Post-Surgery Pain Relief: Why Some Ointments Are Not Recommended

Postoperative ointment for hemorrhoids?

Hello Dr.
Chang, I visited you a few months ago, and you diagnosed me with grade III hemorrhoids, which were not severe enough to require surgery.
However, after experiencing intermittent flare-ups, I decided to undergo traditional hemorrhoidectomy.
Due to the tearing from bowel movements and the irritation from the wound coming into contact with feces, I purchased a topical ointment from the pharmacy, specifically Da Feng Pharmaceutical's (Zhi Mian Zhong), which contains 30mg of Lidocaine, to alleviate the pain and discomfort.
During my follow-up visit, the doctor advised against using the ointment and suggested that I only soak in water to relieve the pain.
I would like to understand why I cannot use the ointment for pain relief.
Are there any topical medications that can help alleviate the pain at this stage? Note: I had the surgery on August 29.

Pa Li, 30~39 year old female. Ask Date: 2023/09/08

Dr. Zhang Shuhao reply Surgery

In addition to pain-relieving ingredients like Lidocaine, hemorrhoid ointments often contain steroids, which can be detrimental to postoperative wound healing.
Postoperative pain management for hemorrhoid surgery primarily involves warm sitz baths and oral anti-inflammatory pain relievers.
It is recommended to use antibiotic ointments that do not contain steroids, such as Neosporin or Bacitracin.

Reply Date: 2023/09/08

More Info

Post-surgery pain management is a critical aspect of recovery, especially after procedures like hemorrhoidectomy. While it may be tempting to use topical ointments like the one you mentioned (containing Lidocaine) for immediate relief, there are several reasons why your doctor may have advised against it.

Reasons Against Using Certain Ointments Post-Surgery
1. Risk of Infection: After surgery, the surgical site is vulnerable to infection. Applying ointments, especially those not specifically designed for post-operative care, can introduce bacteria or other pathogens to the area. This is particularly concerning for wounds that are healing, as any foreign substance can compromise the integrity of the healing tissue.

2. Delayed Healing: Some topical medications can create a barrier that traps moisture and bacteria against the skin, potentially leading to maceration of the tissue. This can delay the healing process and increase the risk of complications.

3. Chemical Irritation: Lidocaine, while effective for numbing pain, can also cause irritation or allergic reactions in some individuals. If the skin is already sensitive due to surgery, applying a topical anesthetic may exacerbate discomfort rather than alleviate it.

4. Masking Symptoms: Using pain relief ointments can mask the pain that serves as a warning sign of complications. If there is an underlying issue, such as an infection or improper healing, the absence of pain might lead to a delay in seeking necessary medical attention.

5. Alternative Pain Management Strategies: Your doctor may recommend other methods for pain relief that are safer and more effective in the long run. These can include sitz baths, which help soothe the area with warm water, or oral pain medications that can provide systemic relief without the risks associated with topical applications.

Recommended Pain Relief Strategies
1. Sitz Baths: Soaking in warm water several times a day can help reduce pain and promote healing. This method is gentle and can provide significant relief without the risks associated with topical ointments.

2. Oral Pain Medications: Over-the-counter pain relievers such as acetaminophen or ibuprofen can be effective in managing pain. Your doctor may also prescribe stronger medications if necessary.

3. Dietary Adjustments: Ensuring a high-fiber diet can help prevent constipation and straining during bowel movements, which can aggravate pain and discomfort in the surgical area.

4. Hydration: Drinking plenty of fluids can help soften stools and make bowel movements easier, reducing the risk of further irritation to the surgical site.

5. Follow-Up Care: Regular follow-up appointments with your healthcare provider are essential to monitor healing and address any concerns that may arise. If pain persists or worsens, it’s important to communicate this with your doctor.

Conclusion
While it may be frustrating to avoid certain pain relief methods that seem effective, it’s crucial to prioritize healing and minimize the risk of complications after surgery. Always follow your healthcare provider's recommendations and discuss any concerns you have about pain management. They can provide tailored advice and alternative strategies to ensure a smooth recovery. If you feel that your pain is not adequately managed, do not hesitate to reach out to your doctor for further evaluation and adjustments to your pain management plan.

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