Our Summary

This study examines the use of opioids (strong painkillers) after surgery for hemorrhoids, a common and painful condition. Currently, there are no guidelines for prescribing opioids to patients after this type of surgery. Using data from the US Department of Defense Military Health System, the researchers looked at the prescription patterns for over 6,000 patients who underwent surgery for hemorrhoids. They found that 88% of patients filled an initial prescription for opioids, typically enough for five days. However, about a third of these patients needed a refill. The likelihood of needing a refill was influenced by several factors, including race, history of substance abuse, and the length of the initial prescription. The study concludes that there is a wide range of how long patients use opioids after this surgery, with the optimal duration seemingly between five and ten days. This suggests that doctors can better manage pain relief for their patients while also minimizing the risk of over-prescribing painkillers.

FAQs

  1. What percentage of patients filled an initial prescription for opioids after hemorrhoid surgery, according to the study?
  2. What factors influenced the likelihood of a patient needing a refill of their opioid prescription after hemorrhoid surgery?
  3. What is the suggested optimal duration for the use of opioids after hemorrhoid surgery as per the study?

Doctor’s Tip

A helpful tip a doctor might tell a patient about hemorrhoidectomy is to discuss pain management options before the surgery and to follow the prescribed pain medication regimen closely. It is important to communicate any concerns or changes in pain levels to your healthcare provider so they can adjust your medication as needed. Additionally, incorporating stool softeners, fiber-rich foods, and staying hydrated can help prevent constipation and discomfort during the recovery period.

Suitable For

Patients who are recommended hemorrhoidectomy typically have severe or persistent symptoms of hemorrhoids that have not responded to conservative treatments such as dietary changes, topical medications, or rubber band ligation. These patients may experience symptoms such as severe pain, bleeding, itching, or prolapse of hemorrhoidal tissue. Additionally, patients with large, external hemorrhoids or thrombosed hemorrhoids may also be recommended for surgery. Ultimately, the decision to undergo hemorrhoidectomy is made on a case-by-case basis by a healthcare provider after a thorough evaluation of the patient’s symptoms and medical history.

Timeline

Before the hemorrhoidectomy:

  • Patient experiences symptoms of hemorrhoids such as rectal bleeding, itching, pain, and discomfort.
  • Patient consults with a doctor or specialist who recommends a hemorrhoidectomy as a treatment option.
  • Patient undergoes pre-operative tests and evaluations to ensure they are fit for surgery.
  • Patient is advised on pre-operative instructions such as fasting and medication adjustments.

After the hemorrhoidectomy:

  • Patient undergoes the surgical procedure to remove the hemorrhoids.
  • Patient is monitored in the recovery room before being discharged home.
  • Patient is prescribed pain medication to manage post-operative pain.
  • Patient may experience discomfort, swelling, and bleeding in the days following the surgery.
  • Patient is advised on post-operative care instructions such as wound care, diet modifications, and activity restrictions.
  • Patient follows up with the doctor for post-operative check-ups and to discuss any concerns or complications.
  • Patient gradually recovers from the surgery, with symptoms improving over time.
  • Patient may need a refill of pain medication depending on their individual pain levels and recovery progress.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with hemorrhoidectomy surgery?
  2. What is the typical recovery time and expected post-operative pain level?
  3. What pain management options will be available to me after the surgery?
  4. How long do you typically prescribe opioids for pain management after hemorrhoidectomy surgery?
  5. Are there alternative pain management options that I can consider instead of opioids?
  6. What steps can I take to minimize my risk of needing a refill for opioid medication after surgery?
  7. How will you monitor my pain levels and adjust my pain management plan accordingly?
  8. Are there any lifestyle changes or home remedies that can help with pain management during recovery?
  9. What signs should I watch for that may indicate a need for medical attention after surgery?
  10. How will you ensure that my pain is effectively managed while also minimizing the risk of opioid dependence or addiction?

Reference

Authors: Lu PW, Fields AC, Andriotti T, Welten VM, Rojas-Alexandre M, Koehlmoos TP, Schoenfeld AJ, Melnitchouk N. Journal: Dis Colon Rectum. 2020 Aug;63(8):1118-1126. doi: 10.1097/DCR.0000000000001570. PMID: 32015286