How Is Pain Managed After Hemorrhoid Surgery?

Medically reviewed by: Gary H. Hoffman, MD

When painful hemorrhoids do not respond to less-invasive treatments, surgery may be necessary to allow healing and help you return to your previous quality of life. This procedure, called a hemorrhoidectomy, typically involves a colon and rectal surgeon removing the affected tissue with a scalpel or other specialized tools. This procedure can be extremely painful, but your doctor will offer you a range of options for reducing the pain until the incision heals.

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Will I Be Prescribed Painkillers?

Hemorrhoidectomies are, in most cases, performed as an outpatient procedure. Because of the sedation or anesthesia you were given, and the medication you may be prescribed to help you manage the pain, you will not be allowed to drive yourself home after surgery. Make sure you have a friend or family member who can drive you home from the hospital or surgery center.

It is not uncommon for spasms to occur in the area where the hemorrhoids were removed, and these spasms can be excruciating. In addition, the surgical wound itself may be sore, and may also sting or burn during bowel movements.

In order to help you manage this pain, you will most likely be given a prescription painkiller. Frequently, Vicodin or Tylenol #3, which are acetaminophen and hydrocodone or acetaminophen and codeine, respectively. The dosage recommendations of these medications typically allow for one dose every to six hours as needed. They should be used only if absolutely necessary, however, and never more than prescribed. This is because both of these drugs can cause constipation, which could cause more serious complications and disrupt your healing.  Typically, a stool softener is given in conjunction with narcotic pain medications.

At the same time, many over the counter pain relievers will most likely need to be avoided for several days before and after the procedure. This is because they interfere with blood clotting and may hinder healing. This list of temporarily discontinued medications often includes aspirin, ibuprofen and naproxen.

Your doctor may allow acetaminophen as an alternative to opioids, or prescribe a stronger non-narcotic painkiller if you cannot take this type of medication. Be sure to discuss this option with your doctor before your surgery so that you can have a prescription to meet your needs as soon as you are released from the hospital or surgical center. The pain is frequently the worse in the first 24 to 72 hours after surgery, and you will probably want medicinal pain relief during this time.

Are There Other Things I Can Do To Relieve the Pain?

In addition to prescription narcotic medications and over-the-counter drugs, there are also non-medical treatments that may be used to relieve some of the pain after a hemorrhoidectomy.

Swelling in the anal area can exacerbate pain, so ice packs may come in handy to help reduce this swelling and offer some pain relief in the first 24 to 48 hours after surgery. It is important, though, to remember to never apply an ice pack directly to your skin. This will reduce blood flow, impede healing and may even cause damage to the skin. Using a cloth-wrapped pack or placing a towel between the pack and your skin is a much safer option.

Sitz baths, shallow soaks in warm water with no soap or additives, can also be used to reduce the swelling. These baths can also help with hygiene after bowel movements. A hand-held shower head may also be very helpful. You will not want to rub the area dry after the bath, however. Patting it dry with a towel or allowing it to air dry will be more comfortable. Some people even find that a small fan helps them dry the area with minimal irritation.

Another option after bowel movements is using specially designed pads to clean the area. Tucks Pads and other similar options are preferred over baby wipes because they do not contain perfumes or other irritants. Discuss this with your surgeon, because some prefer patients to use a shower or bath for all hygiene purposed instead.

How Long Does It Take To Recover After A Hemorrhoidectomy?

While the first few days after a hemorrhoid surgery can be painful, most people recover quickly. In fact, most patients have returned to all of their regular activities within the first two weeks after a hemorrhoidectomy. Limitations will include not being able to drive while taking narcotics, and avoiding vigorous exercise and heavy lifting for about ten days.

During the first week after surgery, it is important to watch for any sign of complications from the procedure. If you see any of the following, it is important to call your doctor immediately.

  • Inability to urinate
  • Heavy bleeding from the surgical wound
  • A blood blister known as a hematoma inside the incision
  • Fever and/or chills
  • Fecal matter trapped in the rectal canal

While you will be allowed to eat a regular diet immediately after the procedure, it is important to recognize the role your previous diet may have played in causing your hemorrhoids in the first place. Preventing a recurrence relies heavily on avoiding the original causes, and is often entirely dependent on the patient’s ability to prevent constipation. A daily intake of 25 to 30 grams of dietary fiber is recommended to help stools pass easily. Your doctor will probably also recommend other lifestyle changes to help you prevent a recurrence.

Los Angeles Colon and Rectal Surgical Associates

The board certified surgeons of Los Angeles Colon and Rectal Surgical Associates are experts in the diagnosis and treatment of hemorrhoids. They are specialists in all diseases of the colon, rectum and anus. By calling (310) 273-2310, you can schedule a confidential appointment and discuss any of your questions with your physician.

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