Post-Surgery Care: Using Suppositories and Ointments for Healing

Please provide information regarding the use of suppositories and ointments prescribed by the physician after fistula surgery?

Hello Dr.
Ke, I visited you yesterday regarding the reason my wound has not fully healed one and a half months after the fistula surgery.
You mentioned that because I previously underwent a hemorrhoidectomy, if the incision is made near the dentate line, the surrounding muscles may cause increased pressure during bowel movements, leading to the wound reopening and bleeding.
However, after examining my wound, you said it is healing well.
Since my previous surgeon did not prescribe any suppositories or ointments after the surgery, you prescribed "Hemorrhoid Suppositories" and "Hemorrhoid Ointment" to aid in the healing process.
I have a few questions for you, thank you!
1.
Do I need to lie down immediately after using the suppository and avoid doing anything else? In other words, if I have tasks to do after taking a shower, should I use the suppository right before going to bed to ensure it melts and prevents it from coming out while moving around?

2.
Should the suppository be inserted deeper into the rectum? (This was my first time using it, and I’m not sure if I inserted it deeply enough or if I should have urinated first.
After inserting it, when I urinated and contracted my anus, the suppository came out.)
3.
Both the suppository and ointment make the anal area oily and difficult to clean with just water, especially since I am currently doing sitz baths three times a day.
Will this oily residue make it easier for feces and tissue fluid to adhere, thus compromising the cleanliness of the wound? Is it necessary to gently wash with a fragrance-free or low-additive soap and then dry before applying the medication, or can I simply rinse with water and gently clean with my hand? (I’m concerned that since you prescribed a 14-day supply, the daily oiliness might lead to accumulating fecal matter or tissue fluid, making it less clean over time.)
4.
I heard that suppositories can melt in high indoor temperatures, so I placed them in the refrigerator.
Is it okay to take them out when needed?
5.
I have been accustomed to squatting for bowel movements since childhood, which makes it easier for me.
However, does squatting increase pressure on the anal rectum and lead to bleeding, or does it not make a difference? (I read online that some doctors say squatting can actually increase abdominal pressure, aiding in bowel movements.) If I continue to squat but also do sitz baths afterward, will that help with wound healing and prevent hemorrhoids?
Thank you very much, doctor!

A Guo, 40~49 year old female. Ask Date: 2018/11/28

Dr. Ke Fangxu reply Surgery

1.
It is generally recommended to use suppositories before bedtime to prevent the medication from slipping out after movement.

2.
A suppository should be fully inserted into the rectum; as long as it remains within the anal sphincter, it will not slip out.
Urination can cause relaxation of the sphincter, which may lead to the medication slipping out, hence the recommendation to use it before sleep.

3.
The anal area should be cleaned adequately, but excessive cleaning can lead to skin damage.

4.
Yes, squatting to defecate can indeed increase abdominal pressure, making it easier to pass stool; however, the increased abdominal pressure can also lead to swelling of hemorrhoids.
Sitz baths cannot reverse the congestion and swelling caused by squatting.
If possible, it is still recommended to sit while defecating.

Reply Date: 2018/11/28

More Info

Post-surgery care, especially after procedures like fistula surgery, is crucial for ensuring proper healing and preventing complications. Your questions regarding the use of suppositories and ointments are very pertinent, and I will address each of them in detail.

1. Using Suppositories and Activity: It is generally recommended to lie down for a short period after inserting a suppository to allow it to dissolve properly and be absorbed by the body. This minimizes the risk of the suppository being expelled. If you need to engage in activities after using the suppository, it is best to wait at least 15-30 minutes before doing so. Ideally, you should insert the suppository before bedtime, as this allows for maximum absorption while you are resting.

2. Insertion Technique: When using a suppository, it should be inserted gently into the rectum. It is advisable to push it in about an inch or so to ensure it is placed correctly. If you experience difficulty or if the suppository seems to come out after insertion, you might want to try a different position or ensure that you are relaxed during the process. Emptying your bladder before insertion can also help, as it may create more space in the rectal area.

3. Cleaning and Hygiene: After using ointments and suppositories, it is important to maintain good hygiene to prevent infection. If the ointment makes the area feel greasy, you can gently clean the area with warm water and a mild, unscented soap. Avoid scrubbing, as this can irritate the skin. After cleaning, pat the area dry with a soft towel. It is essential to keep the area clean to prevent fecal contamination, which could lead to infection or delayed healing. Regular sitz baths can also help maintain cleanliness and soothe the area.

4. Storage of Suppositories: Suppositories should be stored in a cool place, and refrigeration is often recommended, especially in warmer climates. Keeping them in the refrigerator can help maintain their shape and effectiveness. Just remember to allow them to reach room temperature for a few minutes before use, as this can make insertion easier.

5. Bowel Habits and Pressure: Squatting for bowel movements is a natural position that can facilitate easier passage of stool. However, if you have recently undergone surgery, it is important to be cautious. Excessive straining or pressure during bowel movements can lead to complications such as bleeding or reopening of the surgical site. If squatting feels comfortable and does not cause pain, it may be acceptable, but you should listen to your body. If you experience discomfort or bleeding, consider transitioning to sitting on the toilet, as this position may reduce pressure on the rectal area. Regular sitz baths can help soothe the area after bowel movements, regardless of your position.

In summary, following your surgeon's post-operative care instructions is essential for optimal healing. Use the suppositories as directed, maintain good hygiene, and monitor your body’s responses to different bowel habits. If you have any concerns about your healing process or experience unusual symptoms, do not hesitate to reach out to your healthcare provider for further guidance. Your recovery is a priority, and addressing these questions is an important step in ensuring a smooth healing process.

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