Recovery after haemorrhoid surgery: the first days, bowel movements and what is normal

Recovery depends above all on the method and on how enlarged the haemorrhoids were. With conventional surgery (haemorrhoidectomy), when the haemorrhoids are surgically removed, small wounds remain in the anal canal and around the anus and heal gradually. With less extensive methods, such as laser haemorrhoidoplasty, tying off the blood vessels that supply the haemorrhoids (dearterialisation) or stapled haemorrhoidopexy, pain is usually milder and recovery shorter. On the other hand, after these methods the chance of the haemorrhoids coming back is usually higher than after conventional surgery. Which of these methods are performed at Maja Hospital, and which one the surgeon suggests for the specific findings, is explained at the consultation.

As a rough guide: pain is usually worst in the first few days and then gradually eases. For most patients, pain has eased considerably by the end of the second week. After less extensive methods, recovery and a return to lighter activities usually take from a few days to two weeks. After conventional surgery, recovery usually takes two to four weeks, and complete healing of the wounds four to six weeks, longer for some patients. These are general guidelines, not a promise, because every recovery is different.

In the first days there is usually pain and stinging around the anus, a feeling of pressure or fullness and mild swelling. Pain is usually most noticeable during and immediately after a bowel movement. There may also be some moisture, that is, a small amount of discharge, so a thin gauze pad or sanitary pad is worn and changed often. The doctor decides which painkillers to take and when. They are usually taken regularly, on the agreed schedule, rather than only once the pain becomes severe. Do not take additional medicines on your own, because some painkillers slow the bowel and make bowel movements harder. If the patient normally takes blood thinners, the doctor decides when to start taking them again.

After a spinal or general anaesthetic, and also because of pain and swelling, passing urine for the first time can be difficult. This is why staff usually check that the patient has passed urine before they go home. Whether the patient goes home the same day or the next day depends on the method, the type of anaesthetic and the surgeon's assessment.

In the first days, these usually help:

• rest, with short walks around the home several times a day
• lying on your side, which many people find more comfortable than sitting
• a cold compress wrapped in a towel, for no more than 15 minutes at a time, if the surgeon recommends it
• enough fluids from the first day

The first bowel movement is what patients most often fear. It usually happens within the first two to three days after the procedure. Pain and stinging are expected at that point, as is a little blood on the toilet paper. A common mistake is holding in a bowel movement for fear of pain: the stool then becomes harder and emptying the bowel more painful.

What usually helps:

• go to the toilet as soon as you feel the urge, without putting it off
• do not strain and do not sit on the toilet for long, so no phone or reading
• put a small footstool under your feet, so that your knees are slightly higher than your hips
• after a bowel movement, wash the area with lukewarm water or have a shower, then gently pat it dry, without rubbing
• take a stool softener only if the doctor has recommended one, at the dose they have set

If there has been no bowel movement by the third day after surgery, despite fluids and diet, or if pain makes it impossible to empty the bowel, contact the surgeon. The surgeon will then assess whether additional help is needed.

Light bleeding after haemorrhoid surgery is expected, especially with the first bowel movements. Most often this is a little fresh blood on the toilet paper or gauze, or a few drops in the toilet bowl. A little blood with bowel movements may occasionally appear over the following weeks too, until the wounds have fully healed. Towards the end of the first week or during the second week, when scabs come away from the wounds, bleeding may briefly increase. Less often, heavier bleeding occurs during exactly this period, at home, days after discharge. Bleeding like this is not expected and needs an examination without delay.

Bleeding is not expected when it is heavy, when it does not stop, when it soaks through gauze or a pad, when larger clots appear or when it is accompanied by dizziness, a racing heart or weakness. In that case, contact a doctor or the emergency services without delay. Moisture and mild discharge may continue until the wounds have healed. Discharge containing pus, an unpleasant smell, increasing swelling or redness should be shown to the surgeon.

The aim of your diet after surgery is simple: soft, regular bowel movements without straining. The most important things for this are fluids and fibre. A special diet is usually not needed, but some habits help:

• water and other fluids throughout the day, unless a doctor has limited your fluid intake because of other conditions
• vegetables, cooked or fresh, and fruit, for example plums, pears, apples and berries
• porridge oats, wholemeal bread and other wholegrain cereals
• soups and broths, especially in the first days
• less white bread and pastries, fried food and very spicy dishes
• no alcohol while you are taking painkillers and until the wounds have healed

Fibre should be introduced gradually, because a sudden switch to a lot of fibre can cause bloating and cramps. If the surgeon has recommended a fibre supplement or a stool softener, it is taken regularly and with enough fluids. Fibre without enough water can make bowel movements harder instead of easier.

Sitting is uncomfortable in the first days, so it is advisable to sit for shorter periods on a soft surface and to get up more often. Many people find it easier to lie on their side. Sitting usually becomes easier during the first two weeks. Gentle walking is helpful from the first days, because it stimulates the bowel. Heavy lifting, strenuous exercise and cycling are avoided until the surgeon says otherwise.

Sitz baths mean sitting briefly in warm, but not hot, water, either in the bath or in a special bowl that fits over the toilet. Many surgeons recommend them several times a day, especially after a bowel movement, because for some patients they ease muscle spasm and make hygiene easier. The evidence for their benefit is not clear-cut, so they are done on the surgeon's advice. They usually last 10 to 15 minutes, without any additives the doctor has not advised. After the bath, gently pat the area dry.

A return to lighter work, for example office work, is usually possible after a few days to two weeks with less extensive methods, and usually after two to four weeks following conventional surgery. Physically demanding work, heavy lifting and strenuous exercise take longer, sometimes six to eight weeks. How long you will need off depends on the method, how recovery goes and the type of work, and this is agreed with the surgeon.

After a general or spinal anaesthetic and after sedation, you must not drive for at least 24 hours, and the exact period is given by the anaesthetist. This is why the patient needs someone to drive them home. Later, driving is usually possible once sitting and braking hard no longer cause pain and you are no longer taking medicines that cause drowsiness.

The first post-operative check-up is usually 7 to 14 days after the procedure, and the exact appointment is agreed with the surgeon. At the check-up, the surgeon checks how the wounds are healing, answers questions and gives instructions for the following weeks. Whether the check-up is included in the price of the operation is worth asking when booking the procedure. Prices for the first post-operative check-up and the surgeon's follow-up examination can be found in the price table on this page and in the Maja Hospital general surgery price list. Questions that come up between check-ups are better put to the surgeon than looked up on forums, because recovery differs from person to person.

After haemorrhoid surgery, contact a doctor or the emergency services without delay if any of the following occur:

• heavy bleeding, bleeding that does not stop or larger clots, even if this happens at home, days after the procedure
• severe pain that gets worse instead of easing and is not relieved by the prescribed medicines
• a high temperature, shivering or general weakness
• being unable to pass urine for several hours after the procedure or later, with a feeling of a full bladder
• being unable to empty the bowel, with bloating, stomach cramps or vomiting
• discharge containing pus, increasing swelling, or spreading redness and warmth around the wound
• dizziness, fainting or a racing heart

In an emergency, at any time of day or night, call the ambulance service on 194 or go to the nearest emergency department. For other questions during recovery, the patient should contact the surgeon who performed the operation or Maja Hospital through the contact page.