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Texas Health Care, P.L.L.C. Colon & Rectal Surgery Britton R. West, M.D., Stephen D. Fitzgerald, M.D., Glen D. Hooker, M.D., Eduardo D. Castillo, M.D.
1420 8th Avenue, Suite 103, Fort Worth, Texas 76104 BEFORE ANORECTAL SURGERY
1. Extra fiber intake 2 days before surgery and 2 weeks after surgery helps to prevent constipation. Take 2 tablespoons or 2 tablets of fiber (Citrucel, Metamucil, Perdiem, or Konsyl) with at least 8 ounces of water twice daily.
2. Avoid aspirin or aspirin-containing products (Alka-Seltzer, Anacin, Ascriptin, Ecotrin, Empirin, Excedrin, Halfprin) for 1 week prior to surgery. Avoid anti-inflammatory medications Advil, Aleve, Anaprox, Arthrotec, Celebrex, Clinoril,Daypro, Diclofenac, Etodolac, Feldene, Ibuprofen, Indocid, Indomethacin, Ketoprofen, Ketorolac, Lodine, Motrin,Naprosyn, Nuprin, Relafen, Sulindac, Toradol, Vioxx, Voltaren) for 2 days prior to surgery.
3. Do not eat or drink anything after midnight before surgery. Take your regular heart or blood pressure medications in the morning with a small sip of water. If you are diabetic, do not take insulin or diabetic medications until after surgery. 4. Take one Fleet enema (green and white box) one hour prior to coming to hospital.
AFTER ANORECTAL SURGERY
1. Take pain medication as needed and take Phenergan, if prescribed, for nausea or extra pain relief. Do not take pain 2. Some bloody discharge is expected after anorectal surgery, particularly with bowel movements. Change a dry gauze dressing as needed. Call if bleeding is persistent or profuse. Within 24 hours after surgery, you may also noticepassage from the anus of a small piece of dressing called gelfoam, which was placed at the time of surgery.
3. Take a fiber supplement (Citrucel, Metamucil, Perdiem, or Konsyl) 2 tablespoons in 8 ounces of water or juice twice daily.
4. Take 2 Colace or Surfak tablets twice daily. Avoid straining or sitting on the toilet for longer than 5 minutes as this can 5. If you do not have a bowel movement by the third day after surgery, take 4 tablespoons of Milk of Magnesia, and repeat in 6 hours if no results. If still no bowel movement occurs, please call.
6. Diet should include fruits and vegetables. Avoid spicy foods, tomato products, alcohol, and drinks containing caffeine (coffee, tea, cola). Drink 6-8 full glasses of water daily.
7. Beginning on the morning after surgery, start taking sitz baths: -First take off the dressing.
-Sit in tub of lukewarm water 4-6 inches deep for 10-15 minutes; do this 3 times daily and after bowel movements.
-After the sitz bath, gently rinse anal area with water. A hand-held shower spray is ideal for this purpose and may be purchased at a hardware store. Do not use soap. You may use Cetaphil Gentle Skin Cleanser.
-Pat dry with a soft towel. You may apply Prax lotion, Anusol, Vaseline, externally 3-4 times per day.
-For a dressing, use gauze, cotton balls or sanitary pads.
8. If you are unable to take a sitz bath after a bowel movement, use a moistened towelette (baby wipes, Cottonelle wipes, Tucks pads, or Fleet pain relief pads) rather than dry toilet paper. Some pain and oozing is to be expected.
9. Avoid aspirin and other anti-inflammatory or arthritis medications (see list in “Before Anorectal Surgery” above) for ten days after surgery, unless instructed by your doctor. You may continue any of your other regular medications.
10. Activity should be limited to avoid strenuous exercise or heavy lifting. Avoid driving while you are taking prescription pain medication. Walking, climbing stairs and riding in a vehicle may be done in moderation.
11. If you have difficulty urinating, get into a tub of warm water, relax, and urinate right into the tub.
12. Call the office (817-924-9002) to schedule a follow-up appointment after your surgery, as directed by your physician.
CALL US AT 817-924-9002 IF YOU HAVE ANY OF THE FOLLOWING PROBLEMS: • Persistent bleeding dripping into the toilet bowl • Increasing pain unrelieved by pain medication and Phenergan

Source: http://txcolonrectal.com/pdf/anorectalpostop.pdf