Hemmeroidectomy Walk Thru - hope this helps you

Hemmeroidectomy Walk Thru

Ortisan (2 packs)

Prunes (250g)

Cotton Wool pleats / panty liners (1 pack)

Bleach (2 bottles)

Arnica Gel (eg Atrogel by A Vogel)

Porridge oats

Soup (home made 14-21 large servings or cartons)

Salad vegetables

Beet root 

Yoghurt (14-21 500g tubs)

Yakult x10 pack

2L bottle of water (can be refilled from tap or filter jug)

A few extra clean towels

A bunch of soft cushions

Extra under wear

A back brush

Shower head with adjustable stream

Turmeric (powder or root)

Small plastic bowl

Calc Fluor

Multi Vitamin

OK you've got piles. I am a 44 year old male approaching the end of the third week post op for 3rd degree hemmeroids. I had become borderline 4th degree which prompted the move toward a more permanent resolution of symptoms. In total two hemmeroids were removed, another was ligated (falling out a few hours after the op) and a fourth injected. The following suggestions are made based on my experience of managing the condition over a few decades and undergoing the above procedure.

For reference I was at the 3rd degree for 10-15 years and had become quite comfortable with it. I had and have what I would describe as a healthy diet living without red meats since the initial reports of BSE in the early 90's. Processed and prepared food forms the minority of my intake. Occasional itching would annoy me and manual reinsertion would occur once or twice a month often less, with no problem. I found that Calcium Fluoride (Calc Fluor) pillules were extremely effective in reducing symptoms and general management of symptoms. I also noticed it working for friends and acquaintances I recommended it to. Calc Fluor is a skin salt which it is said increases the elasticity of the veins. However changes in European Law made off the shelf supply illegal last year (2013) and so I had to resort to asking a naturopath chemist to make up a prescription. This inconvenience contributed to my 4th degree episode which I think was triggered by accidentally consuming a more than usual amount of chili powder. Oven baked chili powder lends a wonderful aroma and warm taste to food. Unfortunately I failed to notice how much I had sprinkled on my lunch one time and to make matters worse sort of inhaled it through my mouth which resulted in a bit of a coughing. The next morning symptoms reached what I understand are the 4th degree and I spent a very uncomfortable hour or so wrestling myself back to 3rd base. That was the last straw.

Following a GP and referral appointment I opted for surgery after it became clear my piles would not clear up on their own. I did not consider any kind of manual/physical plug device. It was not suggested to me and I don't believe it is available on the NHS. You may wish to investigate this yourself before opting for surgery. I did and here are my suggestions to anyone undergoing surgery:

3 - 5 days before your procedure you need to begin preparations for taking at least 2 - 3 weeks off work and off your feet (depending on the severity of your condition). If you intend or have no choice but to recover on your own or will have someone around to nurse you, either way I would recommend:

1) you stock up on soup and yoghurt and also get in the bare essentials I have suggested above. If you can make your own soup that is excellent. I suggest you add the turmeric (teaspoon to each serving). It's very good for the gut. Plain or flavoured yoghurt is good either way - try and go for live culture yoghurt. You'll be on fairly strong antibiotics for about a week and will need all the help you can get bringing your stomach flora back up to healthy levels.

2) if you can find or make a comfy place for yourself to lay down and rest close to your bathroom do it. Ideally this will be off the floor - perhaps a couch or similar can be temporarily moved into place.

3) about 3 days before the op start taking the Ortisan (go from a 1/2 to a full one) and reducing the size of your meals. Porridge with fruit and nuts is a great food for keeping you going throughout a day. Perhaps also switch to eating mixed salads, cottage cheese etc as an evening meal. I would suggest upping your water intake and get your gut moving soft and strain free stools. Your energy levels may alter a little which is to be expected. You basically want to reduce the volume of your stools down IMHO. The opiates you'll receive during the op will slow you right down anyway so you want to make life easier for yourself once you wake up.

4) try and time your last bowel movement to just before you go under. This is perhaps more a matter of luck but if you can get into a predictable rhythm in the days running up to your op it will help. Certainly you may not want to eat anything after 10pm the night before if you are expected to be in the ward early the next day.

