Not for the squeamish

Posted by @ 6:06 am on Monday 6th February, 2012.

I wasn't intending to go into great detail about my haemorrhoidectomy, primarily because it should have been a routine day-procedure with a necessarily-uncomfortable but pain-managed recovery period, and also because it's an op that a lot of readers will remember with mixed feelings.

However, circumstances changed when post-op complications kicked in, so now I've decided to publish the tale so that folk considering such a procedure can get a handle on how it can go wrong, how the wrongs could have been righted or even avoided, and how impressively some of the hospital staff can

  • mismanage such complications;
  • regard with contempt the certain knowledge of a patient in need of help;
  • gather inaccurate information, analyse it, act upon it and disseminate it despite being told of the inaccuracies by the patient.

So, if you're interested in a frank and clear account, just click the little "+" sign or message below and all will be revealed. Worry not, I've not included any gory photos (although they are available on request).

 

Click here to show/hide the rest of the post

 

The story starts way back in Autumn 2011. External piles were giving me trouble so I went to my GP and after having the presence of external piles confirmed I got me a referral to a BUPA Colorectal Consultant.

The consultation took place in October. During the session I made it quite plain that I had been suffering with external piles. The Consultant did a full examination and confirmed that piles were present and in need of removal. I was given a choice - treatment under BUPA within a few weeks or treatment under the NHS before Christmas. Either way, the Consultant said that it would be a day-procedure that he would perform himself and he went on to explain the procedure and the equipment that he would use to rid me of all of my piles. I took the second option.

A while later I received a letter asking me to contact the hospital to arrange a date for the operation. I phoned ASAP to find that the soonest available slot would be sometime in late January... so it seems that the "before Christmas" offer was off, I suspect that someone at the hospital had over-ruled the Consultant. No matter, I booked the first available slot.

A week or so later the paperwork arrived. Loads of instructions, a date for the op, a date for a pre-assessment and that festrous green form.

In early January I went in for the pre-assessment. Nurse 1 did sats and pressures, pulse-checks, height & weight measurements, MRSA-swabs and general notes. Nurse 2 did an ECG-check and went through my records discussing Lactulose, lifestyle, smoking-cessation and the procedure itself. There was much discussion about nicotine-patches and the like. Nurse 2 had a copy of the letter from the Consultant, the part about being done before Christmas had been crossed out and marked "disregard", IIRC. Anyway, I was pronounced to be in fine fettle and was given the OK for the op.

I did all the right things on the lead-up to the op - I took the Lactulose, I cut down the smoking and I did the fasting thing.

Op-day (Wednesday January 25th) dawned and all was going to plan until I learned that the Consultant that I'd seen in October had subbed-out my op to a different surgeon. Hmmm... As usual I was one of the first to arrive and as usual I was the last one into theatre. That's the way my life works. Anyway, after the procedure I was told that all had gone well and I was allowed tea and toast before being given a home-pack of instructions and pain-killers (Diclofenac for two days and then Co-codamol). It was explained yet again that I had a pad in my pants and that I had a dressing of "special foam-like material" (hereafter referred to as "the bung") in my back passage (holding both sphincters open) to help to stop any bleeding, this dressing would come away on its own either within the first 24-48 hours or at the time of my first bowel movement. I checked the pad in my pants to find that it wasn't as described - instead of being in my pants like a liner-pad, it was actually stuck onto my arse with 2"-wide tape, forming a fully-sealed crap-retaining barrier. God only knows how I'd have coped with having to remove it in a hurry - it took me fully 20 minutes to get the damned thing off when I got home and needed the loo.

Anyway, back at home it was time for the first "performance". I was on the loo, desperate to crap, but the bung wouldn't shift. 20 minutes later I was still unable to move it so I had a warm bath in the hope that a little relaxation would help. I tried the loo again, nothing budged so I went back to the bath, at which point it all went tits-up... a very small bit of the bung appeared in the bathwater, the rest went the other way, up into my rectum, and stayed there.

