Common Anal Conditions · Version 2.0
Appendix D — Post-Procedure Discharge Instructions
Dr. Tamer Rushdy Elalfy · 6 min read
In this chapter
- D.1 Rubber band ligation (banding)
- D.2 Injection sclerotherapy or infrared coagulation
- D.3 Excision of a thrombosed external haemorrhoid
- D.4 Incision and drainage of a perianal abscess
- D.5 Fissure ointment treatment
- D.6 Haemorrhoidectomy
- D.7 Pilonidal abscess drainage
Printable patient sheets. Plain language. The return thresholds are identical on every sheet so that patients and staff learn one set of numbers.
D.1 Rubber band ligation (banding)
| Topic | What to do |
|---|
| What is normal | A dull ache or feeling of fullness for 1–3 days. A little bleeding when the band falls off, usually within 5–10 days. |
| Pain control | Regular paracetamol; ibuprofen if your doctor allows. Avoid codeine if you can — it causes constipation. |
| Bowel care | Fibre, plenty of water, and a stool softener. Do not strain. |
| Washing | Warm-water baths or showers are fine. No antiseptics in the water. |
| Special warning | Pain that gets worse after day 2, with fever or difficulty passing urine, is an emergency — say that you have had banding. |
| 🚨 Seek urgent care | Go to the emergency department now if: bleeding soaks more than 1 pad in an hour or you pass clots; temperature above 38.0 °C or shivering; you cannot pass urine for 6–8 hours or your lower tummy is painful and swollen; pain is getting worse instead of better, or is not controlled by your painkillers. |
D.2 Injection sclerotherapy or infrared coagulation
| Topic | What to do |
|---|
| What is normal | Mild discomfort for a day; slight spotting for a few days. |
| Pain control | Paracetamol as needed. |
| Bowel care | Fibre, water, and do not strain. |
| Washing | Normal showers; warm-water baths if sore. |
| 🚨 Seek urgent care | Go to the emergency department now if: bleeding soaks more than 1 pad in an hour or you pass clots; temperature above 38.0 °C or shivering; you cannot pass urine for 6–8 hours or your lower tummy is painful and swollen; pain is getting worse instead of better, or is not controlled by your painkillers. |
D.3 Excision of a thrombosed external haemorrhoid
| Topic | What to do |
|---|
| What is normal | Soreness for several days; small amounts of bleeding or ooze from the wound. |
| Pain control | Regular paracetamol, plus ibuprofen if allowed. |
| Bowel care | Fibre, water, and a stool softener from today. |
| Wound and baths | Remove the dressing after the first bowel movement or the next day; warm-water baths 2–3 times a day and after bowel movements; pat dry; wear a pad. |
| 🚨 Seek urgent care | Go to the emergency department now if: bleeding soaks more than 1 pad in an hour or you pass clots; temperature above 38.0 °C or shivering; you cannot pass urine for 6–8 hours or your lower tummy is painful and swollen; pain is getting worse instead of better, or is not controlled by your painkillers. |
D.4 Incision and drainage of a perianal abscess
| Topic | What to do |
|---|
| What is normal | Discharge from the wound for 1–2 weeks; gradual healing from the inside. Routine daily packing is usually not needed. |
| Pain control | Regular paracetamol, plus ibuprofen if allowed. |
| Bowel care | Soft stools: fibre, water, a stool softener. |
| Wound and baths | Shower or warm-water bath 2–3 times a day and after bowel movements; absorbent pad; no antiseptics. |
| Follow-up | If discharge or a lump returns after healing, you may have a fistula — see your surgeon. |
| 🚨 Seek urgent care | Go to the emergency department now if: bleeding soaks more than 1 pad in an hour or you pass clots; temperature above 38.0 °C or shivering; you cannot pass urine for 6–8 hours or your lower tummy is painful and swollen; pain is getting worse instead of better, or is not controlled by your painkillers. |
D.5 Fissure ointment treatment
| Topic | What to do |
|---|
| What is normal | Pain usually improves within 1–2 weeks; full healing takes 6–8 weeks. |
| How to use | A pea-sized amount on a gloved fingertip to the edge of the anus, usually twice daily, for the full 6–8 weeks. |
| GTN ointment | Headache is common at first. Do not use sildenafil, tadalafil, vardenafil, or avanafil while using GTN. |
| Bowel care | Soft stools every day: fibre, water, a stool softener. |
| When to return | Not healed after 6–8 weeks; fever, swelling, or throbbing pain (possible abscess). |
| 🚨 Seek urgent care | Go to the emergency department now if: bleeding soaks more than 1 pad in an hour or you pass clots; temperature above 38.0 °C or shivering; you cannot pass urine for 6–8 hours or your lower tummy is painful and swollen; pain is getting worse instead of better, or is not controlled by your painkillers. |
D.6 Haemorrhoidectomy
| Topic | What to do |
|---|
| What is normal | Pain for 1–2 weeks, worst with bowel movements; spotting for several weeks; some swelling. |
| Pain control | Regular paracetamol plus an NSAID if allowed; prescribed ointment; minimal opioid. |
| Bowel care | Stool softener daily and fibre; aim to open your bowels by day 2–3. |
| Wound and baths | Warm-water baths 2–3 times a day and after bowel movements; pad in underwear. |
| 🚨 Seek urgent care | Go to the emergency department now if: bleeding soaks more than 1 pad in an hour or you pass clots; temperature above 38.0 °C or shivering; you cannot pass urine for 6–8 hours or your lower tummy is painful and swollen; pain is getting worse instead of better, or is not controlled by your painkillers. |
D.7 Pilonidal abscess drainage
| Topic | What to do |
|---|
| What is normal | Discharge for 1–2 weeks; slow healing from the base. |
| Pain control | Paracetamol, plus ibuprofen if allowed. |
| Wound care | Daily shower; dressing changes as advised; keep dry; avoid long sitting on hard surfaces. |
| After healing | Your surgeon may suggest hair removal or a planned operation to prevent recurrence. |
| 🚨 Seek urgent care | Go to the emergency department now if: bleeding soaks more than 1 pad in an hour or you pass clots; temperature above 38.0 °C or shivering; you cannot pass urine for 6–8 hours or your lower tummy is painful and swollen; pain is getting worse instead of better, or is not controlled by your painkillers. |
