32yo M 2x hemorrhoidectomy experience / tips

Currently writing this on day 3 following my second hemorrhoidectomy, 13 months after my first, both on the NHS (technically the contracted company Circle Health). Told myself I'd write one of these after the first op, and it's now fresh in my mind + got a lot of free time so here I am!

TLDR: Experiences like these were particularly helpful for me:

https://www.quora.com/How-successful-is-hemorrhoid-surgery-1 (this explains why 2 ops)

https://patient.info/forums/discuss/haemorrhoidectomy-sharing-the-experience-497818

And in order of priority:

1. Do regular, healthy bowel movements. Do not hold it in or put it off. Drink plenty of water.
2. Warm water is a godsend, from the shower head or in a sitz bath. Just use it whenever and for however long you want. Have it warm + ready so you can transfer straight from the loo.
3. Be gentle with yourself and 'listen' to your arse. Everything will take longer and you'll be walking stiff like an old man but don't rush, and let your recovering body dictate your daily routine rather than you pushing it as you're used to. Need to sack off the evening to get back in bed? Fine. Family member needs the loo but you're hogging the bath? They'll just have to go in your presence. You're only going to be 'useless' for a few weeks and you don't want to set it back because you're impatient getting dressed or won't ask someone to pick something up for you.

And now my experience(s):

BACKGROUND

I'm in this position because I had constipation type issues a lot while younger and ignored the warning signs (bleeding, stage 2 prolapsing). Probably inherited poor digestion from my mum with Crohns, but exacerbated it with a diet of coffee, alcohol (= chronic dehydration) and evening junk food through my 20s. Come my late 20s and I'm pushing them back in after every BM, sometimes they won't stay in, they keep flaring up with soreness and I'm basing my socialising around how long I'm going to have to stand for and how hard the chairs will be.

So I went to my GP when it started actually keeping me from work, they gave me lactulose to get me regular and told me to eat + drink properly. You may need to do this before they let you have the op as the hems will return without those good habits, and you don't want to go through the op if management will suffice. You'll certainly want your regular, healthy bowel movement routine to be established by the time of the op. For me that means strong black coffee and a few bran flakes every morning to get things going; my body now 'expects' this and it makes the worst (but most important, see above) part of recovery more predictable. (Also I eat a lot of veg/fibre and drink a lot of water through the day which is also necessary, fibre intake in particular though you shouldn't just 'spring' on your body immediately before or after surgery, it needs building up over time beforehand).

The healthy diet allowed me to put off surgery for another couple of years but it was still ultimately a drag on my life (and actually getting me down more than I acknowledged at the time - I am one of many who say "why didn't I address this sooner?"). So I went ARMED WITH A VIDEO TO SHOW THE GP OF MY HEMS at their worst state i.e. immediately post-BM. I'd had a few appointments and a proctoscopy in between where it seemed the doctor wasn't appreciating how bad they were, because in my case they didn't always look that way. If you "wish the GP could see how bad it gets when they're not there to inspect it", take a video and show them. When they saw the extent of my prolapsing and heard my now very cut-down, clear, and frank description of what I was suffering from they waved me through to a surgeon's appointment. GPs are too busy nowadays and trying to do quick assessments based on imperfect information. If you come armed with a clear (internet educated) understanding of what's wrong and what outcome you're after, it increases their ability to make the best decisions for you. I am not saying at all that you should 'override' them or you can't trust their judgement, quite the opposite, but it took me a few goes to learn what information best helps them make that judgement, and how to give it to them clearly.

The surgeon also saw that video, inspected me, rated my hems as severe and warned that the shape of my hems can complicate treatment options. They formed a circular doughnut all the way round which prolapsed out mostly during BMs, so not the classic long 'polyp' hanging out but instead loose skin all the way round my anus which would balloon up, get trapped, and become a nightmare every few weeks. These are complicated because the integrity of that perianal tissue is very important - surgeons worry about causing incontinence or stenosis if they just hack it away. It turns out I had the internal hems too, and these need removing separately from the 'secondary' perianal hems / skin tags to avoid too much thinning of skin / scarring all at once. The top link above describes this and is why I needed two ops.

