Preparing for the visit

It is advisable to take an analgesic (Tylenol or Advil, if there is no contraindication from your family doctor) one hour before your visit.

It is important to stop any blood-thinning medications (that prevent clots from forming) to help ensure that you do not experience significant bleeding following this procedure. These may include anti-platelet drugs (Aspirin, Clopidogrel (Plavix) or others) or blood thinners (Coumadin, Eliquis, Xarelto or others). Most of these medications should be stopped the day of the procedure and for at least 7 days afterwards. It is important to get your doctor’s approval before stopping any of these medications.

It is suggested that you have someone accompany you to the clinic and, in particular, that you not drive after the surgery.

What to expect during the procedure

You will be met by your doctor who will explain the procedure and obtain your consent. You will then be greeted by the nurse who will help you lie down on the stretcher with your legs placed on supports (similar to the position for childbirth).

The doctor will begin with disinfection then proceed with local anesthesia, which is the slightly more unpleasant part of the procedure. Anesthesia removes the pain associated with the procedure. If you still feel pain, the doctor will add more anesthesia. It is normal, however, to feel movement such as friction or pressure as well as heat. Depending on the surgery, there may be stitches, which are dissolving and will therefore go away on their own. At the end of the procedure, a bandage will be held in place using a disposable undergarment that will be provided to you.

What to expect after the visit

Symptoms vary considerably depending on the extent of the surgery. Surgery performed entirely on the surface (e.g.: removal of one or two large skin tags) will produce fewer symptoms. In the case of surgery involving excision of one or more internal hemorrhoidal pedicles, discomfort will be more intense and prolonged. Minor fistulotomy under local anesthesia is usually minimally symptomatic.

Pain is exacerbated during defecation, which is why it is recommended to ensure soft stools by eating a diet rich in fibre and water, or by adding natural products such as prune juice or laxatives such as Metamucil, Lax-a-day or others that will be prescribed or recommended by your doctor or pharmacist.

A prescription will be given to you, including a combination of analgesics that you will take depending on the severity of the pain:

• Start by taking Tylenol (Acetaminophen)
• If that is not enough, add an anti-inflammatory (Naproxen or Advil)
• If that is still not enough, add an opiate (Oxycodone, Morphine or Dilaudid)

WARNING: Because opioid painkillers (Oxycodone, Morphine, Dilaudid) can cause fatigue, you should not drive while taking this type of medication. They can also cause nausea and constipation. It is recommended that you take them only if you are experiencing pain that cannot be controlled by other analgesics, and that you take a laxative as well if necessary.

It can take anywhere from 7 days and up to 3–4 weeks for the wounds to heal, depending on the extent of the surgery. It is normal to experience some blood loss or oozing during this period. To promote healing, sitz baths or showers are recommended two to three times a day as well as after each bowel movement, and the anal area should be dried gently without rubbing. An antibiotic cream will be prescribed for application after each shower or sitz bath, until the wounds heal.

The duration of convalescence depends mainly on the type of job you do and the extent of the surgery. It can vary from 3 days to 2 weeks.

If very heavy bleeding (such as hemorrhaging) occurs, then an emergency room visit is required. This is rare and usually associated with the use of anticoagulants.

If the pain is very severe, and not relieved by medication, if it is accompanied by fever or an inability to urinate, it is important to consult a doctor.

In these circumstances, you can call the clinic during business hours (7:00 a.m. to 1:00 p.m.) and leave a message. We will return your call. Outside of business hours or days, you will need to go to the emergency room.