POST-OPERATIVE CARE INSTRUCTIONS:

These are instructions for post-operative care following your outpatient rectal operation. It is important that you read and follow these instructions for best results:

1. When you return home from surgery, we suggest consuming liquids or light food (soups,jello, etc.) if your stomach feels okay.

2. Keep the dressing that was placed on the wound during surgery in place for 4 – 6 hours. Keep an ice bag on the anal area for the first 4 - 6 hours following surgery. This will help reduce the amount of swelling.After that time, remove the dressing.

3. You may have a small amount of bleeding and/or drainage. THIS IS NORMAL. You can have some minimal bleeding up to 3 months after the procedure. Rarely, if the dressing is saturated with blood place a thin pad and sit on a frozen hotdog or peas. Reexamine the area for bleeding if you have more than a cup of clotted blood, at any time, from your rectum call me or my nurse. If you can not reach either of us head to the nearest emergency room so that we can determine if the bleeding will require additional treatment.

4. If the dressing is dry or a few spots of blood are present, you may begin to take hot baths every four hours for 15 minutes per bath during the first 24-48 hours following surgery. (The only dressing needed between these baths is a Kotex mini-pad or sterile gauze.) This will help decrease the pain. If you have little or no pain do the hot baths only after stooling to keep the area clean.

5. If you do not have kidney problems or an allergy the medication you have been prescribed is Toradol. You are to take one pill every 6 hours until they are gone. You will be given a total of 12 pills. These pills are for pain and for swelling. Even if you have no pain take them every 6 hours.

6. If you have pain take 1 - 2 tablets of your other prescription pain medication every 4-6 hours. Take the first tablets as the local anesthetic wears off. DO NOT wait until the pain is severe before taking the pain medication. It is best to take the medication with food or liquids. DO NOT drink alcoholic beverages while taking the pain medication.

7. If the pain is severe and not well controlled with other medications, you have been provided a prescription of either a cream preparation or a patch or possibly both prescriptions. The patch is to be used as directed and is left for 3 days. The cream can be applied around the anus or near the incision up to 4 times per day.

8. If the pain is increasing and you are having fevers, chills or sweats call me or my nurse.

9. It is important that you urinate the evening of the day of surgery. DO NOT wait until your bladder feels uncomfortably full. If you cannot urinate normally, try to do so either in the shower or bath tub. This will not hurt the wounds. DO NOT overhydrate yourself trying to urinate; drink only your usual amount of liquids.

10. If you have not urinated even by sitting in the tub or any other method within 6 hours of your procedure immediately call me or my nurse.

FOLLOWING DAY OF SURGERY:

1. Eat a regular diet as tolerated including plenty of oatmeal, fresh fruits and vegetables.

2. Take a hot bath after bowel movements but not longer than 10 minutes. (Remember that the only dressing needed between these baths is a Kotex mini-pad or sterile gauze. A small amount of bleeding and/or drainage is normal).

3. On the day after surgery, begin to take Metamucil, Konsyl or an equivalent bulk stool softener. Take one tablespoon twice a day, morning and evening. If you have had a large bowl of oatmeal you do not need to consume the Metamucil or Konsyl.

4. If your stools are too hard, you may substitute a 240 mg capsule of Surfak stool softener for one of the doses of Metamucil and increase your fluid intake.

5. If you do not move your bowels on any given day, take 2 or 3 tablets of Senokot at bed time. If you go 2 days without a bowel movement, or feel as though you need to have a bowel movement, take a Plain Fleet Enema.

6. If you are having diarrhea add more fiber to your diet or consume some Kaopectate.

GENERAL INSTRUCTIONS:

1. DO NOT drive if you are taking the narcotic prescriptions for pain following surgery. Also, DO NOT drive if you feel weak or lightheaded or are taking pain medication more often than every 6 hours.

2. NEVER mix pain medication with alcohol.

3. Except for your pain medication prescription, all medications listed above (Metamucil, Konsyl, Surfak, Plain Fleet Enema, Senokot and FiberCon) are available at your local drug store without a prescription.

Other Tips:

1. No rubbing - Only patting to clean or apply medications.

2. The local injection will last for approximately 2hrs.

3. As soon as you return to your home, eat and then take pain medications. Sit in the sitz bath or the tub, use only warm water (no less then 4 times a day).

4. Have the first bowel movement on the sitz bath if necessary. After cleaning, you may use a warm flow hair dryer for total drying.

5. Keep the anus clean and dry.

6. The first 2 days after surgery take pain medications as often as they are prescribed.

7. AVOID narcotics if possible; these are constipating (Vicodine, Codiene, Percocet).

8. There is 2 refills on medications. If per chance you need a refill call the office (602)-253-4271 Monday - Friday from 8am-4pm.

9. If you have some difficulty in urinating, this is not unusual, sit in a hot tub and run warm water over the palm of your hands. If the difficulty persists call the office.

10. Some bloody discharge is normal for up to 2 weeks to 3 months. Use the light day pads.

11. There will be some irregularities in the skin tissue around the area of surgery: this is swelling not hemorrhoids and shall be resolved in 6 weeks.

12. Remember- after surgery return to a regular hi fiber diet including oatmeal, fruits and vegetables. DO NOT think soups and jello are fine - they are not. Diarrhea and thin stools are as bad as hard stools and sometimes worse.

13. Drink plenty of juice and liquids; at least 6-8 glasses of water a day.

14. SENEKOT - S – is for constipation and if you are taking the narcotics regularly. Take 1 capsule A.M. and l capsule P.M. Take stool softeners ever day until you see Dr. McConnell in the office.

15. Mineral oil- take 1 teaspoon in juice every evening until you see Dr. McConnell.

16. Call to schedule an appointment for a follow visit for two weeks.

If you have any questions or concerns you may call me, Dr. McConnell at 602-743-3546 - Physicians Assistant Annie Moe at 602-361-9531, or my nurse, Kim at 602-373-5760.

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