5) after you wake up and before you leave the recovery ward ask yourself how much pain you can feel. If it feels like someone may have just kicked you hard in the backside and or between the legs ask the nurse for a shot of morphine. If you are firm and polite you'll be given a dose orally. This will dull the pain a bit and help spin the first day out. As a result I left the ward when it closed at 8pm. If you are doing this on your own you may want to opt to stay over for the night. This is in your patient rights but will doubtless involve a hassle of changing wards so I wouldn't recommend it. So long as you pee before you go home they will let you go. Don't expect a BM anytime soon. Check that you leave with some lactulose and movicol in your set of meds. If you are there all day, as I was, take some lactulose while you are there. Later I combined this with the Ortisan to no ill effect and I wouldn't have minded starting that sooner rather than later. In retrospect I would have taken it in the run up to the op. Nb: The lactulose/movicol and Ortisan (fig and senna) work in different ways. Once you have been awake for a 5-7 hours if not sooner start sipping water. You need a minimum of 2L per day. Just try and relax.

6) once home resist the urge to resume food intake at anything like your normal level. If you haven't already searched YouTube for hemmeroidectomy and watched a few ops do so now. It will help you understand the process of recovery you are about to undergo. Don't bother removing the wadding taped to your backside for 12-24 hours, you will be seeping mix of blood mucus and faeces in reducing amounts for a while. After I removed it I switched to toilet paper (changed every few hours) for the first 3-5 days then onto cotton wools pleats for the remainder as the flow decreased.

7) you might want to have enquired with your surgeon how he/she operated. Mine used a laser to cauterise the wound but others may use staples. This perhaps depending on the health authority etc. Either way won't make much difference - you will be advised not to push afterward. Listen to that advice. Since pushing will probably have got you into this position this may be a bit difficult sensation to fight. I didn't have a BM until day 4 or 5. The anxiety attached to this is most of the problem. If you are male your pain and stress management will need to take into account that the prostate gland is very close to where your surgeon will have been 'rummaging around'. You may be well advised to google the location of your prostate if you are not aware of its location. I'm sure the prostate isn't used to any sort of contact similar to that resulting from such an op. So it is understandable that it will ache. It sits in a nerve plexus which will undoubtedly be traumatised from the pushing pulling etc of the hospital team. I found that much of the discomfort I felt resulted from this area more so than my anus. There being little or no nerve endings inside the gut seemed to support this. In any event for the first two weeks peeing, farting and defecating all felt equally painful.

8) I only started taking the Ortisan 4-5 days after the op once I remembered its beneficial effects. I was not impressed with either movicol or lactulose. Although they do soften the stool. They don't work on relaxing the muscle as Ortisan's main ingredients do. They can also be a bit acidic. I took them both together as mentioned to no bad effect. By day four I was googling about first BM as I was getting concerned after moving up to 6 movicol per day without any result. Your first BM can become a bit of a focus. By this time I was taking a lot of full and sits baths with the water really quite warm. I was also using the shower head to direct a jet of water on to my perineum. This seemed to counter act the pain and reduced my discomfort immensely. My first BM was taken laying in the bath with a warm jet relaxingly directed around my aching sphincter. I am not ashamed to say the plug was in and I had already urinated. It was fairly vocal too but by that time I was past caring and I was in the best place to get cleaned up afterward. This was where the little plastic bowl came in handy. If you live in a tiny flat as I do, you will probably find you can easily gather up your turd in the bowl and transfer it to the loo while still in your bath. If not then you'll need to make other arrangements. TBH having to poop on the loo was impossible so I jettisoned my pride and got down to it in my bath. Things can be worse.

9) live in the bath. Water, the shower head and the little bowl are your friends. By the end of the first week I was taking 3-4 bath/showers a day and spent upwards of 8 hours in the bath (feet out, thighs and backside submerged) at a time. I definitely needed the extra towels. Soup and yogurt were my dietary staple. Thankfully I had an iPad and could watch TV and movies in the bath. When I got a bit better I would pee in the bowl and empty it into the WC thus changing the water and cleaning myself and the bath less often. 

10) moving out of the bath took about 10 days maybe more and I often returned for soothing douches after a BM, fart or pee. I was eating soups and yoghurt but only a carton of each per day with a multivit, yakult and Ortisan once a day too. I found laying on my back and peddling my legs helpful. It exercises/massages the bowel and sphincter a bit and if you put something soft under the base of you spine it can be done in the bath to help a BM in the early days too.

