Rafaelo Procedure - Recovery Diary

Hi everyone, this forum has been a god-send during my Rafaelo procedure recovery and I wanted to give something back, so apologies for the length and graphic descriptions of my back-passage's activities over the last couple months but hopefully this will give you something to hold onto while you get through a physically and psychologically trying time!

Apparently Rafaelo isn't yet available, at least not widely, in the US so it doesn't get much coverage online, but in Europe it's becoming more common and it's now available on the NHS in the UK.

I'm early 40s and suffered from 3 grade 3 haemorrhoids for 15 years. Went for banding 9 years ago which did nothing except make me extremely uncomfortable for half a day. The horror stories around haemorrhoidectomy guaranteed I would never go down that road, so once I heard about Raf I started going through all the hoops required to get it done on the NHS.

Annoyingly, I had to wait 3 months to even find out when I would be treated, and when I finally heard my waiting time it was a further 3 months away. In that time I suffered mild food poisoning which, for the first time in 15 years, turned the 'roids permanently painful from all the extra toilet visits. There was no question, I had to go private and it would cost just under £3,000. Ouch.

Based on reading these forums, I booked myself in at The Whiteley Clinic in London the following week, and was seen by Mr Armyn Haji, who seems to be a minor celebrity around these parts. I immediately saw why, he was extremely professional and his bedside manner was just the right balance of sympathetic but also professionally detached, and knew how to distract from the massively embarrassing business of having your back-passage examined/probed/operated on.

He examined me and said although I was almost too far gone for Rafaelo it would be worth trying and offered to treat me that afternoon. The fact that there is a possibility of being 'too far gone' should be a warning - if you've got internals and you want to avoid haemorrhoidectomy then act sooner rather than later.

So, here was my experience...

Day 1 - procedure was moderately painful. Surgeon injected anaesthetic and roasted each of the 3 large ‘roids until I said ‘ouch’, then he’d back off. He did this a few times to each ‘roid then cooled down each one with a cold gauze. It’s uncomfortable and I was using the squeezy he gave me through the whole thing. Apparently one of them shrank considerably almost immediately. If you’ve seen the YouTube videos of the procedure then it’s remarkably less painful than it looks.

Afterwards there was a dull ache and mild soreness for rest of the day, nurse gave me two paracetamol. It ‘feels’ like you’ve had internal surgery in an area with few nerves - it’s uncomfortable and tender, and I feel a bit weak. Pretty much exactly as you’d expect! Alternated paracetamol and ibuprofen every few hours.

Much less pain than when I had banding, after which I kept feeling ‘urgency’ - needing to poop even though there’s nothing there. Surgeon said I might feel this with Rafaelo but haven’t so far.

Night 1 - woke up twice from pain, took one paracetamol the first time, one ibuprofen the second. Surgeon also prescribed me Diltiazem cream which loosens the involuntary sphincter muscle, which in my case was unusually tight (I guess I’m a literal tight-ass)

Day 2 - First BM. Used a ‘squatty potty’ and leant forward, clutching the sink, telling myself ‘don’t strain’. The good - none of the excruciating pain I was expecting. FINALLY didn’t have a bulging cauliflower of flesh to push back in, my back passage just closed up in its own, something I haven’t experienced for 15 years. Already the ‘roids have been shrunk massively.

The bad - despite feeling (and sounding) like I was passing a thin, medium sized stool, there were only two small bits of crap in the bowl. I sat there for about 5 minutes waiting for the rest. I have no idea if the post treatment war zone that is my sphincter ‘imagined’ they were a normal sized turd because it’s so sensitive down there, or if I did pass a medium poo and it somehow bypassed the thin slice of toilet paper I always lay in the water to avoid splash and snuck down the pipe..??

One possibility is that the pain meds have given me constipation, which would be unusual for me since I have mild IBS and nearly always pass overly loose stools. In which case there could be some nasty surprises coming. It ‘feels’ like I’ve had a morning dump but… did I? I’m now scared something is going to burst out unexpectedly in Sainsbury’s.