For the next two days I was on a normal diet - 3 meals a day, good wholesome food - but I passed hardly anything because of the obstructing bung. On the third day I upped the laxatives but cut the food - there was no more room for it and I was feeling nauseous. I'd finished the Diclofenacs and was on the Co-codamols but they weren't cutting it, it was incredibly painful when I tried in vain to pass anything. Towards the end of the afternoon I phoned the hospital, explained the situation and they told me to come in to the surgical assessment unit ASAP.

When I arrived I was put in a side-ward and told that I was "nil-by-mouth" until I'd been assessed. After about an hour the assessment took place, it consisted of a doctor shoving her finger right up my arse and proclaiming that the bung couldn't be felt. She asked me to clench my inner sphincter but the bung was preventing me from doing so. She said that I wasn't trying hard enough because of the pain, I told her that the bung was stopping me but she wasn't having any of it.

She disappeared for another hour or so, during which time the evening-meals were served to the others but not to me, and a male doctor arrived and took some bloods. When the original doctor returned I asked her if I could eat and drink, she said that I could, she said that she would tell the nursing staff that I was no longer "nil-by-mouth" and she said that she would send a nurse with some food. Yet another hour later a nurse turned up with... a small potted orange juice (declined due to the acidity), some cheese sandwiches (I don't eat cheese) and a micro-sized potted blackcurrant ersatz cheesecake. Dismayed at my refusal of the sarnies, she went off to look for alternatives but I didn't see her again for three hours, and even then she didn't bring me any more food.

Eventually they put me on the ward proper and I was formally admitted for the night - I needed to be seen by the registrar and he was busy in surgery. I asked for food and drink but the nurses still had me down as "nil-by-mouth" despite the doctor's instructions and despite the ID board on the wall clearly stating "F+D". The Co-codamols still weren't cutting it, and I had to take them dry as water was withheld. Funnily enough, they expected me to down two cups of industrial-strength laxative drink - maybe they were expecting me to take it nasally? Eventually Chris went walkabout and provided me with a Mars Bar from the vending machine, hardly the most healthy of foods but it was heaven!

After Chris went home I dozed a bit between failed attempts to open my bowels. Sometime around midnight I was brought some water, and my Co-codamols were taken away and replaced with Ibuprofen on the basis that Co-codamols could have (but hadn't) caused constipation (makes you wonder why I'd been given them after the op, doesn't it?).

The registrar eventually left surgery and hit the wards sometime after 3:30 a.m.. I explained my predicament, he had a cursory non-invasive look at my butt-hole and declared me to be oozing blood and constipated. I explained yet again, with no lack of conviction, that I was physically blocked and wasn't constipated, stating that my gut-contents were sloshing around like a fairground goldfish in a plastic bag, and implored him to either get in there and remove the bung, or to insert a drain to allow the gut-fluids to bypass the obstruction. No, he insisted that I was constipated and he ordered me another dose of industrial-strength laxative. I protested but he just walked away.

After that I had even more urgent needs to open my bowels but nothing came to pass despite many painful attempts. Sleep was impossible, I dozed but got no rest. At 5 a.m. I went for a walk, having got permission from the registrar to have a ciggie in the smoking-shelter.

Some hours later and the ward came alive - the Consultant was on his rounds. By strange coincidence it was the same Consultant that had done my op. He didn't examine me at all - based solely on my notes he declared me to be constipated, recommended prunes and more laxatives, said that I was to be discharged and then disappeared after completing his rounds. I was gobsmacked at how he could have arrived at such a conclusion. Clearly there had been some mistake, and soon it became apparent that my notes were indeed incorrect... two nurses were doing the rounds during their shift-change and the departing one told the other that I was to be discharged because I'd opened my bowels. I went ballistic! I told them in no uncertain terms that I hadn't passed anything, the incoming nurse queried the discrepancy (as I shouldn't have been allowed out if I hadn't passed anything) but she took the word of the night-staff instead of my testimony and I was told to prep for home after breakfast.

