​​Digestive Pelvic Floor Centre

Haemorrhoidal Arterial Ligation – RectoAnal Repair (HAL-RAR)

It is within expectation that you experience mild to moderate pain in the first 2-3 days after the surgery. Some of you might have a slightly more severe pain due to the size of the haemorrhoid that required lifting. The anaesthetic effect on the nerve normally subsides 24 hours after the surgery, you are advised to take regular paracetomal or anti-inflammatory to control the pain in the first 3-5 days. Your doctor will also prescribe you a stronger analgesic medication if you have moderate-severe pain. 

It is also common to notice some swelling and quite often it might give you the impression of haemorrhoid has returned. You are reassured the swelling should be resolved one week after the surgery. 

Blood spotting can happen especially during or after bowel movements. After the surgery, your doctor will normally pack the wound with spongistan which it will be passed together with your first bowel motion after the surgery. The most important thing for you is to AVOID straining or prolonged sitting on toilet when you are using your bowels first few weeks after surgery while the wound is still in the healing process.

Bowel Function
Use your bowel only when you have a strong sensation for bowel movement. Do not suppress your urge due to the fear of pain. Some of you might have more frequent urge to go due to the swelling in your back passage, this sensation should disappear as the swelling subsides. You should keep your stool soft to avoid excessive straining on toilet, this can be achieved by:

  • Adequate fluid intake

  • Adequate soluble and insoluble fibres

  • Engage a good sitting posture on toilet 

  • Use the toilet no more than 5 minutes

  • Use movicol if you are taking strong analgesia (Strong analgesia can slow down your gut which can cause hardening of stool). DO NOT use fleet enema. 

You should also ensure good skin hygiene after bowel movement. You can use wipe or water to clean, try to avoid repetitive wiping with scratchy toilet paper as this might cause irritation to your skin. Do not apply any ointment over the wound as this might increase the risk of infection.

Bladder Retention
Bladder retention occurs when you have a strong desire to urinate but having difficulty to empty your bladder. It is a potential complication of HAL-RAR and the cause remains unknown. Some has suggested the anaesthesia for the surgery and the pain afterwards have the effect on the contraction and relaxation of the muscles that are controlling the bladder and the urine passage. Men especially with history of prostate problem are at higher risk of having bladder retention. 

After surgery, the nursing staff will ensure you can pass water normally before you get discharged. However, there is still possibility of getting bladder retention after your get home even you have achieved that at the hospital. If you have a desire to urinate but unable to, resulting in abdominal discomfort and pain; or you have not empty your bladder for more than 4 hours despite drinking normally, you should contact us or your GP, or go to Concord or Hawkesbury Emergency Department for catheter insertion. 

Activity Restriction

  • Lifting heavy weight

  • Participating in water sports

HAL-RAR has an excellent outcome of relieving the symptoms of haemorrhoid in majority of patients. You should see a significant improvement one week after the surgery once the postop symptoms subside. This improvement will continue until the final result is achieved at approximately three months.