All in all I’m extremely relieved that there was only mild discomfort on my first BM.

Three hours later I needed the toilet again. I braced myself for extreme pain but it was similar to last time - discomfort and a sensation that I was passing something ginormous and hot. Looked in the bowl and two small pale brown slugs was all that fell out.

Normally I’m one and done so I’m not sure why my bowel is insisting on multiple small instalments. On the one hand it’s preventing me from passing anything huge and hard that could cause damage, on the other hand it means more frequent stress-sessions. Not sure if it’s a blessing or a curse.

Update: had two more of these, totalling four BM’s on Day 1. All were uncomfortable, like I could sense the roasted coagulating haemorrhoids as stool passed through, but none were especially painful.

Day 3 - After a good night’s sleep aided by Night Nurse, I had a sudden urge to ‘go’. I scrambled to get an ibuprofen down before the show began. I set up the squat pot, clenched the sink and leant as forward as possible. This thing ‘felt’ long, hot and with ‘fatter’ parts, probably took a few minutes to evacuate, including a ‘break’ when nothing was coming. Definitely bigger than before but, once again, little evidence in the bowl.

It was very uncomfortable but not exactly painful, the pain came afterwards, a lot of aching and some stinging as everything ‘resets’ down there. It took another ibuprofen and lay in bed, the pain wore off after about an hour, pain rating of 2/10.

Things that help during BM - try to avoid dry wiping. I use a portable bidet which is a mini shower (like what they use in India), you fill the base with water, aim the head at the area and squeeze a showery spray all around. Then I use folded up toilet paper dipped in water to dab away anything offensive. Then I use an Anusol wipe to apply the cream around and just inside. Then eventually a warm bath which relaxes everything and cleans away the crime scene.

Update: by the end of Day 3 I’d had 3 BMs. The final one was my first actual proper full evacuation since the Rafaelo procedure. It was uncomfortable but not painful, and hugely relieving. Clearly my body was trying to avoid passing anything as a response to the trauma down there, but it couldn’t hold out forever. General pain throughout the day has also reduced, I only needed one ibuprofen all day. I don’t want to speak too soon but this is my first glimpse of light at the end of the tunnel. I’m still weak, fragile and afraid to commit to anything lest I get another surprise attack and have to rush to the nearest toilet.

Day 4 - slept well with the aid of Night Nurse, urgently needed toilet at 8:30am and not much came out, then had a persistent ache (pain rating 3/10) for an hour or so after, needed Ibuprofen to calm it down.

Went back to bed and slept another 2 hours. That’s about 10 hours total which is very unusual for me, I guess most of the healing happens when you’re asleep and that’s what my body is craving. On waking I needed the toilet again and this time was a full load (which bodes well for later) and minimal discomfort.

Update: two more bathroom visits. Right now everything is bearable except the constant urgent need to crap. Hoping this calms down!

Day 5 - heavy sleep. One BM in the morning which left a persistent 3/10 ache which needed one ibuprofen. Tried to leave it for an hour to give the painkillers a break but it just becomes unbearable and you can’t concentrate on anything so I caved.

That was my first and only BM of the day, and I felt ‘normal’ for the whole evening which was great. Started eating solid food again, actually trying to bulk up the stool (to avoid too many BMs per day) while still keeping it soft with Fibre tablets and Kefir.

Day 6 - bit of a step backwards today. 4 BMs, the third was at 10pm as I was watching the final moments of a film. Rushed out and struggled with a solid BM with lots of hard ‘pebbles’, it never felt finished despite nothing else passing. I didn’t want to sit there forever and add more strain so wiped up and was in pain for another hour until more wanted to drop. It’s now after midnight and I’m praying that’s the end of it. 3/10 pain but very persistent, a throbbing ache that won’t end, I’ve taken an ibuprofen. Might go back to soup tomorrow.

