Planning for Anorectal Surgery

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Female doctor recommends to fill in a medical document in the office.
Knowing what you can expect before, during and after anorectal surgery can make you feel more comfortable and confident going into your procedure. Read on for details about what you can expect.

What to expect before anorectal surgery

Most people have anorectal surgery on an outpatient basis, meaning that they return home the same day as their surgery. Your surgeon can perform anorectal surgery either at our outpatient surgery centers or UNC REX Hospital. If your surgeon thinks that you may need to stay overnight in the hospital after your anorectal surgery, your surgical team will discuss this with you when they schedule your surgery.

Preoperative testing

You may need preoperative testing before the day of your anorectal surgery. This testing confirms that you are healthy enough to undergo anesthesia (sedation) safely. If your doctor determines that you need preoperative testing, our Surgical Navigators will schedule this appointment for you. Preoperative testing can include drawing blood and imaging or other tests. You will also be evaluated by the Preoperative Assessment Team at UNC REX composed of skilled nurses and anesthesiologists.

Preparing for your anorectal surgery at home

Before the day of surgery, gather any stool softeners or over-the-counter pain medications that you may need after your procedure for recovery and pain control. The night before surgery, you may eat regular foods and liquids up until midnight, and then you should not have anything further.

What to expect on the day of your anorectal surgery

If your doctor recommends you take your daily medications on the morning of your surgery, you can take them with a small sip of water.

Arrive at the hospital at or before your scheduled registration time. After you complete the registration paperwork, our staff will accompany you back to the preoperative area. There, you will change into a gown, have an IV placed in your arm and meet with your nurses, anesthesia specialist and surgery team.

A member of your care team will take you to the operating room when it is time. We understand that having surgery can be stressful and even overwhelming, but rest assured that everyone here works hard to keep your experience as pleasant and smooth as possible.

After your surgery, a member of your care team will take you to the recovery area, where nurses will closely monitor you and help manage your pain while you come out from under the effects of anesthesia. If you are going home the same day as your surgery, your care team will provide you with detailed discharge instructions and answer any questions that you have. Once you have spent some time in a recovery room, awaken from anesthesia, and your pain is under control, you will be able to go home.

What to expect after anorectal surgery

We have provided general instructions here, but each person’s care plan is different. Your surgeon and care team will provide you with details on your specific recovery plan and make additional recommendations before you are discharged from the hospital.

  • Have a responsible adult stay with you the night after surgery.
  • Walk several times daily to promote good circulation. If you need to stay overnight in a hospital room on the surgical floor, nurses will get you up and walking within four hours of arriving to your room.
  • Once you’ve returned home, you can drive a vehicle as long as you are not taking any narcotics (opioid pain medicine) and you feel comfortable doing so. You should never drive if you are taking narcotics.
  • You may return to work when you are comfortable with your healing and your pain management. This timeline varies for each patient. If you need a return-to-work note, please call our office during business hours, or ask at your postoperative visit.
  • Drink plenty of water (six to eight glasses daily) to stay hydrated and keep bowel movements soft, especially if you’re taking opioid pain medications. You can tell if you are properly hydrated if your urine is clear or light yellow. If your urine is dark or tea-colored, you are probably not drinking enough water and should drink more.
  • You may eat a regular diet.
  • Do not drink alcohol within 24 hours of being under anesthesia or if you’re still taking narcotics.
Bowel movements

Initially, you may experience pain and a small amount of blood when you have a bowel movement. However, these symptoms will lessen with time as your wound heals.
Especially if you are taking opioid pain medications, follow these tips to avoid constipation after surgery:

  • Take a daily fiber supplement, such as Citrucel, Benefiber or Metamucil. Make sure to drink plenty of water with any fiber supplement; otherwise, you can become constipated.
  • Take Miralax – a gentle laxative – once or twice daily.
  • Take Colace – a stool softener – two to three times daily.

Note that if you have an ileostomy or J-pouch, the tips above do not apply to you. Instead, you should follow the specific directions that your care team provided at your surgery.

Wound care

Your care team may give you specific instructions for wound dressing care, but, in general, it is a good idea to keep a dry folded gauze in the area around your anus to absorb moisture. You should change this gauze daily.

Expect some light bloody or yellowish drainage from the surgical area, which should decrease as time passes.

You can apply ointment – such as Vaseline, Aquaphor, or antibiotic ointment – to the area around your anus for comfort. You can also use Dermoplast or a benzocaine spray or RectiCare Lidocaine 5% ointment, which you can find in the wound care aisle at a pharmacy or grocery store. However, if your surgeon used Exparel during your surgery, you should not use Dermoplast or RectiCare (or anything that may contain lidocaine) until five days after your procedure. Your care team will advise you of this situation if it applies to you.

Pain control

Your surgeon may prescribe one or a combination of the following to help keep you comfortable during your recovery:

  • Acetaminophen (Tylenol). You can take this every four to six hours; do not take more than 4g (4000mg) in a 24-hour period. Do not take this medication if you have liver disease. If you were prescribed an opioid pain medication that contains acetaminophen, be careful to avoid the maximum dose in a 24-hour period. Ask your care team or pharmacist if you have questions about safe dosing.
  • Anti-inflammatories or nonsteroidal anti-inflammatory drugs (NSAIDs). You can take an NSAID such as Ibuprofen, Advil or Motrin every four to six hours. Do not take an NSAID if you are on a blood thinner, have kidney disease, have gastric ulcers or have been otherwise recommended not to take it.
  • Heating pads and ice packs. You can use these at home to help reduce your pain at the incision site(s).
  • Washing with warm water. You can take a sitz bath, tub bath or shower after every bowel movement and as often as you would like. Sitting in warm water helps many people control pain after anorectal surgery better than any medication. You can also use Epsom salts in a bath, but they are not necessary.
  • Narcotic pain medications (opioids). The surgeon will prescribe narcotics in some cases. If your surgeon determines that you need opioid pain medication, they will prescribe it at the time of your surgery. You should only use these strong, but highly addictive medications for breakthrough pain control after you have taken the non-narcotic pain medication listed above, and it is not working to control your pain.

You should only need opioid pain medication for the first week or so after surgery. After that, use them sparingly as they can cause constipation and addiction. Only your surgeon will prescribe narcotics; on-call providers or after-hours staff cannot refill a prescription, so please plan ahead. See here for more information on our Narcotics Policy.

Follow-up care

When you are discharged from the hospital, your care team will provide you with the date and time of your postoperative visit (approximately four weeks after your surgery). If you do not receive this information, please call our office to schedule this appointment.

If you experience any of the following, please call our office immediately:

  • Fever over 101 degrees F, or a fever that does not come down after you take acetaminophen (Tylenol)
  • Inability to urinate (urinary retention)
  • Pain that you cannot control with the management tools listed above
  • Persistent bleeding (soaking through pads every hour)
  • Prolonged nausea or vomiting