The first line treatment was banding of internal hems although the surgeon warned mine were probably past that point, and he was right. They were bad as ever after a couple of months so back I went (another negotiating-the-NHS tip: these surgeon appointments were booked many weeks in advance, so don't put off going to the doctor on the assumption that things will happen as soon as you've told your GP you've had enough. There may well be months of waiting for appointments and the eventual surgery. Get the ball rolling sooner rather than later).

SURGERY

He recommended the standard "open" (Milligan-Morgan) hemorrhoidectomy, but I was afraid of the painful recovery and having heard of the newer HALO (Haemorrhoid Artery Ligation Operation) I asked for that instead. He said he wasn't sure of the appropriateness of that for my hem shape but transferred me to a surgeon at Circle who could do it.

On the morning of the op I met that new surgeon who persuaded me away from HALO. He said that for all the quicker and relatively painless recovery HALO promises, the excess hemorrhoidal tissue that would otherwise be removed needs to be stapled back up inside. 'Early adopters' are now coming back 1-2 years later having initially recovered fine, with complications from the stapling such as its breaking away from the rectal wall that needs repeated reconstructive work. By contrast the standard "open" procedure is incredibly well practiced and potential complications thoroughly understood + minimised. By that point I wanted whatever most decisively solved the problem so Milligan-Morgan it was.

If you've never had an operation before, a) everyone's dead keen on making sure you're the correct patient, that you can describe them what op you're expecting to have, and you have no risk factors like loose teeth or drug allergies. You get asked the same questions over and over again, and they confirm with each other that stuff in theatre at the beginning just to make triple sure everyone's on the same page. It's a well oiled machine that's very mistake-averse. b) General anaesthesia just feels like nothing, not even a 'blank spot' in memory. One minute they're telling you to breathe deeply and the next minute they're calling your name to wake you up. In between they will have pushed a breathing tube down your throat and taken a knife to your arse, but you will not have to 'experience' any of this at all. In fact the drugs take awhile to wear off so you'll wake up feeling pretty fine if not slightly chipper relative to the apprehension going in. As the link above says though, this is a lie, the pain will come once the anaesthesia wears off.

The surgeon described what he'd done very shortly after I returned to my cubicle and I was still coming round really. I could have done with a dictaphone or third person writing it down as he was trying to explain what he'd removed and why he couldn't do it all in one go (see above) while I was, it turns out, about to faint from not eating and general shock to the system (+ my fairly low blood pressure). Biscuits and hot chocolate with added sugar sorted that right out, and for my second op I warned the nurses this might happen so they had something sweet and a drink ready for me.

I got picked up and went home to bed to sleep off the anaesthesia. They prescribed me paracetamol, ibroprufen, dihydrocodeine, senna (laxative) and an anti-emetic. I only used the first two because opiates cause constipation (again, regular healthy BMs are most important), I've found laxatives to be too harsh on my bowel like the second link above, and I didn't get nauseous. But the ibroprufen and paracetamol were very useful. Like several others, I ended up taking them before bed to sleep better, and about an hour before I was due to go to the toilet (i.e. when I woke up) so they kicked in ready for that. But otherwise "listen to your body" applies, I took them when I felt I needed it, this was coming up against the daily dosage limits in the first few days but fell back to only occasionally after a week or so.

My recovery following both the first op and this one (so far) have been similar. In the first couple of days I felt "rough" like I'd just been drugged and injured. My GF said I looked pale. On days 2-5 I shuffled round the house a little, mainly in the living room rather than bed-bound, but returned to bed if it was too painful to sit, after bowel movements, or just when I felt like I wanted a rest. In the first 48 hours or so that whole area feels inflamed up like a cricket ball behind your gooch. It ranges from dull ache like you've been kicked hard, up to sharp stabs like there's an open wound in there being shifted about (there is). Right now I am sitting sideways on one cheek in my armchair. After 3 days it still feels tender/sore but the inflammation is down.

