POST OP MANAGEMENT FOLLOWING SURGERY FOR RECTAL PROLAPSE：

Surgery on this part of the body can cause significant pain. This will subside over time and you will
appreciate the surgical results once healing occurs. Please follow the instructions below to ensure pain
levels are kept under control and to allow optimal healing to occur.
For patients with a history of constipation, an aggressive bowel regimen is maintained for the first one to
two weeks following surgery to avoid constipation and excessive straining that may lead to recurrence of
rectal procidentia.

Pain Relief:
Anal surgery is painful. You will be advised which pain killers are recommended before you are
discharged home. Generally we advise regular Paracetamol (Panadol) 2 tablets every 4-6 hours
(maximum of 8 tablets in 24 hours). This is very safe, is not constipating, and should be taken regular for
best results. In addition to Panadol, a regular anti-inflammatory medication such as Ibuprofen (Nurofen)
may be prescribed. This should be taken with food to avoid stomach irritation, and should not be taken
continuously for more than 5 days without the approval of your specialist or GP.
You will likely also be prescribed a stronger pain killer such as Oxycontin to be taken in addition to
Panadol and Nurofen. The stronger analgesics can have a constipating effect, however this can
generally be counteracted with regular fibre supplements (see below) and laxatives. This problem can
also be minimised by the use of Targin instead of Oxycontin. If you have severe pain you should use the
stronger analgesics, but also continue to take Panadol.

Laxatives:
You should avoid dehydration. Consume at least eight glasses of water per day.
Take a regular fibre supplement such as Metamucil or Benefiber
You will be on regular laxatives Macrogol 3350 (Movicol®) from day 1, and should remain on this for 6
weeks. The dosage is individualised, with huge variation between patients. Everyone is different. You
may need to alter the dose you take depending on stool frequency and consistency. Aim for a formed
soft stool that is easy to pass.
The usual starting dose is one Movicol® sachet twice daily. This can be halved or doubled or quadrupled
depending on the response.
Other alternatives to Movicol include Lactulose (Duphalac)

Avoid straining to pass a bowel motion, and avoid prolonged sitting on the toilet. Note that the surgery
can cause the sensation of needing to move ones bowels, even if the rectum is empty. This sensation
will settle over the coming days.
The aim is to have a soft stool to avoid straining. This is VERY IMPORTANT as further straining post op
may result in recurrence of problem.

The use of dry toilet paper should be avoided. After bowel movements use a wet Kleenex, cotton or
Sorbulene on toilet paper to clean yourself, or if possible, take a warm bath.

Salt baths / Sitz bath:

Warm baths have a soothing effect when you are in pain. The warm water can help relax any spasm of
the anal sphincter, improve blood flow and aid healing. A handful (about ½ cup) of table salt can be
added to the water and helps keep the wound clean. You should sit in the warm bath 2-3 times a day,
and after a bowel motion.

Bleeding:
Don’t worry if you have some bleeding, discharge, or itching during your recovery. A small amount of
bleeding is common following rectal surgery. It is to be expected. A sanitary napkin or gauze may be
worn over the anal opening to keep the underclothing clean. Some bleeding might be noticed on the
underwear or on a pad, as well as in the first few bowel motions. However, if you have prolonged or
profuse bleeding or experience passing of clots contact the surgeon or after hours present to the
emergency department for assessment immediately.

Concerns:
Please contact the surgeon if you are experiencing severe pain unrelieved by pain killers, have a fever,
cannot pass urine, have excessive bleeding from the anus, or if generally unwell. Where possible the
surgeon should will contact you to discuss your condition. Alternatively you may be advised to present to
the emergency department for assessment and management. 

Difficulty urinating after rectal surgery is usually due to spasm of the urinary sphincter
resulting from pain due to the surgery. Getting the pain under control and relaxing the
sphincter usually allows for the urine to pass. Take the pain medication you were
prescribed and do warm sitz baths – either in a bath tub or sitz basin. While soaking,
attempt to relax the bladder and urinate into the water. If you are unable to urinate in
the first eight hours after your surgery, notify the doctor’s office. After hours, go to
the nearest emergency room or urgent care center. A bladder catheter will be placed
and remain in place for 2 days, you may call the office to have the catheter removed.
Once you have started to urinate, drink plenty of water and fruit juices (such as prune
juice) after your surgery.

Contact your surgeon or attend Emergency Dept if:

- sweats, chills, fever >38 °C.
- redness, tenderness, warmth of wounds
- diarrhoea or constipation for more than 3 days

Diet :
Immediately after your procedure you will be commenced on free fluids (semi thickened fluids such as
custard, yoghurt, thin porridge). Once you have passed flatus, and any nausea has settled you will be
commenced on a light diet. As you recover further you can progress to a more "normal diet" with solid
foods. It is important to eat a fiber-rich diet in the weeks after surgery to avoid constipation and
excessive straining that can lead to recurrence of the rectal prolapse.

Exercise:
Early mobilization is essential to reducing the risk of postoperative complications such as pneumonia
and venous thromboembolism. Walking is encouraged from day one, as this improves your recovery
and prevents against developing a venous clot and pneumonia. Gentle swimming or cross-trainer or
cycling can occur after 48 hours.
Avoid strenuous activity for 1-2 weeks after your procedure.
No vigorous running, jumping or exercises are recommended for 6 weeks after surgery.
Take rest periods as necessary. Most patients undergoing rectal prolapse repair will be able to return to
normal activities, including work, within four to six weeks after surgery. Heavy lifting (Max 5kg)or
straining of the abdominal and perineal muscles is to be avoided until the muscles are fully healed in
approximately a few months. The majority of patients will experience a significant improvement in
symptoms and have a low chance of prolapse recurrence if heavy lifting and straining is avoided.

Dressings:
Water proof dressings will cover each of your incisions, and can be removed 7 days after surgery and
simply left open.

Discharge Home:
You will be discharged from hospital once you have opened your bowels and are tolerating a normal
diet. This can range from 3 days to a week.

Regular medications:
If not already done so, you are to go back on all your regular medications on discharge.

Follow-Up:
Please ring and organise a follow-up appointment with your surgeon at 2-6 weeks after your procedure.

Physio: In conjunction with surgery, patients with rectal prolapse often require pelvic floor physiotherapy
and biofeedback. Revisiting correct techniques for defecation is beneficial to avoid straining and enable
efficient defecation. Usually this involves seeing a Physio who specialises in this area.