Front Range Surgical Associates
James C. Garlitz, MD
8300 Alcott St., Suite 201
Westminister, CO 80031
303-428-0004 Fax 303-428-1539
Post-operative Instructions for Ano-Rectal Procedures
1. General considerations:
 For 48 hours after exposure to anesthetics and for the entire time that you are using your pain
medications, do NOT drive, drink alcoholic beverages, and/or make important decisions. Your reasoning
and judgment may be impaired.
 Surgery is stressful to your system. You may be easily exhausted by even minimal exertion for anywhere
from 1 to 2 days to 1 to 2 weeks. Give yourself time to rest and recover.
 Continue your regular, pre-operative medications, unless otherwise instructed by your physician.
2. Wound care considerations: (also please refer to the procedure-specific instructions listed below)
 Remove all dressings in about 6 hrs.
 Begin Sitz baths after your dressing has been removed. Use plain, HOT water, and take the baths 3-5
times daily, or after bowel movements. It is OK to do more Sitz baths as needed for comfort.
 If you have an anal packing, remove it with the first Sitz bath.
 You may replace a dressing if there is significant drainage or soilage, or to keep your clothes clean.
3. Activity:
 Resume activities as directed. Please give yourself a chance to rest and recover. However, it is
important to get up and move around frequently. Unless specifically instructed, strict bed rest is NOT
necessary.
 You may climb stairs. Take your time and use assistance if necessary.
 You may be unsteady on your feet initially, so it is a good idea to rise slowly and have assistance
nearby. This is especially true the first days after surgery.
 Try to limit any lifting to no more than 10 to 15 lbs (the equivalent of a gallon of milk) for about 2 weeks.
 Let your body be your guide. If it hurts too much, you are probably overdoing it.
4. Discomfort and pain:
 Some discomfort and pain after surgery is normal- to a degree. That is why we give you pain
medication. Use your pain medication as prescribed. Use Sitz baths preferentially for comfort.
 Narcotic pain medications can upset your stomach. Try not to take them on an empty stomach.
 The amount of discomfort you experience will vary depending upon the extent of your surgery and your
individual pain tolerance.
 Do NOT take aspirin for 2 weeks, unless otherwise instructed.
5. Diet and Bowel Movements:
Note: (OTC = over the counter)
 Eat a high fiber diet with plenty of vegetables and fruits.
 Narcotic pain medications are constipating. It is also OK to use an OTC stool softener, laxative, and/or
apple/prune juice while taking narcotic pain medications.
 Please use a fiber supplement: 1 tablespoon (= five tablets/capsules = 2 wafers) of Metamucil, Citrucel,
Fiber-Con or Benefiber (OTC).
 Stay hydrated- drink plenty of fluids, at least 6-8 glasses of water daily.
 Please take stool softeners twice per day. I recommend Colace (OTC) 100mg, twice per day.
 If you have not had a bowel movement in 48 hrs, please take Milk of Magnesia (OTC). The
recommended dose is 2 tablespoons every 6 hrs until you have a bowel movement.
 If you haven’t had a bowel movement in 72 hrs, please take 1 bottle of Magnesium Citrate (OTC), or 1
bottle of oral Fleets prep (OTC). You may also try a gentle Fleets enema (OTC).
6. Post-operative nausea:
 Nausea in the early post-operative period is becoming less frequent with the improvements in
anesthetic technique. However, it is not rare.
 To limit post-operative nausea, stick to relatively bland foods and/or a liquid based diet for the first few
days after anesthesia. It may also be helpful to eat frequent, small meals for the first few days after a
procedure, rather than a few, large meals.
 If nausea persists for longer than 36 hours, if it is debilitating, or if you are concerned, please contact us.
7. Contact us if you experience any of the following:
 A few tablespoons, even up to ¼ cup of bleeding is acceptable in the first few weeks post-operatively. If
there is more than that, you should notify your doctor.
 Sustained temperature of 100.5 F or greater.
 Redness, swelling, warmth, drainage, or blistering around your incision.
 Any symptom that causes you concerns.
8. Procedure-specific instructions:
 If you had a plug placed for an anal fistula, avoid ANY straining and ANY lifting more than 10 lbs, and
avoid ANY exercise for 2 weeks. You should also be on a liquid diet for 2 days.
 If you have had drainage of an infection or abscess, please change the dressing starting tomorrow by
removing all of the old packing, and then using a damp saline-soaked gauze dressing in the wound and
then covering it with a dry gauze, and continue that twice daily until seen in the office.
 Remove any internal packing within 6 hours of your surgery.
9. Please Note: Pain medication refills can only be done during regular business hours, Monday
through Friday.
10. Follow-up Appointment:
 Please schedule a post-operative appointment with my office for about 3 weeks after your surgery,
unless otherwise instructed. Please notify my office if there are any scheduling changes that need to be
made.
These instructions are not a substitute for your own good judgment. Please contact me at any time if you have
any questions or concerns. I can ALWAYS be reached at 303-428-0004. If it is after regular office hours, our
answering service will contact me or the physician on call. There is coverage 24 hours a day, 7 days a week to
ensure that your questions are answered expertly and expediently.
If you are concerned that you may have a severe, life or limb-threatening problem, please call
9-1-1 first, or go directly to the nearest ER.
I look forward to seeing you at your follow-up appointment. Thank you for the opportunity to participate in your
health care.
Sincerely,
James C. Garlitz, MD
Rev. 7/15