Here at Anna Toker, MD in Mansfield, Texas, my treatments range from in-office to
extensive rectal reconstruction surgeries. Depending on your symptoms and anatomy, I
can offer you the simplest, least painful, and the best approach to anorectal surgery.
IMPORTANT: We are a NARCOTIC FREE practice, please read the instructions to
patients regarding post-operative pain medications and supplements. Opiods are
addictive and, for intestinal surgery, actually worsen outcomes. Please do not ask for a
*Warning: This advice does not always work. *
If I have not yet examined you in the office, please start following this advice now while you wait for your appointment. Patients who fail this advice do frequently require surgery or at least further testing. If you do not have an appointment make one with me or your local colorectal surgeon for an actual exam to ensure there is no life threatening issue occurring.
We go over a lot in the office and there just is not time for every little detail. Watch this video as many times as you need to-take notes! These types of surgeries are complex and can be hard to heal, but with the proper diet and activity, you can get through this process!
Recent evidence has shown that patients who use narcotic pain medications are slower to heal and have more complications than those who do not. We will not write for opiod medications! We will manage your pain using an alternative approach....
Your post-operative medications have been sent to your pharmacy. There will be 2 prescriptions waiting for you.
1) a muscle relaxant (cyclobenzaprine)
2) a medication for nerve pain (gabapentin)
3) medication is an NSAID nasal spray. (It comes from an out of s tate pharmacy and you should call them at 1-844-977-7749 as so on as possible to confirm that they have the prescription and so that they can work with your insurance to cover the cost. This medication is an extremely effective non-narcotic anti-inflammatoy but is hard to find at a reasonable cost. This pharmacy can help. If you are allergic to NSAIDS please let the doctor know- you should not take this medicine.) If you are over the age of 60 I may prescribe Celecoxib or oral ketorolac instead
Avoiding constipation is critical after rectal surgery, but you must avoid diarrhea as well! Starting prior to surgery, you should take a fiber supplement (can do kiwi fruit, prunes, prune juice, or powdered supplements mixed in water like citrucel) You will want to continue these supplements after the surgery as well to improve your healing.
You may want to consider several holistic supplements as well- NOW brands has many of these items online...
1) n-Acetylcysteine (NAC) 600 mg daily. This is a good anti-inflammatory.
2) Inulin and Pectin supplements are prebiotic foods that can sup port the probiotic supplements suggested
3) L- Glutamine 500 mg is an amino acid your intestines like and c an promote more normal bowel function
4) Arnica montana, quercetin and zinc all help minimize bruising, take as directed on the bottle- Arnica is typically a topical cream, quercetin and zinc come in tablet form
5) Turmeric- a great anti-inflammatory- you can get at any grocery store, a medical grade version is made by Standard Process.
6) Boswellia can be found at many whole food groceries- Standard process has a medical grade boswellia which is combined with ginger and turmeric and is available online.
The night before your surgery you should do one fleet enema and then repeat the morning of surgery. You will need to be on an empty stomach for 8 hours.
After your surgery, you should spend time in a warm bath tub-unless otherwise directed. Do not sit on a donut pilow and avoid prolonged sitting on the toilet.
There are no food limitations after surgery, per se. Normal bowel habits promote healing so....avoid foods and medications that cause diarrhea or constipation!
The incisions should then be dried off and covered with dry non-woven gauze. If dry gauze is too rough, you can cut cott on t-shirts into small squares and use that as a topical patch over the incisions.
The incisions will have mild amounts of bleeding and even drainage until they are healed. There is a 1% chance of severe post-operative bleeding that occurs between days 7-15. Please call if this occurs for advice. Rarely, this type of bleeding requires operative intervention.
I typically inject a long acting local anesthesia during your surgery, this medication reacts negatively with topical lidocaine. If you need a topical medication, I suggest a post-operative topical ointment that contains 5% lidocaine, 0.2% nifedipine, 1% metronidazole and 1% cbd. This compounded medication Is made by Adams Pharmacy in DeSoto and is available in my office for purchase.
Alternatively, there is an over the counter lidocaine cream called Recticare which you can purchase at pharmacies such as Walgreens or CVS.
Rectal surgery hurts, but to heal you must have normal bowel function- avoid constipation and diarrhea. If you have had no BM in 24 hours after surgery, take milk of magnesium or Perdiem (an herbal laxative). These medications can be repeated 8 hours later if needed. If still no results, you can take magnesium citrate- 1 bottle. If still no luck, I suggest a dose of miralax every 15 minutes until it produces a bowel movement (this may be a large number of doses)
Any questions? Contact us at 214-942-3740 by leaving a voice message or text