Close attention must be paid to “pain” and “bleeding” after surgery. Improved drugs can control the pain. Treatment for the bleeding is more problematic. The first postoperative bowel movement is particularly concerning, so a laxative is used to facilitate bowel movements. However, because stools pass through the surgical wound, bleeding occurs at every bowel movement until 7 to 10 days after surgery. However, if bleeding does not stop or if a blood clot passes through the anus, such conditions pose risks and the bleeding must be stopped. At our hospital, the doctor preoperatively tells the patient that "there will be slight bleeding after surgery" and gives a full explanation on postoperative bleedings, showing pictures so that the patient can distinguish between non-serious and serious bleedings. The nurses are also given specific instructions on distinguishing bleedings.
After surgery, bowel movements are painful, and constipation may occur in some patients while they are unwilling to pass stools. Patients are instructed to tolerate some pain and to defecate before they are constipated. The use of moderate laxatives is acceptable. However, it is not good for patients to keep passing diarrheal stools, which may cause the anus to become inflexible, resulting in various problems. It is favorable that the anus is dilated to a certain extent by feces and the perianal skin is healed with anal dilatation. However, if the wound is healed without anal dilatation, the anus may become narrow or a duct may form like an anal fistula. Patients should not keep passing watery stools using laxatives to avoid painful defecation. It is important to pass solid stools to dilate the anus. Proctologists perform postoperative examinations, checking if the anus has become inflexible, and if this is observed, manual anal dilatation will be performed. During a certain postoperative period, patients experience painful defecation, dull pain similar to that caused by anal fissure. Despite such pain, patients should pass stools to allow the anus to be dilated.
Regarding criteria for symptoms requiring a revisit, patients who have noticed recurrence of similar symptoms should revisit the hospital. In patients in whom similar symptoms have recurred after once being resolved, such symptoms are mostly more severe than before. Such patients must understand what symptoms are serious and require treatment. Severe symptoms are more difficult to treat, so keep in mind the significance of early treatment.
