Most surgery and endoscopy is done under either sedation or general anesthesia. This requires a fast of at least 6 hours with, no solids or liquids prior to surgery. You may continue to take antihypertensive medication with a sip of water on the morning of surgery but avoid diabetic medication. Blood “thinner” medication such as aspirin, plavix (clopidrogel), Brilinta, Elliquis, Pradaxa or other similar cardiac drugs should be stopped at least 3 days prior to surgery. 

If in doubt, call your doctor.
Bowel preparation may be required if your doctor has instructed you.

Bowel Preparation

The large intestine needs to be clear of faecal matter for adequate visualisation otherwise small polyps can be missed. Medication to evacuate stool plus a clear liquid diet is necessary at least 6 hours prior to colonoscopy or bowel surgery.

Clear liquids - this may consist of water, tea or coffee with sugar only, barley water, sugar cane juice, chrysanthemum tea, fruit juice without pulp like apple juice, clear broth, jello without milk or coconut. Electrolyte drinks like Gatorade, 100 plus and H2O are also acceptable. Drink at least 2 litres.

For best results, avoid fruit and vegetables, high residue foods like oats for 3 days prior to the procedure.

Medications taken usually consist of oral fleet 45 mls which is a concentrated salty liquid best consumed chilled and rapidly without dilution. PEG (Fortrans) is a synthetic laxative powder prepared by mixing a sachet in a litre of water. Best flavoured with Ribena or Lemon juice as it is tasteless.

Important: Please let your doctor know if you are on any blood thinning mediations like aspirin, plavix, xarelto, warfarin because you will need to stop them for at least  days prior to the procedure. Also if you have any kidney or heart disease, your physician should be informed so that adjustments can be made.

Regular medications: High blood pressure medications should be consumed with a sip of water on the morning of the procedure. Diabetic medications are best omitted from the night before when bowel preparation is being performed.

Following Anal Surgery

What should you do?

Wound Care
Please remove all packing and dressings after shower spray of the anal area with warm water the morning following your surgery. The dressing may fall off or out prior to that time, which is fine.Please perform sitz baths twice each day as well as after each bowel movement (10-15 minute soak in warm water), only if you have an open wound. You may do this more frequently for cleanliness or if they help relieve discomfort.Do not sit on a "donut". For prolonged sitting, use a pillow or styrofoam pad.

Bowel Medications
Please take 1 tablespoon of Fybogel, Mucilin or other fiber supplement of your choice once each day. Dissolve this in a glass of water or juice. Drink additional 8-10 glasses of water during the course of each day.You may use Lactus syrup 20cc per day to supplement the fibre if stool consistency is still hard.If you go 72 hours without a bowel movement, please contact your doctor as you may need a gentle enema to relieve stool impaction.

Pain Medication
You will be given pain medications(usually Naproxen and Tramadol). Take the Naproxen as directed every 6 hours and the Tramadol can be taken in between for breakthrough pain.

Rest today. Do not do any heavy lifting or vigorous exercise for 5 days.

If you cannot urinate, sit in a warm bath or shower then try again.

Resume a regular diet.

Following Endoscopy

Immediately post procedure

Be sure not to drive as the sedative drugs used can impair your judgement.Get plenty of sleep to ward off the effects of the sedative.Drink lots of water to clear your system.Progressively move onto your normal diet from liquids. Avoid eating too much if you are feeling nauseous. In some cases, you may require additional medication.

What you should look out for

1. Abnormal bleeding per rectum after colonoscopy.  This is especially important if a polypectomy has been done as the base of the cauterized blood vessel may slough off and give rise to bleeding. Contact your doctor immediately as repeat endoscopy and hospitalization is usually necessary.

2. Black tarry stool

3. Pain on swallowing

4. Abdominal pain -
you should be pain free following gastroscopy and colonoscopy. If there is pain and fever, please contact your doctor immediately.

Following Ligation of Piles

What to expect

1.Pain and swelling is expected 4-6 hours following the procedure. Please take pain medications (Naproxen or double strength panadol) for 24 hours. This pain subsides after a day.

2.There may be some bleeding 7-10 days post ligation when the rubber slips off or from ulceration. Most of the time, this is self limited. Should bleeding persist, please contact your doctor immediately. An examination and injection of the haemorrhoidal complex is usually required.