I had one last discussion with the most senior person I could find on the ward. I explained my condition yet again and pleaded yet again for either a bung-removal or a bypass drain, I even asked if the bung would show up on a scan or if he could have a look for it with an endoscope but he was having none of it. He told me that I was wrong about the bung, it wasn't there, and even if it was it would "absorb water and shrink". I find that last bit totally amazing - how many things do you know of that shrink when they absorb water? Personally I think he was even more full of 5h1t than I was!

I gave up. Nobody was prepared to listen, they all wanted to guess. Before leaving I told them that their records were woefully incorrect but they were in denial. I pointed out that my discharge form, vetted by the registrar(?) that had OK'd me to go out for a smoke, stated that I was a non-smoker. They didn't care.

So, Chris took me home in a worse condition than that in which I'd arrived, and my faith in the hospital system had completely failed. What a waste of time and resources.

Back at home I was in dire straits - it was 5 days after my op and I was still desperate for a crap but unable to pass anything. After a sleepless night I made a decision - after the next round of painkillers I would get things sorted myself. I went upstairs, bit the bullet, aligned my insides as best I could, screamed every expletive known to Man and after 30 or so minutes out popped a large chunk of  "special foam-like material", followed immediately by five-day-old evil crap and blood, followed by my insides trying to prolapse. Jeez, that hurt beyond all belief but it was proof that I was right.

Over the next couple of days my incontinence managed to keep my emissions about in pace with my intake, but everything was painful and messy as it all had to be done in the standing position - sitting was a no-no as my innards would try to prolapse and nothing would pass. During those two days I had over 40 sessions on the loo. It was obvious that there was still more of that damned bung inside.

After a while external soreness set in and I started to get external obstructions too - my external piles had returned, they hadn't been removed, there was no new scar-tissue visible around my butt-hole to indicate that anything had been removed. These external obstructions were painful, engorged and bleeding after each motion. Angry? Me? You bet!

That night I could take no more. I phoned NHS Direct to find out if I could apply over-the-counter haemorrhoid-cream. They couldn't say, so they sent a night-shift GP from the hospital. He was very sympathetic and helpful, and he OK'd the use of the cream, told me to supplement the Ibuprofen (400mg) with Paracetamol (500mg) and told me to see my own GP ASAP.

First thing next morning I called my GP's surgery, they wanted me to go in but I couldn't as I was still incontinent so they sent a doctor sometime after noon. She too was helpful and prescribed some heavy-duty ointment (Proctosedyl) which was just about strong enough. She listened to my moaning about the piles still being there and suggested that I should visit the surgery as soon as I was able, to get my rear-end obstructions checked.

A day or so later I managed the short walk to my GP's surgery to get checked. 0.4 miles, half an hour. No need for a sat-nav to work out that one. After the appointment I shuffled home even more slowly, and just as I reached home I started to leak blood. Lots of it. Down my legs and into my socks. I got indoors, stripped off and struggled upstairs but just before I got "in the saddle" it all exploded. There was fresh blood and/or sloppy blood-clots everywhere - in the hall, up the stairs, on the landing, up the wall, in the pan, in the sink, down my legs, you name it and I painted it red! Major pain! Major panic!

I couldn't find the emergency number for the hospital - the letter was out of reach as I stood in the bath with the red stuff dripping out so I grabbed the mobile, phoned my neighbour and he raced round to the rescue. He's a star - he found the number, called it but got no answer so he called 999 instead. Within minutes a paramedic was wading through the mess as I stood in the red-watered bath. He was brilliant - full of concern, attentive and caring. In the bath we found bits of the bung with scar-tissue attached to them - clearly my "solids" had ripped the bits of bung, together with the scar-tissue to which they were attached, off my insides and I was bleeding from the open wounds left behind. Eventually it all stopped and I went downstairs to be assessed again. He suggested that I should go back to hospital by ambulance but he understood my reluctance after my being discharged in a worse state than I'd arrived in a few days before. Besides, I felt much better than I had before the bleed. We came to an agreement that suited both of us - he allowed me to stay at home on the condition that I would go back to hospital without fail if I had another such bleed that day. Meanwhile my neighbour had been busy cleaning up the mess - like I said, he's a star! I called Chris at work and she raced home in case I had another bleed but I was bleed-free for the rest of the day and overnight.