My approach to that whole area is to just accommodate it and not interfere with it while it recovers, but keep it clean. If it gets too sore I take a lukewarm shower / sitz bath. Often I will have several of these in a day, it is at least as helpful as painkillers, I'd say more so. I don't put anything in the water except bath salts and I don't touch or wipe the area directly, just wash with clear running water. Afterward I dry it with a cool hair-dryer, again because keeping it clean + dry is important but you don't want to be rubbing it with towels.

I leaked blood and mucous for several days (still am now on day 3) and you risk ruining clothes and furniture unless you keep absorbent padding in your underwear. Lots of people seem to use sanitary towels, I am using a little surgical tape to keep kitchen towel in place while I shuffle about. I replace it several times a day to keep things clean. I bought several extra packs of boxer shorts and have thrown a few away already. I am wearing tracksuit bottoms with a comfortable elastic waistband that I similarly don't mind messing up. Again, you want to focus on being comfortable and recovering, not having to worry about things like messy clothes.

After 2 weeks following my first op, I was basically walking around like normal and debating whether to go back to work. I probably could have done except for the risk of a 'difficult' bowel movement at work - I wasn't quite ready to forego the shower and sitz bath in case I needed it, or being able to shout a bit during the act itself without worrying anyone. After 3 weeks I was definitely OK though and way too bored to stay home any longer. I walked gently and didn't exercise or lift anything for a couple of months after, to be sure. If I'd gone back to heavy lifting on day 1 of return to work I probably would have busted it all open again I think, but I was perfectly capable of walking 20mins there/back and doing a desk job. There were no painkillers or painful bowel movements by that point.

Bowel movements post-op

This gets its own section because I found it the most painful but necessary part of the recovery process. You use that part of you a lot, and it needs to heal up in the circumstances under which it will be used. If you don't go regularly even while the wound is fresh and raw, you risk bad scarring and stenosis. My surgeons were not so worried about incontinence (a concern of mine but now very rare), or operative complications, but they repeatedly warned of stenosis. If the canal heals up too tight through scarring or insufficient tissue left behind, you're looking at repeated and possibly doomed attempts to rectify it via graded 'dilators' (they are what they sound like) fighting the tissue's tendency to re-scar back up. Get your new arse accustomed to its job early on.

This is an issue because it hurts so much people can become basically phobic and avoidant of going to the loo. The laxatives can serve to force it in the first few days. You cannot afford to hold it in and become constipated, because the effect on your (attempted, eventual) bowel movements is antagonistic to recovery and surely much, much worse. The ideal opposite is a body thoroughly used to vegetables, fibre and hydration, with that diet - less fatty and refined foods, probably softer e.g. slow cooked - continuing after surgery, and the regular pattern of soft, effortless BMs therefore following. A maybe gentler version of your usual roughage diet basically.

Another thing that lowered the fear factor for me is arriving at a post-BM 'routine' which I knew was optimal for bringing the pain back down and which (although it might take awhile sometimes and longer initially) would always bring it to a close eventually. Then the event itself is ideally just a smooth, predictable and decisive element of a longer process otherwise made of relief. Probably for you the exact steps will differ, again "listen to your body" and accommodate it etc.

So I've doubled up ibroprufen and paracetamol about an hour ago, eaten my bran and drank my coffee, and I can feel the usual urgency. I take my clothes off and start the shower on lukewarm. I do the deed by 'letting go' not 'pushing' at all, one great check I've read on here is you need to be breathing through your mouth, not holding your breath. These are all good habits you'll need to continue anyway, so again good to have down before the op. I shout/scream a bit especially in the first few days - easier to just do it than stifle/worry, and the GF's usually out at that point in the morning anyway. It will bleed, and surgical packing/gauze will probably come out the first time.

I don't attempt to wipe with anything but transfer straight to the shower. Might still be bleeding at this point but if I'm done I'd rather have the water stemming it than be sat there waiting in pain. Eventually I will sit down in a sitz bath. Whatever combination of shower head and bath then continues until I'm done/bored.

In the first few days my behind is still too tender to sit down following that, and it can be draining, so I dry off (as above), reapply clean padding and go back to bed for a little bit. And that's it. That's the most taxing bit of the day over with.

For me it was worst initially and got/gets better every day. It sounds like for some their 'worst' is the second or third day in

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