Return home (After)

• Length of stay: Day hospital.
• Day hospital: Patient is discharged the same day from the hospital between 4-6pm.
• 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®….).

Ointments can also be prescribed to reduce pain and spasm of the sphincter (Xylocaine ointment 5%®, Rectogesic® ointment, magistral preparations with. Diltiazem….).

Antibiotics are not required.

Perversion of deep vein thrombosis is rarely necessary after  tattooing with methylene bleu.

• 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®, Xarelt®, 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: →Immediately.

Bath: → Immediately.

Walk: → Immediately.

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

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

Stairs: → Immediately.

Physical activity: → No restriction.

Sport: → Immediately.

Professional activity:

→ Manual/physical work: 1 day.

→ Sedentary office work: 1

day.

Sexual activity:

→ Stop in function of pain symptoms.

                  → No anal penetration until healing of wounds.

• No wound, no wound dressing

No postoperative diet.

• Consultation at 10 days after surgery.

Normal symptoms

• Anal pain is normal but should subside over time.
• The anal margin will color bleu for 2 – 4 weeks.

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 is limited to 1 day.