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Thread: Hemorrhoidectomy and autonomic dysreflexia

  1. #1

    Question Hemorrhoidectomy and autonomic dysreflexia

    I met with a colorectal surgeon this week and I?m looking at traditional hemorrhoidectomy surgery to take care of hemorrhoids on the inside and outside. I was told the inside ones could be banded but the exterior ones would need to be removed with surgery. I?ve been doing my research and I have some additional questions.

    Here?s a little context about me. I?m a C5 quadriplegic complete since my injury in 2001. I have dealt with hemorrhoids for quite some time. They have become a bigger issue in the past year. I experience bleeding with almost every bowel program (scheduled every other day via magic bullet sitting up in my shower chair). During my bowel program I experience significant autonomic dysreflexia at times. Additionally, I?ve experienced great discomfort during intermittent catheterization and I believe irritation from the hemorrhoids might be to blame. I met with the urologist recently and had everything checked out (ultrasound of kidneys and scoping to visually see if there were any problems in the urethra and bladder). The urologist did not find anything. Lastly, I had surgery in 2005 to have my gallbladder removed. This was unplanned but went very well and I don?t remember any issues with autonomic dysreflexia during the recovery.

    I?m seriously considering the hemorrhoidectomy surgery but I have many questions and thought it best to get some direction from this community.

    1. Should the surgeon band the ones he can and surgically remove the others, or just surgically remove them all?
    2. The surgeon recommends general anesthesia for the surgery to control autonomic dysreflexia during the surgery. Are there any questions I should ask the anesthesiologist?
    3. How long should I be monitored and kept in the hospital after surgery?
    4. Recovery for an able-bodied person is around six weeks. I expect to remain in bed for at least one week after but I?m unsure what to expect. Should I expect to stay in bed longer?
    5. Should I expect to shorten my time in the chair during the whole recovery?
    6. Should I load up on stool softeners and start prior to surgery (old threads mention Colace 250 mg. 3-4X daily)?
    7. I supplement my diet with 1 teaspoon of konjac (glucomannan) and one serving of Amazing Grass in 8 ounces of water, twice a day. Should I continue this before and during recovery?
    8. I understand the surgery is extremely painful for able-bodied people and as a result I am greatly concerned about autonomic dysreflexia. I?m not sure my primary doctor has dealt with someone who experiences autonomic dysreflexia. He?s very good about listening to me, but in this case I don?t know the answer. Who is the right person to talk to that REALLY understands autonomic dysreflexia?



    I was recently on vacation, doing my bowel program in bed on my side and attempted to bring down my blood pressure when it was 180/90 (my baseline is typically 90/65 sitting up). I tried nitropaste on my chest which resulted in little change and then tried sublingual nitrostat 0.4mg tablets which also had little change. In this case, discovering and manually removing hard stool alleviated the problem. BUT, how should I manage autonomic dysreflexia during the recovery period if the problem is the actual recovery? I?m more concerned about autonomic dysreflexia than I?ve ever been in my life as a quadriplegic.

    Sorry for the long post but I appreciate any first-hand experiences and guidance from the nurses

    Thank you!
    C5 injury with partial C6 function on left.

  2. #2
    Do you have a physitrist or rehab doctor? If not i would have them maybe consult with spaulding rehab in boston on how to deal with it. I cannot answer the other questions however but good luck.
    T6 Incomplete due to a Spinal cord infarction July 2009

