The following is general advice for informational purposes only. It is not intended to be comprehensive and does not cover every situation. It does not replace the advice of

Pain and pain relief

It is natural to feel nervous about what to expect after surgery. In general, you might experience some pain after the surgery, but we will manage this by giving you a combination of medications. Specifically, if you have no allergies, you will have some oral painkillers to take on a regular basis, as well as some stool softeners to avoid stretching the wound when you move your bowels.

Opening your bowels

While it is common to fear damaging the wound, rest assured that when we perform the surgery, we are aware that — unlike other parts of the body — this is an area that is difficult to avoid using. Opening your bowels will not damage the wound. However, you might get a bit more discomfort from the wound at this point. So, we often recommend that patients take their pain medication regularly, or — if they are taking it as needed — to take it about half an hour before they are likely to move their bowels. In addition, stool softener medication will also help to avoid stretching that wound too much and reduce discomfort.

Bleeding

It is not uncommon to have a bit of bleeding from the wound. This should just be spotting on the dressing or toilet paper and should stop with a bit of pressure. However, if there is a large amount of bleeding, or if you are uncertain, please contact the clinic for advice.

Wound discharge

Some discharge from the wound is expected, as inflammation in that area will result in some secretion of tissue fluid intended to keep the wound moist and aid healing. The concern will be if there is brisk bleeding or increasing pain around the wound, and not just on the exposed surface of the wound. If there is significant bleeding, or increasing redness around the wound, you should contact us for advice.

Caring for the wound

In most cases, the wound does not require any special cleaning, and often just rinsing the area with a shower spray is sufficient. There is usually no need to apply a dressing over the wound, but a non-adherent dressing pad can help to avoid staining your underwear. A pantyliner or pad can also be used as an alternative.

Bathing and showering

The main difference to consider between taking a bath or a shower is how long the wound is soaking in water. A short bath is probably going to be fine, but if you are soaking in a tub for extended periods, then wound healing might be affected. The stage of wound healing is another factor. The main point is to avoid over-hydration of the tissue, which can result in maceration of the wound edges and impair wound healing. As such, in general, a shower with running water is usually better for wound healing than soaking in water. Nevertheless, in certain circumstances, soaking in warm water for short periods can sometimes help with pain relief.

Returning to normal activities

Generally, for most perianal surgery, the main concern will be with managing the pain associated with sitting or moving, rather than a concern about "damaging" the wound. This is usually task-dependent. In many cases, we will need to assess what your work entails to be able to advise appropriately. Sitting for long periods might be uncomfortable, so I often advise my patients to take breaks from sitting every half an hour.

Diet and recovery

There are generally no dietary restrictions. However, if you have a perianal wound, you might find that spicy food causes discomfort when you open your bowels. In terms of optimizing recovery, the main factors that apply to all surgical wounds also apply here. In particular, ensure that you are getting enough sleep and that you have enough protein in your diet, as this will aid wound healing.

Constipation

Constipation after perianal surgery is very common and may be related to the pain from the wound. In some situations, you will be given some laxatives to soften your stools, to encourage you to open your bowels with less straining and stretching of the anal canal. In most situations, straining should not affect the wound, but the specific site of the wound will be the main determinant. If you are unsure, contacting your doctor/clinic is probably best.

Follow-up

Following perianal surgery, you should have an appointment to review the wound, and the clinic should advise you accordingly. If not, do reach out to the clinic for clarification. As it is difficult to see and assess the wound yourself, it is best to have a doctor look at the wound to ensure that it is healing well.

When to seek help

In general, you should see an improvement in symptoms over the course of a few days. If pain is increasing, or a fever develops, these are situations where you should contact the clinic for advice. Most situations are unlikely to require a trip to the Emergency Department or Urgent Care Centre. Excessive, persistent bleeding is likely to be the main condition requiring a trip for emergent care.