Return home (After)

• Length of stay: Day hospital for the majority of patients. Exceptionally, patients stay one night.
• Day hospital: Discharge from hospital between 4-6pm.
• Discharge from hospital is scheduled before 2pm, after an overnight stay.
• Discharge is planned when the patient can eat independently and mobilize autonomously. A bowel mouvement is not necessary before discharge.
• For patients who are not independent, it is important to contact the social service quickly, even before hospitalization, to organise home care or post-operative rehabilitation.

Social service contact details:

+32 2 614 92 92

• At admission, it is important to hand over, as soon as possible, all the certificates to be filled in: Insurance, mutual insurance, sports club certificate, disability certificate…
• Make sure you recollect all your certificates completed at discharge.

Analgesic on discharge from hospital:

• Paracétamol: Dafalgan® 1gr 3-4x /day
• Non-steroidal anti-inflammatory drugs: Brufen® 400mg 3x /day
• Morphine: Tradonal® retard 50 mg max 6x /day if needed

In normal circumstances, pain is controlled with a combination of paracetamol, non-steroidal anti-inflammatory drugs and morphine.
When pain subsides, morphine should be stopped first, then non-steroidal anti-inflammatory drugs and lastly paracetamol.

Morphine can cause nausea and vomiting. To alleviate these side effects, it may be necessary to take an anti-emetic (against nausea) tablet. (Litican® 50mg, Litican® 10mg….).

Non-steroidal anti-inflammatory drugs: (Brufen®, Brexine®, Nurofen®, Apranax®, Catafam®,…) should not be taken chronically.

Chronic intake of non-steroidal anti-inflammatory drugs may cause bleeding due to inflammation of the the stomach (gastritis) and stomach ulcers.

The pain symptoms can be relieved with sitz baths (e.g. with Kamillosan®….).

Antibiotics are prescribed for their pain-relieving effect. The number of days is determined by the surgeon.

Antibiotic schedule:

– Flagyl 500 3x/day for 7 days

• Anticoagulants are necessary after surgery with prolonged immobilization, obesity, history of deep vein thrombosis or pulmonary embolism and in case of surgery in the small pelvis. The purpose of anticoagulants is to reduce the risk of deep vein thrombosis (blood clots). Blood clots can break loose and potentially clog blood vessels in the lungs (pulmonary embolism). Pulmonary embolisms can be fatal.

ANTICOAGULANT: CLEXANE® – FRAXIPARINE®

• Subcutaneous injection into the abdomen or thighs.
• Dosage according to weight for at least 10 – 20 days.
• There is an exception if anticoagulants (Sintrom®, Xarelto®, Clopidogrel® …) are taken at home.

Postoperatively, Clexane® is administered to the patient. When the risk of postoperative bleeding is considered limited, Clexane® will be stopped and the anticoagulant resumed. Whether or not to resume the anticoagulant Sintrom®, Xarelto® or Clopidogrel®…. will be decided by the surgeon.

COMPRESSION STOCKINGS

• It is recommended to wear compression stockings overday for 10 to 20 days after surgery. At night the compression stockings may be removed.

All activities may be resumed after surgery. The only limiting factor are the pain symptoms.

Shower: → After 10 days with permission of the surgeon.

Bath: → After 10 days with permission of the surgeon.

Walk: → Immediately.

Sleeping position: → No position is contraindicated (back, stomach, side…).

Car: → Immediately (avoid long trips in the first week).

Stairs: → Immediately.

Physical activity: → Avoid excessive physical activity during first 10 days. No lifting more than 10 kg.

Sport: → 10days.

Professional activity:

→ Manual/physical work: 7 – 10 days.

→ Sedentary office work: 2 – 7 days.

Sexual activity:

→ Stop in function of pain symptoms.

                  → No anal penetration until healing of wounds.

Daytime

• We recommend placing an absorbent pad, sanitary napkin or panty liner in underwear to absorb wound fluid.
• Strict perineal hygiene. Rinse the perineum with the shower head or in a bidet after each bowel movement, if possible.

When showering and bathing

• No dressing

Link to the chapter : Wound care

The purpose of a high-fibre diet and laxatives is to facilitate the passage of stools through the anal canal. Soft stools prevent hurting the healing wounds so that wound healing is accelerated and the postoperative pain is reduced.

Diet:

• High-fibre diet.
  
• Fiber supplements fibre 2x /day.
  
• Hydration minimum 2l of fluids.

Link to chapter : Nutrition

Laxatives:

• Lansoyl® 3x/day : teaspoon 15 min before meals.
• Movicol® : depending on the consistency of bowel movements.
• We recommend taking Movicol if no bowel movements after 48 hours.

• Consultation 5 – 7 days after surgery with your surgeon to rule out soft tissue infection and to follow up pain symptoms and bowel movement pattern.
• After 21 days, consultation with your surgeon to check postoperative evolution (wounds, nutrition, general condition).
• After 6 weeks to exclude a recurrence.

Normal symptoms

• Anal pain is normal but should subside over time.
• Burning sensation and constant urge to defecate and urinate during first 2 weeks.
• Seepage of serous (yellowish) anal fluid.
• Fluid loss may be bloody but should subside over time.

Abnormal symptoms

Contact your doctor or GP or go to the emergency room:

• If pain increases over time.
• If fever does not subside over time.
• If pus volume increases or foul smelling viscous fluid increases.
• If blood loss persists.

If symptoms seem abnormal to you, contact your GP (General practician).

If this is not possible, you can contact your surgeon.

If you are unable to contact your GP or your surgeon, go to the emergency department at St Elizabeth Hospital in Uccle.

– Work incapacity depends on the occupational activity and the patient’s age.

• For a physical occupation, the incapacity is at least 7 – 10 days.
• For office – sedentary work, the incapacity is at least 1 – 7 days.

– Physical recovery depends on age and preoperative physical condition.

– Most patients experience (severe) fatigue after the euphoria of returning home.