Noticed that after these difficult sessions there’s some prolapsing - much less than when I had the ‘roids but having to push ‘stuff’ back in again.

On the plus side, during the day I felt less tired and was able to shop, get a haircut etc with no discomfort.

Day 7 - 2 BM’s. First one is always painful for a couple of hours after, probably because everything gets agitated. Second much milder. Felt fine for the rest of the day.

Day 8 - step backwards today. Epic morning BM which, despite soft stool, left me in pain for hours afterwards. Went for a second in case persistent pain was caused by ‘lodged’ stool, didn’t help much. Needed 2 ibuprofen and 1 paracetamol to relive pain. Not happy about making drug cocktails but have no choice.

Day 9 - Bit better. Morning BM, moderate pain for a couple hours, second BM around 3pm and then fine rest of the day. Previous day had a chicken and veg dish for lunch and a pizza in the evening - bulking out the stool presents more problems than keeping it loose, it seems.

Day 10 - 2/10 painful morning BM, went out for lunch and there was a persistent ache. Second BM as soon as I got home, lots of straining, worried I’m giving myself a whole new set of haemorrhoids at this rate. Needed a 3rd BM and it took a few hours for that calm down even after an ibuprofen. I was told ‘2 weeks recovery’ and right now that seems absurdly optimistic.

Days 11 - 14 Pattern of one BM in the morning with mild pain, then over the next few hours pressure and pain building until another BM, which is always more painful, bloody, and involves straining, painkillers needed afterwards. On a good day that’s it, on a bad day a third BM is needed.

Day 15 - good one today. Didn’t need a BM until 5pm, noticeably less painful but quite a bit of blood. No painkillers needed. Best day so far!

Days 16 - 20 - Massive improvement, mainly because I started a new system of waiting as late in the day to take a BM, followed by hot bath, followed by sitting to work or watch TV until bedtime.

It means I’m just taking one BM per day which means there’s very little aggravation of the healing roids.

No blood, no pain, just minor discomfort during and sometimes for a while after BM. Feels like I’m over the hill and it’s hugely relieving.

Days 21 - 30 - Continued improvement and gradual evaporation of pain and discomfort. Pooping as late in the day as possible was the key.

Basically, Rafaelo will knock a month off your life in terms of doing anything important or remotely strenuous, so definitely plan ahead!

Day 45 - this was supposed to be my follow-up appointment but Mr Haji had to delay two more weeks, which was fine. There's a reason they make the follow-up 6 weeks after the operation - because that's how long it really takes to meaningfully recover from Rafaelo. All this talk of 'you'll skip out of the clinic and be back to work the next day', or even in 2 weeks, is marketing BS and they shouldn't say it.

The dumb thing is they don't need to mislead because the reality is you've got a choice between Rafaelo and 6 months of screaming bloody hell with haemorrhoidectomy.

Day 60 - had my check-up and basically the 3 'roids have massively shrunken but not disappeared, and I'm still having to push back in some swollen skin tags after a BM. was it worth it? 100%

Mr Haji said there was an 80% chance of success with Rafaelo and I'd say it appreciably worked 95%. I can actually sh1t normally again. Everything falls straight down into the bowl instead of exploding everywhere as the 3 massive 'roids burst out.

The bulging skin tags are annoying but they're fairly easy to push back in, and in my case nobody has the misfortune of having to 'encounter' that part of my body except me, so my plan is just to live with it until/if the shrunken 'roids make a comeback, in which case I'll go for another round of Rafaelo on the NHS.

Mr Haji suggested a round of banding to finish off the 'roids but I'm going to give that whole area a rest for now. It's been an exhausting experience but totally worth it!

Thank you to everyone on here who described their experiences. I hope my recovery diary has been helpful if you're (contemplating) going through the Rafaelo tunnel, and don't hesitate to ask any questions if you have 'em.

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