11) During week 2, I rediscovered arnica in gel form. This really helped in untangling and soothing the jangle of nerves under my perineum. These nerves appear in Grays to surround the prostate and seem definitely connected to the area that was operated on. The arnica feels a bit similar to Deep Heat (another preparatory ointment) but is much less aggressive. I cannot recommend the later but the arnica, despite an initially overly warm sensation, gave out a lasting, comforting and restful glow and helped the nerves down there re distinguish different sensations. This helped me manage the discomfort associated to the op. 

12) by the start of week 2 I was so clean that my nose had become quite sensitive to the certain smells. So whenever I was out of the bath I would but some bleach down the plug hole making sure to flush water down when I came to go back in. I was also using a slightly perfumed body lotion just to make things smell even more rosey. Having a shave after a while helped me feel normal. If you are on your own you want to have frozen soups stocked up (at least 14-21 cartons split between the fridge and freezer and also an equal amount of yoghurt. Don't worry too much about eating more than that every day - you won't expire and basically will want to rest your bowel while keeping it 'ticking over' as you heal up. Being on your feet for any amount of time may seem out of the question as it was for me. Peddling on your back with your feet in the air helps, as did short walks around the flat. Putting you legs and feet up above the level of your heart/shoulders will also help reduce the throbbing as can shoulder stands if you are able. Once in a shoulder stand peddling and splaying your legs and other slow movements can help reacquaint your body with itself. 

13) hopefully by the end of week 3 you'll be very firmly back to pretty much normal. Pooping may still likely sting and may need to be followed by a bit of aqua therapy courtesy of the shower head and a warm jet on the perineum or a hot sits bath. As the anaesthetic and morphine can take upwards of a week to leave your system the nature of your stools, which may as I have said can become a bit of an obsession, will probably be stiff or impacted at the front. As a result they stay intact when they are in water. This makes removing them to the WC via the bowl a fairly easy task. You may find, particularly if you start taking the Ortisan earlier than I did, that this isn't the case. When it started working on me there was a noticeable difference to the structure of my poop and using the WC became preferable. If you have seen the movie Shawshank Redemption you may find yourself relating deeply to the lead character by this time but remember freedom awaits. Sorry if that's a spoiler for you.

14) take the pain killers (I had codydramol) as long as you feel like it. TBH the codeine part seemed to slow my gut so you may not find it helps across the board. It's pain relieving effects were not a patch on the either the immediacy of a hot bath/warm jet of water or the comfort of the arnica gel but it obviously comes down to personal experience. Try and stay away from overly acidic fruit such as oranges for example as these can sting a little. By e/o week 3 you should be alright on your feet for short lengths of time but don't expect much. If you have to go out perhaps take a folding stool. You may also, again depending on the legislation where you live, find that vaporised THC helps you manage your levels of pain. Despite such issues I found its effect quite extraordinary and would place it well above the warm bath/shower/arnica. However having a range of options is best and vaporising THC does require specific equipment and a certain amount of pharmacological deregulation.

15) in a short addendum to the above: women may find the use of arnica gel around the perineum uncomfortable due to proximity of the lady garden. However I think in such cases its use may be unnecessary due to the physiological differences between the sexes. In particular the absence of a prostate type gland that close to the area operated on. In my experience the connection of this gland to my gonads played a significant part in understanding and managing the level of pain I experienced. Either way, who ever and whatever you are, try and keep your environment as calm and as quiet and relaxed as possible with little or no unexpected visitors for at least 2 weeks. Be patient with yourself and those around you. Keep away from processed foods like bread and sweets although an occasional bit of chocolate and spoon of ice cream will be a welcome treat. Find a bunch of books and stuff to do while you are flat out for a fortnight, an iPad or tablet PC makes for a great distraction. Remember don't really contemplate driving for a week and learn not to push going forward. As of now I think I am definitely out of the woods so I am relaying my experience. If you have sudden bleeding of course contact your doctor or go to A&E immediately. This is unlikely, because the success rate of this type of op is so high you will need to be a fool or have desperately poor karma for things to go bad. Chin up, keep smiling. It will be a memory soon.

I hope this helps you get through a fairly stressful experience quickly. Bon fortune.

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