Hemorrhoid Surgery Recovery: The Honest Week-by-Week Guide

Which operation you had matters

There are several ways of treating hemorrhoids, and the recovery is very different between them. Banding, injection and other clinic treatments involve no cut and settle in days. Stapled procedures and artery ligation are surgical but usually less painful afterwards. A haemorrhoidectomy, where the hemorrhoids are cut out under a general anesthetic, is the one this guide is mostly about, because it is the one with the hardest fortnight. Your discharge letter will say which you had.

The first three days

You will go home the same day or the next. The area will be sore, then very sore once the local anesthetic put in at the end of the operation wears off, usually within the first evening. Take your pain relief regularly and on time from the start rather than waiting for the pain; catching up is much harder than staying ahead.

Two things dominate these days. The first is pain, especially after passing a stool and for an hour or so afterwards, as the muscle around the wound tightens. The second is the dread of the first bowel movement, which is worse than the event for most people. It will sting, it may bleed a little, and it will be over. Do not put it off, because the longer stool sits, the harder it gets.

You will have been sent home with stool softeners or a laxative, and this is the moment to take them exactly as directed. Drink plenty of water. Eat, even if it is little and often, because an empty gut produces hard stool. Most people are advised not to take codeine-based painkillers, which cause constipation, and not to take ibuprofen if there is bleeding; follow the instructions you were given.

Some bright red blood on the paper, in the pan and on your dressing is normal in the first days and after each bowel movement. Heavy bleeding, clots, or bleeding that does not stop is not. See the warning signs below.

The sitz bath

A warm sitz bath is the single most helpful thing in the first two weeks, and the one thing the guidance and every surgeon agree on. Sit in warm, not hot, water for ten to fifteen minutes, two or three times a day and after each bowel movement. It relaxes the muscle, eases the spasm that follows a stool, and keeps the area clean without wiping.

You can do this in an ordinary bath, but filling and climbing in and out of a bath several times a day gets old quickly. A sitz bath basin sits over the toilet bowl, holds a few inches of warm water, and takes a minute to fill and empty. Plain water is fine. Do not add anything unless your surgeon has suggested it.

Keeping clean without pain

Wiping with dry paper is the thing people are least prepared for. Instead, rinse. A peri bottle, the squeezy bottle given to new mothers, or a handheld bidet attachment lets you clean with water after every bowel movement. Pat dry with soft paper or a clean cloth; do not rub. Witch hazel pads, which are cooling and soft, are a good alternative when you are out. A small pad in your underwear catches the discharge and spotting that continue for a few weeks and saves your clothes.

Sitting, lying and getting comfortable

Sitting is unavoidable and sitting hurts. Two things help. A ring or donut cushion takes the weight off the area when you have to sit at a table, in the car or at a desk; use it for sitting, not for lying, and take it with you anywhere you will be for more than a few minutes. And lie down more than you think you should for the first week. Lying on your side with a pillow between the knees takes all pressure off the wound and is the most comfortable position most people find.

Gentle walking around the house is good from the first day; it helps the bowel work and keeps the blood moving. Standing for long periods and any straining, lifting or bending are not.

Week one to two

The pain peaks in the first three to five days and then improves, although each bowel movement will sting for the first two weeks or so. Keep the routine going: pain relief on time, softeners every day, sitz baths after each stool, rinse rather than wipe, lie down when you can. Fibre matters now. A daily psyllium husk supplement with plenty of water keeps stools soft and formed, which is the aim; watery stool is as unpleasant as hard stool on a healing wound.

You may notice some itching as the area heals, a little discharge, and occasional spotting. All normal. Passing wind can be painful and occasionally you may not have perfect control over it for a week or two; that settles.

Most people take one to two weeks off work for a desk job and longer for a physical one, and sit on a cushion when they go back. Driving is fine once you can sit comfortably and are off strong painkillers, usually a week or more. Our driving after surgery guide covers the rules.

Weeks three to six

By three weeks most of the pain has gone and bowel movements are close to normal. Some tenderness, minor spotting and a feeling of fullness can continue for up to six weeks while the area finishes healing. Keep the fibre and fluids going permanently, not just for recovery; the guidance is clear that the diet and habits that prevent hemorrhoids are the same ones that stop them coming back. Do not sit on the toilet for longer than you need, do not strain, and do not ignore the urge to go.

Warning signs to take seriously

Contact your surgeon or the hospital, or out of hours seek urgent care, if you have:

Bleeding that is heavy, will not stop, or contains clots. Go to the emergency department or call emergency services if it is a lot.

Not being able to pass urine in the hours after surgery, which happens because of the pain and needs treating.

No bowel movement for three days despite softeners, or severe pain that your medication does not touch.

A high temperature, feeling hot and shivery, or a discharge that is smelly or pus-like, which point to infection.

Pain that gets worse after the first week rather than better.

The honest summary

The first three to five days are hard. The first bowel movement is the thing everyone dreads and nearly everyone gets through. Warm water, soft stools and lying down are the treatment; a sitz bath basin, a rinse bottle, a cushion and a fibre supplement are the kit. By two weeks you will be turning a corner, by six weeks you will be glad you did it, and the fibre habit you built in recovery is the thing most likely to keep you from ever needing it again.