Every Wednesday afternoon, we will conduct health promotion and education on the knowledge of anorectal medicine for a group of newly admitted patients. Inform the patient in detail about the care of the anorectal department before the operation, during the postoperative hospitalization and after the discharge, in order to better assist the patient in the postoperative care work, so that the patient can recover health faster. The specific content is organized as follows for the reference of the majority of patients.
1. Avoid eating and drinking before surgery
Generally, patients undergoing surgery in the morning are required to fast after 12 o'clock in the evening before the operation; patients whose surgery time is scheduled in the afternoon are required to fast after 7 o'clock in the morning that day. If it is a patient with high blood pressure, you can take the antihypertensive medicine with a small sip of water on the morning of the operation. Do not drink more water.
2. Clean the intestines before surgery
Because the incision in anorectal surgery is close to or located in the anus, in order to avoid contaminating the incision with fecal discharge after anesthesia during anal relaxation, or short-term defecation after surgery, it is necessary to clean the intestine adequately before surgery. The doctor in charge will give preoperative enema or oral laxative treatment according to the specific conditions of the patient. The patient should cooperate with the doctor to clean the intestines. If there is still residual stool in the anus that has not been discharged, the doctor in charge should be informed in time. Further processing.
3. Postoperative wound care
The patient should be accompanied on the day of the operation, and every half an hour after the operation, observe whether there is fresh blood oozing from the auxiliary material at the anus. It is necessary to distinguish between old blood and fresh bleeding from the wound. If there is any abnormality, inform the doctor or nurse in charge. All getting out of bed for elderly or weaker patients must be accompanied by medical staff or the patient’s family members to prevent falls or orthostatic hypotension.
4. Postoperative diet
5. Urination after surgery
Postoperative patients may experience poor urination in the short term due to mental stress, postoperative pain, anesthesia, or middle-aged and elderly men who have prostate hyperplasia or hypertrophy. Encourage patients to get out of bed early after operation, drink water appropriately, and strive to urinate as soon as possible. Use hot compresses on the abdomen and listen to the sound of water to promote urination. If urination is still not smooth, inform the medical staff to deal with it in time.
6. Defecation after surgery
In principle, patients are required to defecate after 24 hours after surgery as much as possible. At the end of the operation, we will pack gauze in the anus to stop the bleeding, so after the anesthesia subsides, the patient will feel blockage or defecation in the anus.
Because the intestinal cavity has been cleaned before the operation, most of the stools that appear at this time are the patients' discomfort due to gauze packing or postoperative discomfort, not the real stool. At this time, the patient stays in bed and avoids squatting repeatedly in the toilet. In the early morning of the second day after surgery, the nurse routinely enema assisted defecation once.
Patients should develop good bowel habits. Our patients after anorectal surgery have aggravated pain due to fecal friction on the wound surface, fear of defecation, and inability to defecate on time, resulting in constipation due to excessive retention of stool in the intestinal cavity, resulting in excessive water absorption and constipation , Stool stimulates the wound in the rectum and aggravates the local inflammatory reaction, and also produces a feeling of abdominal distension, which is not conducive to postoperative recovery. Therefore, it is essential to develop good bowel habits. Get up before 7:30 in the morning, eat breakfast, then defecate, smoke and wash, and be ready to wait for dressing before 7:30. Defecate 1-2 times a day, preferably once, with a time of about 3 minutes, and avoid prolonged squatting or excessive defecation. It is best to develop the habit of defecation regularly after getting up early in the morning, and then go to defecation when the bowel movement is obvious. If the bowel movement is difficult or can not be solved, get up first and wait until the next time the bowel movement is obvious. Prolonged squatting is prohibited. One more point about defecation, because the anus is forced during defecation, and the stool is discharged through the scalpel. Some patients have obvious pain. In order to relieve the pain, patients can squeeze Obucaine Hydrochloride gel into the anus 10 minutes before defecation. The specific method is: first squeeze a little lubrication into the anus, then insert about 2cm into the anus, squeeze in half, and then defecate after 10 minutes. This is a submucosal analgesic that can effectively relieve pain during defecation. If you still can't solve it, you can defecate while fumigating and washing, which can also effectively relieve pain. In addition, if patients have dry stools that are difficult to discharge, they should first adjust their diet, eat more fruits and vegetables, drink more water, and drink a large mouthful of sesame oil every morning and evening to moisturize the bowel and relax the bowels, and exercise appropriately to promote bowel movements. If the symptoms of constipation still do not improve significantly, inform the doctor in time for medication.
