Many haemorrhoidectomies are done as a day case procedures nowadays, about 1 in 5 patients admitted as day cases however, require admission for pain relief and management. The traditional teaching, prior to the era of day case surgery was that it was necessary to keep the patient in hospital untill after they had passed a bowel motion.
Patients should receive analgesia; they will most likely already have received a field block with long acting local anaesthetic and probably a Diclofenac Na suppository at the time of surgery, it would be reasonable to recommend something like distalgesic 2 QDS PO. They should also receive advice to take oral metronidazole 400 mg TDS for seven days.
Post operative metronidazole, 400 mg PO TDS for seven days, reduces pain post haemorrhoidectomy. [CKMP98]
They should continue to take lactulose (10 ml TDS) or another stool softner. Advice should be given to take regular warm baths, especially after passing a bowel motion and they should re-attend their doctor in 3 days if they have not passed a bowel motion or if there is heavy bleeding. The patient should be warned about the possibility of urinary retention and to seek medical attention if they cannot pass water.
It may be possible to reduce the rate of urinary retention post haemorrhoidectomy by;
Most people will require at least 2 weeks off work.