The next day I had another bleed, about half as much as the previous one. It happened under more-controlled conditions and was less messy and shocking. Again, I felt much better after it so I didn't call it in.

The next two days were much better but they were still painful, bloody and unpredictable.

12 days after the operation and I still think that there are more bits of bung stuck up there but there can't be much left. Still incontinent but down to about 15 times a day. Still on the painkillers, still on the laxatives, still passing blooded sloppy stools. Still feeling like I'm prolapsing after each crap, still got the painful external external obstructions and still on the cream. Looks like I'll have to have another op to get rid of these external bastards... which is all I wanted in the first place!

I'll update this post when anything of note happens.

Update - Tuesday 7th Feb: Woke from the first good night of sleep in a fortnight. No blood, no leakage, much less internal pain. I'd be ecstatic if that was all, but now I have thrush as well as external obstructions. Started a seven-day course of Metronidazole (400mg) to help to prevent secondary infections.

Update - Wednesday 8th Feb: Blood-free, starting to get by with fewer painkillers.

Update - Thursday 9th Feb: Passed another sizeable bit of bung, feels like all internal blockages are gone, this morning I could crap for England!

Update - Saturday 11th Feb: Regained full bladder-control - no more pain in prostate area. Finished the laxatives. Walked into town and back - first major exercise for over two weeks - was sore afterwards but it was better than having cabin-fever.

Update - Wednesday 15th Feb: No more bung since 9th Feb, still painful when passing solids. The insides still don't feel right - still feels like I'm prolapsing. Thrush is still a problem, and so are the external obstructions. Asked the hospital to arrange a check-up for sometime next week.

 

So, if you're in for a similar op, here are a few tips:

  • Beware the dreaded "special foam-like material" bung. If it goes up inside instead of down and out, get it sorted ASAP. Don't let the hospital staff ride rough-shod over you. I've been Googling for info about the bung material and have found that some references that indicate that some versions of the bung may be made from tissue taken from pigs... worth thinking about if you're vegan or otherwise opposed to porcine products.
  • Make sure that all of the hospital staff are aware of your true food/drink intake status.
  • Make sure that all of the hospital staff make accurate and true records rather than fantasy-notes like some of them made up for me.
  • Think twice about accepting Co-codamol as pain-relief if you're on laxatives - they fight each other.
  • Make sure that you get the op that you need, rather than the one that they want to give you.

Good luck!

Related Posts Plugin for WordPress, Blogger...

11 Responses to “Not for the squeamish”

  1. Quiet_Man says:

    Jesus mate, a true horror story indeed. Get well and then sue tha bastards, it's the only language they seem to recognise.

  2. AlanR says:

    BG, I am staggered and feel for you. Every body knows Co-codomol causes constipation. You don’t have to be in medicine to know that, just read the label. I have had haemorrhoid problems most of my adult life and need to go back to hospital quite often to have them cleared up. It’s not nice, lets be clear on that, but you seem to have been given a dreadful time by your health care people.
    I have never suffered from the type of incontinence that you have suffered and it makes me wonder if they have cut the sphincter a little, especially with them not finding the bung which may have gone inward and past the muscle entirely. What a dreadful state of both physical and mental exhaustion you must have gone through. The trouble with any back passage problems is that you still have to use it despite the agony. The tendency with any pain is to clench the muscles but this causes even more pain. It’s definitely a lose, lose situation.
    Take care with some of those creams too, they are only very short term use and they can cause irritation with prolonged use. If you get irritation you think that the piles are back big style and you put a load more cream on without realising it’s actually the cream thats causing the problem. But worse still after all that why have you still got the piles that you went in to have removed or banded.?
    I have been with both BUPA and NHS for my treatments and have only good things to say about all my consultations and treatment. I hope that you go back in to your GP and have some serious words about his/her referral and also send a copy of this post to the hospital management team who need to be told in no uncertain terms.
    Now, believe it or not i have to make my next appointment. Wish me luck. And all the best to you for some needed relief from all this.

