinating. If there is urgency, but the urine will not flow, a catheter is used to empty the bladder. Outpatients may need to stay overnight, if they are unable to urinate. Patients must be able to urinate on their own before being discharged.

Even though the anesthesia has worn off, most patients remain groggy for the rest of the day. Patients must arrange for a family member or friend to be with them if they are being discharged the same day as the surgery.

Patients experience pain and discomfort during the immediate postoperative period (i.e., about 10 days). Pain medication is prescribed and should be taken as directed. Sometimes relief can be achieved with an over-the-counter preparation such as Tylenol®. If a pack was inserted into the rectum following surgery, the physician usually removes it in a day or two.

An ice pack can help reduce swelling. Soaking in a sitz bath (a shallow bath of warm water) several times a day helps ease the discomfort. Using a donut ring (cushion with a hole in the middle) can make sitting upright more comfortable.

It is important to avoid constipation at this time so, the physician will prescribe stool softeners and a laxative. Eating a high-fiber diet and drinking plenty of liquids also helps. A small to moderate amount of bleeding, usually when having a bowel movement, may occur for a week or two following the surgery. This is normal and should stop when the anus and rectum heal.

Complete recovery takes 6 weeks to 2 months. Most patients return to work within 10 days. Heavy lifting should be avoided for 2 to 3 weeks.

Postoperative Complications

Most patients are satisfied with the results of the surgery and recover without any problems. Complications associated with hemorrhoidectomy are rare and include:

• Anal fistula or fissure
• Constipation
• Excessive bleeding
• Excessive discharge of fluid from the rectum
• Fever of 101°F or higher
• Inability to urinate or have a bowel movement
• Severe pain, especially when having a bowel movement
• Severe redness and/or swelling in the rectal area
• Side effects of anesthesia (e.g., spinal headache)

The surgeon should be notified if any of these symptoms are experienced during the immediate postoperative period.

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