What position are you in for hemorrhoid surgery?
Anal Surgery for Hemorrhoids Periprocedural Care
For all treatments, a conventional anal retractor (eg, a Parks or Fansler retractor) is required. For hemorrhoidectomy, the following additional equipment is required:
Absorbable suture (if the open surgical wound is closed)
For office treatments, local anesthesia is used. For surgical treatments, general anesthesia or local anesthesia combined with mild sedation may be used. No matter what type of anesthesia is employed, the procedure begins with local injection of the entire anal canal with bupivacaine or lidocaine with epinephrine.
For both office and surgical treatments, place the patient in a jack-knife prone, lithotomy, or left lateral decubitus position.
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Hemorrhoids. Image reproduced from original with permission of the American Society of Colon & Rectal Surgeons.
Rubber band ligation. Image reproduced from original with permission of the American Society of Colon & Rectal Surgeons.
Electrocoagulation for hemorrhoids. Image reproduced from original with permission of the American Society of Colon & Rectal Surgeons.
Closed hemorrhoidectomy. Image reproduced from original with permission of the American Society of Colon & Rectal Surgeons.
Open hemorrhoidectomy. Image reproduced from original with permission of the American Society of Colon & Rectal Surgeons.
Stapled hemorrhoidopexy. Image reproduced from original with permission of the American Society of Colon & Rectal Surgeons.
Transanal hemorrhoidal artery ligation (HAL). Marking of rectal mucosa at location of best Doppler signal to identify site for ligation of hemorrhoidal artery and subsequent mucopexy. Courtesy of SpringerNature, Springer International Publishing AG.
Hemorrhoids are swollen veins inside or outside the anus. They may be caused by increased pressure, such as straining when having a bowel movement or pregnancy. Hemorrhoids can cause pain, bleeding, clots, and itching. This handout tells you how to care for yourself after they are removed.
Take a sitz bath at least three to four times a day and after each bowel movement for several days. Sit in bathtub filled with 3-5 inches of warm water for at least 10-20 minutes. Do not add anything to the water Or use a sitz bath unit that fits over your toilet.
Sitz baths help you heal and lessen the pain of rectal spasms. For comfort, you may want to sit on a towel in your bathtub.
Avoid toilet paper. Instead, spray the area with warm water after a bowel movement. We will give you a spray bottle. You may want to use a handheld shower, or gently pat dry with a baby wipe, (free of perfume, dyes, and alcohol).
You will have yellow-red drainage for at least 7-14 days. Wear pads (free of perfume and dyes) in cotton underwear (use dye and fragrance free detergent) to monitor drainage. Change pads every 4 hours or as needed to limit wetness and prevent itching.
You may see more bloody drainage as you have bowel movements and become more active. You may have swelling at the anus with tissue sticking out from anus. You may also have a lump or skin tags grow around the anus. This is your body’s reaction to the incisions made at surgery. These lumps will shrink as you heal.
- Plan for rest during the day. Expect to be up and around doing light duties each day to keep up your strength.
- Change position often for comfort.
- No driving while taking opioid pain pills.
- You may resume sex when your doctor says it is okay.
- Check with your doctor before you return to work. You may be out of work longer if your job involves lifting or sitting.
After surgery, you will have pain. At first, you will feel numb in your rectal area. Take your pain pills before you have pain and take them on a schedule for at least the first 1-2 days to stay ahead of the pain. Taking acetaminophen (Tylenol ®) and ibuprofen throughout the day helps keep the pain at a lower level.
The first 5 days you will have a lot of pain. Expect to have pain with your first bowel movement. Do not hold off on having a bowel movement. Follow the urge to go when you feel it.
If you had banding, the bands fall off in 3-10 days. You will bleed and have more pain.
If you have stitches, they dissolve in 10-14 days. You will bleed and have more pain.
After 5 days you may have less pain. It is normal to see blood on your stool for weeks after surgery.
Buy the stool softener, docusate sodium. Take at least 2 each day. Take these if you use the opioid pain pills and until you have your first bowel movement. This will help stool pass more easily. Follow package directions.
Buy a bulk fiber laxative, such as Metamucil®. If taken every day, it can prevent hard stools. Follow package directions. Do not start until after your first bowel movement.
Drink at least 8 glasses (8 ounces each) of fluid each day. This helps you heal faster, helps your pain pills work better and can help prevent constipation. Drink enough fluid so that the color of your urine is light yellow or clear.
You may want to eat a soft or liquid diet until you have your first bowel movement, though this not a requirement after surgery. Avoid spicy and acidic foods as you heal.
When to Call
- Large amounts of bright red blood from the rectal area that does not stop with firm pressure to the rectal area for 10 minutes
- Fever over 100.4 F
- Foul-smelling drainage
- Excess swelling in the rectal area
- Problems passing urine
Who to Call
Digestive Health Center
(608) 242-2800 or (855) 342-9900
After hours, weekends or holidays this number will be answered by the paging operator. Leave your name and phone number with area code. The doctor will call you back.
If you are a patient receiving care at UnityPoint – Meriter, Swedish American or a health system outside of UW Health, please use the phone numbers provided in your discharge instructions for any questions or concerns.
Last updated: July 2021
Your health care team may have given you this information as part of your care. If so, please use it and call if you have any questions. If this information was not given to you as part of your care, please check with your doctor. This is not medical advice. This is not to be used for diagnosis or treatment of any medical condition. Because each person’s health needs are different, you should talk with your doctor or others on your health care team when using this information. If you have an emergency, please call 911. Copyright © 07/2021 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#4461