  3. #3
    Quote Originally Posted by Lewis View Post
    1. Should the surgeon band the ones he can and surgically remove the others, or just surgically remove them all?
    2. The surgeon recommends general anesthesia for the surgery to control autonomic dysreflexia during the surgery. Are there any questions I should ask the anesthesiologist?
    3. How long should I be monitored and kept in the hospital after surgery?
    4. Recovery for an able-bodied person is around six weeks. I expect to remain in bed for at least one week after but I?m unsure what to expect. Should I expect to stay in bed longer?
    5. Should I expect to shorten my time in the chair during the whole recovery?
    6. Should I load up on stool softeners and start prior to surgery (old threads mention Colace 250 mg. 3-4X daily)?
    7. I supplement my diet with 1 teaspoon of konjac (glucomannan) and one serving of Amazing Grass in 8 ounces of water, twice a day. Should I continue this before and during recovery?
    8. I understand the surgery is extremely painful for able-bodied people and as a result I am greatly concerned about autonomic dysreflexia. I?m not sure my primary doctor has dealt with someone who experiences autonomic dysreflexia. He?s very good about listening to me, but in this case I don?t know the answer. Who is the right person to talk to that REALLY understands autonomic dysreflexia?
    9. How should I manage autonomic dysreflexia during the recovery period if the problem is the actual recovery? I?m more concerned about autonomic dysreflexia than I?ve ever been in my life as a quadriplegic.
    1. This would be a question you should discuss with the surgeon.
    2. You should discuss with them what they will do to block the painful messages from the surgery from getting to your cord. General anesthesia may not be sufficient. Was a spinal anesthetic considered? Regional anesthesia with injections into the area of the surgery can also sometimes be used. I would also want to know what he will be doing and recommending for AD management in the recovery room and for the first few days after surgery.
    3. Likely your insurance will not allow you to be hospitalized longer than 23 hours for this surgery.
    4. We also recommend no sitting for 1 weeks after surgical removal, but after that you should be able to sit up in your chair for your normal time periods. AD may occur though, so you should have a plan for management with medications should that happen.
    5. No.
    6. Definitely. Best to start extra stool softeners at least 3-5 days prior to surgery, consider adding some Senakot or Dulcolax tablets, and do a very effective clean-out the day before so you don't have to do bowel care at all for at least 3 days after surgery. It is common that you would not be allowed to use a suppository for the first week or so post-op, and no digital stimulation for 2-3 weeks after surgery, so laxatives may be needed about 8 hours before you do bowel care. This may also increase your risks for accidents, so you need a plan for clean up and skin protection as well.
    7. Best to continue these.
    8. You should be provided with both pain medications, and with drugs to take "as needed" to manage AD during your immediate recovery period. Ganglionic blocking agents or sodium channel blocker rapid acting antihypertensives are used the most. This includes nifedipine, Minipress, Dibenzyline, and Apresoline. A physiatrist is usually the physician best versed in AD medical management. I would strongly recommend that you download the Clinical Practice Guideline on AD management and share it with both your PCP and the surgeon and anesthesiologist and request that they review it PRIOR to your procedure. You can get a copy here:
    9. See #8 above.


    http://www.pva.org/site/apps/ka/ec/p...oductID=883871

    (KLD)

  4. #4
    Complete C5 C6 here. Had two haemorrhoidectomys and made sure I had spinal anaesthesia both times as I had a previous history of recovering from general anaesthetic with a residual headache. I suspect autonomic dysreflexia whilst out of it. Started sweating profusely once the spinal anaesthesia had worn off the first time but it didn't go any further (e.g. pounding headache) without medication to lower blood pressure. Second haemorrhoidectomy was using a surgical stapling tool done only three weeks ago and took medication(Anginine 600MCG) in with me as I was worried about dysreflexia postoperation. BP started climbing when the spinal anaesthetic wore off and needed to take half a tablet. Had to repeat this once during the night in hospital and once the next afternoon at home.

    I had never used any medication to lower blood pressure previously but it worked like a charm.

  5. #5
    Hello! I had a Hemorrhoidectomy 2 years ago. Best thing I ever did.

    C 5/6 - I had many of your same concerns. I was awake during the procedure. To my knowledge, the anesthetist only discussed giving me anti-spasm med to stop me from jumping/spasm due to pain.

    Minor dyslexia during procedure, but it was over very quick. Afterwards, minor tingling /sweats. Discharged next day. Stayed in bed 2/3 days. No solid food. No BP.

    Surgeon did not suture incision. Name for the technique, but I can't recall. The worst part was the oozing for several weeks while it healed.

  6. #6
    Senior Member dnvrdave's Avatar
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    I'm also C5/6 complete, 29 years post.

    Here's a good thread. I posted there in 2007, after my hemorrhoidectomy. My bottom line is that it never gave me AD (high BP or headache), but the pain manifested as lots of sweating, especially after the surgery, but also for weeks later, due to suppositories. I didn't need general anesthesia (just local), and my surgeon did the surgery with me on my back, instead of face down. Both of these were at my request. But I got the surgeon worried by mentioning possible post-surgery AD, and she put me in ICU as a precaution. That was overkill, and more uncomfortable for me. Also they kept me there for 3 days, and the surgeon gave me the first suppository (which was too soon!). I don't think 3 days is necessary, but my insurance did pay for it.

    http://sci.rutgers.edu/forum/showthr...emerroidectomy

    2. Ask if you can be on your back for the surgery, especially if you stay awake. My anestesiologist stood by during the surgery, just in case I needed general anesthesia, but never did. If you get general, just tell them you don't want the Versed, because it's not necessary, and just makes you feel worse. I also told them not to give me Fentanyl for my last surgery. It allowed me to feel better and recover faster.