7. Fumigation and bathing after surgery
Traditional Chinese medicine sitz bath can fumigate the affected area of the patient through the transpiration of the medicine gas, and use the efficacy of the liquid medicine and the warmth of the bath water to promote blood circulation and metabolism in local tissues, expand capillaries to promote wound growth and healing, and at the same time. To clean the wound, promote the absorption of inflammatory response and relieve sphincter spasm to relieve pain.Therefore, the patient must be fumigated and washed in place. The specific method of fumigation and washing is: the bidet should be large enough. After preparing the liquid medicine, sit on the fumigation lamp of the hospital for 15 minutes while it is hot. After the liquid medicine has cooled to about 40℃, soak the anus and perineum in warm water. Medium, lasting 15-20 min. When fumigating and washing, try to relax the anus to ensure that the liquid medicine can fully contact the wound surface. For patients with relatively large abscesses, deep abscesses or anal fistulas, go to the nurse's station and ask the nurse for a 50ml needle, and draw the liquid to thoroughly flush the deep part of the abscess. After fumigation and washing, use a clean soft towel to damp the wound surface to avoid residual water to avoid irritating the wound surface and even cause perianal eczema. Fumigation and washing will be done in the morning and evening during hospitalization. If you have a bowel movement at other times, add fumigation and washing in time after defecation. Pay attention to cover and keep warm. After taking a bath, the elderly and infirm should be supported to stand up to prevent unnecessary injuries caused by fainting.
8. Postoperative pain
Due to the rich distribution of nerves in the anus, it is more sensitive to pain, and the wounds near the anal margin are more obvious. Especially in patients with complicated perianal abscesses or postoperative sutures, the wound pain is more sensitive due to the local stimulation of the drainage strip. The degree of pain varies from person to person according to the patient's wound condition and personal tolerance. We also have a variety of pain relief measures. Based on the construction of painless wards, we aim to reduce the pain of patients, and strive to reduce pain as much as possible during the recovery process. Our department adopts various methods such as pain-relieving suppositories, pain-relieving drugs, physical therapy, and fumigation and bathing to prevent postoperative pain. Patients can inform the physician in charge of their condition in time.
9. Postoperative blood in the stool
Since the anal incision is generally not sutured, there may be a small amount of bleeding when you force the anus during defecation or when the feces rub the wound surface. This may be a month or so before the wound is fully healed. This is a normal phenomenon. Don't worry too much. If you find that the blood volume increases significantly after a certain time, please inform the medical staff in time to see if it needs treatment.
10. Postoperative anal bulge
In patients with hemorrhoids or after sutures, after 5-12 days after the operation, there may be obvious anal bulging or frequent bowel movements during the hemorrhoid shedding period. This is a common symptom of the hemorrhoids period. At this time, pay attention Rest, avoid excessive activity, and avoid frequent squats. After the hemorrhoids or glue thread fall off, the symptoms will gradually disappear.
11. Levator exercise
During the recovery process, when the patient consciously contracted the anus without obvious pain, he can start to perform levator anus exercises to promote the recovery of anal blood circulation and function. The specific method is: retract the abdomen when inhaling, quickly contract and lift the anus and perineum, pause for 10 seconds, then slowly relax and exhale for 10 seconds, and repeat. Do it 2-3 times a day, about 120 times each time.
12. Care after discharge
Fumigation and washing 3-4 times a day after discharge from the hospital, the method of fumigation and washing is the same as during the hospitalization period. Pay attention to strengthening nutrition, rest, drink more water, eat more fresh vegetables and fruits, avoid spicy tobacco and alcohol, and keep a happy mood. Continue to do levator ani exercises and exercise appropriately to avoid overwork. Follow the doctor's advice to return to the hospital regularly for dressing, and follow up if you feel unwell.
The above is a summary of some common matters needing attention, which are not yet perfect. If patients have other questions during the hospitalization, they can promptly inform the medical staff in charge and add them at any time. It is hoped that this article can play a certain role in helping and guiding patients in the recovery process.