  3. I've just read that again in utter disbelief and I'm still lost for words.

    I sincerely hope you are on the mend sooner rather than later.

    Sandy

  4. Alistair says:

    Sorry to hear that Stef. Get well soon. Prunes, FFS! Did the consultant have a bow tie? Was it revolving?

  5. alan.sloman says:

    Dear God, Stef!

    That all sounds absolutely horrendous. I would be reaching for the best solicitor I could find to sue the arse (sorry!) off these negligent bastards.

    I would also be changing my GP and getting a second opinion from another doctor.

    I hope things clear up for you and it all gets resolved, but at the end of it all I would want your care team's bollocks on a plate.

  6. Robin Evans says:

    What a terrible story. Best wishes for your recovery.

  7. BG! says:

    Thanks for all the advice and sympathy, folks. I hope you won't mind if I don't reply to each comment individually. I do hope that the info that I've imparted is of use to anybody contemplating having such a procedure.

    Anyway, here are just a few words to set straight how I feel about each level of the care-team:

    My GP and his team appear blameless in all this - the diagnosis was correct and the letter of referral is fine if a little vague. I now have a copy of it. They have been pro-active and supportive during the post-op period to date.

    The consultation was fine. I did tell the Consultant that my problems were external piles and I know that he understood this. That said, I don't know what instructions he gave to the surgeon that performed the op. Perhaps there was a loss of communication there, who can say?

    On the day of the op the nursing staff and anaesthetic team were top-notch. The surgeon went through the consent process with me, the procedure was to be a "Ligasure Haemorrhoidectomy" with the instruction to "Remove piles" and I don't think that he got rid of the external ones. OK, the taped-on butt-pad thing was a surprise but we made light of it and all was well on that score.

    Saturday's admission to hospital was a mess, there were communication problems between nursing staff, doctors and surgeons. Aside from the food/drink issue, all of the nursing staff were completely professional and good company. Yes, they did the odd thing wrong but that was because they were following orders that were incorrect so it's not their fault. The registrar and the Consultant seemed arrogant and would not be swayed in their judgements despite evidence that ran counter to their diagnoses. On the whole (no pun intended) the junior doctors were fine apart from the fable of the shrinking bung. The discharge process was in error, I can't say for sure who was responsible for that but it must have been someone in seniority - I guess that it was either the registrar or the Consultant.

    Since then I've seen call-out GPs, surgery-based GPs and a paramedic - they have all been professional, proactive and supportive, I can't fault any of them and would be happy to be seen by any of them again.

    Would love to stay and chat more but the bog beckons yet again...

  8. george says:

    Christ that sounds like a right horror story, hope thaing s start to improve over the next few weeks

Have your say - submit a comment

THE SMALL(ish) PRINT... (updated 23/07/2016)

By submitting a comment to this blog you grant me permission to reproduce its content and to reproduce the submitted name/URL in attribution. I will leave your content in its intended place and in its unedited form unless one or more of the following apply:

If you ask me to modify, move or delete your content, I’ll consider making the requested change(s) so long as there’s no significant alteration of the context of the content or of any debate associated with it;
If you change your email address or URL, I’ll update these details in older comments so that I'm not displaying dead links;
If I decide to change the theme or layout of this blog, thus affecting the placement and/or visibility of comments, I’ll make whatever changes I see fit for the smooth running of this blog;
If any comment contains insulting profanity or other content which I deem to be causing or likely to cause trouble, I’ll edit or delete as I see fit for the smooth running of this blog. I’ll try to remember to display the reason(s) for whatever editing I do, so that folk aren’t left hanging wondering what happened and why. If you can at least try to "disguise" your swearing, it would be much appreciated.

Other things to consider:

Comments must contain at least 3 characters;
You can use some code in comments, feel free to give it a shot and see what works;
If adding pics, the recommended maximum dimension is 600px.;
Comments containing many links will be held for moderation;
I reserve the right to amend this policy in line with proven applicable current legislation;
Free Speech: you may well have the right to it, but you've no right to compel me to a) listen to it, or b) publish it!