    7. Avoid foods that constipate, like meat and cheese, before and after the surgery. Eat lots of fiber and drink lots of water.

    Good luck! My hemorrhoids came back after 3-6 months. They never bled again. But if I had it to do over, I would have gone straight to a colostomy, which I finally got in January 2014.
    Last edited by dnvrdave; 05-03-2014 at 03:59 PM.

  7. #7
    Hi lewis,
    i just found your excellent post re: AD during and post hemorrhoidectomy. I am in pretty much the same situation and am very concerned about AD because my hemorrhoids started causing profuse sweating that would last for over an hour post bowel program. This prompted me to go see the surgeon. Things gave gotten better but I'm still concerned. Just wondering how surgery went for you and if you have any advice? Did you have epidural anesthesia? How long were you in bed? Thanks in advance for any advice!
    best wishes,
    leslie


    Quote Originally Posted by Lewis View Post
    I met with a colorectal surgeon this week and I?m looking at traditional hemorrhoidectomy surgery to take care of hemorrhoids on the inside and outside. I was told the inside ones could be banded but the exterior ones would need to be removed with surgery. I?ve been doing my research and I have some additional questions.

    Here?s a little context about me. I?m a C5 quadriplegic complete since my injury in 2001. I have dealt with hemorrhoids for quite some time. They have become a bigger issue in the past year. I experience bleeding with almost every bowel program (scheduled every other day via magic bullet sitting up in my shower chair). During my bowel program I experience significant autonomic dysreflexia at times. Additionally, I?ve experienced great discomfort during intermittent catheterization and I believe irritation from the hemorrhoids might be to blame. I met with the urologist recently and had everything checked out (ultrasound of kidneys and scoping to visually see if there were any problems in the urethra and bladder). The urologist did not find anything. Lastly, I had surgery in 2005 to have my gallbladder removed. This was unplanned but went very well and I don?t remember any issues with autonomic dysreflexia during the recovery.

    I?m seriously considering the hemorrhoidectomy surgery but I have many questions and thought it best to get some direction from this community.

    1. Should the surgeon band the ones he can and surgically remove the others, or just surgically remove them all?
    2. The surgeon recommends general anesthesia for the surgery to control autonomic dysreflexia during the surgery. Are there any questions I should ask the anesthesiologist?
    3. How long should I be monitored and kept in the hospital after surgery?
    4. Recovery for an able-bodied person is around six weeks. I expect to remain in bed for at least one week after but I?m unsure what to expect. Should I expect to stay in bed longer?
    5. Should I expect to shorten my time in the chair during the whole recovery?
    6. Should I load up on stool softeners and start prior to surgery (old threads mention Colace 250 mg. 3-4X daily)?
    7. I supplement my diet with 1 teaspoon of konjac (glucomannan) and one serving of Amazing Grass in 8 ounces of water, twice a day. Should I continue this before and during recovery?
    8. I understand the surgery is extremely painful for able-bodied people and as a result I am greatly concerned about autonomic dysreflexia. I?m not sure my primary doctor has dealt with someone who experiences autonomic dysreflexia. He?s very good about listening to me, but in this case I don?t know the answer. Who is the right person to talk to that REALLY understands autonomic dysreflexia?



    I was recently on vacation, doing my bowel program in bed on my side and attempted to bring down my blood pressure when it was 180/90 (my baseline is typically 90/65 sitting up). I tried nitropaste on my chest which resulted in little change and then tried sublingual nitrostat 0.4mg tablets which also had little change. In this case, discovering and manually removing hard stool alleviated the problem. BUT, how should I manage autonomic dysreflexia during the recovery period if the problem is the actual recovery? I?m more concerned about autonomic dysreflexia than I?ve ever been in my life as a quadriplegic.

    Sorry for the long post but I appreciate any first-hand experiences and guidance from the nurses

    Thank you!

  8. #8
    Thank you for this excellent reply SCI- nurse! I am a C6 quad in pretty much the same situation and your reply answers so many of my questions! And epidural anesthesia a brilliant idea. Thank you very very much for taking the time to answer so thoroughly and excellently.best wishes,
    leslie

  9. #9
    In the meantime- Lidocaine gel or patch over hemorrhoids- external- will numb pain( now and after surgery if ok with surgeon). Recommend Enemeez plus ( with Benzocaine ) for bowel program or copious use of lidocaine gel with suppository and bowel dig stim. Preparation H ( generic) does help with swelling/irritation before surgery.
    CWO

  10. #10
    The lidocaine I got (more of a paste than a gel) hasn't seemed to help me. Is there a brand that you have heard works well? Thank you,
    leslie

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