Complications include urinary retention, urinary tract infection, bleeding, anal stenosis, incontinence, fecal impaction, infection, and fistula formation. Local infection and fistula formation are quite uncommon, easily recognized, and generally treated in the office with drainage or superficial fistulotomy. Urinary retention is generally secondary to both local pain and the amount of intravenous fluids received intraoperatively. Rates

Fistulotomy Wound
Fig. 7. Surgical hemorroidectomy. (A) Exposure of the hemorrhoid. (B) Excision of the hemorrhoid and exposure of submucosal vascular plexuses. (C) Dissection of the hemorrhoidal plexuses. (D) Wound closure. (E) Completed procedure.

up to 17% have been reported (25), but the incidence can be minimized by limiting intraoperative fluids to less than 300 cm3. Bleeding can be immediate, i.e., in the recovery room, or delayed, at between 7-16 d postoperatively (25). If hemodynamically significant, this must be addressed in an operating room with suture ligation or cautery. Anal stenosis and incontinence are both the result of overzealous excision-stenosis from the failure to preserve native tissue between excision sites and incontinence from excision of sphincter muscle fibers with the hemorrhoidal cushions. Anal stenosis, if present, may require subsequent anoplasty. Incontinence is very difficult to correct and is generally addressed nonoperatively. Fecal impaction is generally avoided by the institution of bulking agents and stool softeners but can also be treated with enemas. Rarely, disimpaction under general anesthesia may be required.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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