Procedures & Preparations

HEMORRHOIDS

This quick, in-office procedure treats more severe internal hemorrhoids that either protrude with bowel movements or are bleeding and have not responded to more conservative therapies. No anesthesia is required. A small rubber band is applied around the base of the hemorrhoid, choking off its blood supply. Both the hemorrhoid and the rubber band fall off in 7-10 days. Mild discomfort and bleeding may occur after this procedure. More than one session may be required to resolve your symptoms.
This is another short, in-office procedure that primarily treats bleeding internal hemorrhoids. A sclerosing agent (similar to ones used for varicose veins) is injected directly into the hemorrhoid causing it to shrivel up. There is virtually no discomfort or bleeding after this treatment. Therefore, this method is ideal for patients on blood thinners such as Coumadin or Plavix. Once again, no anesthesia is required.
Thrombosed external hemorrhoids can be extremely painful so you should not delay in seeking treatment. The clot can be quickly removed via a small incision under local anesthesia in the office. The relief is almost immediate, and there is only mild to moderate soreness for a few days following treatment. This procedure is most effective when performed within 72 hours after initial onset of symptoms.
This involves surgical removal of the symptomatic hemorrhoids, both external and internal. It is performed under local anesthesia with intravenous sedation administered by an anesthesiologist. This procedure is almost always done on an outpatient basis, with an estimated recovery time of 2-3 weeks.

INFECTIONS & ANAL WARTS

An abscess is a pus-filled cavity that can occur anywhere on your body and manifests as a painful, red swelling which is very tender to the touch. Drainage can be performed quickly in the office. A small incision is made under local anesthesia so the infection can be effectively drained, providing immediate and significant relief. Mild to moderate soreness is common for a few days following the procedure. Dr. Tarlowe will drain almost any abscess for you, but he is specially trained in anal and rectal abscesses as well as infected pilonidal (over the tailbone) cysts.
Anal warts are caused by the human papilloma virus (HPV) and are transmitted by direct contact. They can cause itching, bleeding, mucus discharge or cause no symptoms at all. Regardless of the presence of symptoms, they should be removed. If left untreated, they will usually grow and multiply and can potentially lead to an increased risk of cancer in that area. Small to moderate-sized warts on the skin around the anus can be treated in the office with topical chemicals or an excision using a local anesthetic. Some small internal anal warts can also be treated topically in the office. However, larger internal or external warts need to be removed in the operating room under a stronger anesthetic. Patients go home that same day and have moderate discomfort for a few days following the procedure.

ANAL FISTULA

An anal fistula is a tunnel under the skin connecting a previously infected anal gland inside the rectum, to the skin outside the anus. A fistulotomy is the simplest way to remove the fistula. The tunnel is surgically opened which then enables it to heal from the inside out. This quick procedure is performed on an outpatient basis under sedation, and typically has a short recovery time.
Deep fistulas that involve a significant portion of the anal sphincter (muscle that helps control bowel movements) are not treated with fistulotomy as it may result in bowel incontinence. One alternative method to treating these types of fistulas involved the use of a seton. A seton is a piece of suture or silastic material that is passed from the skin opening through the fistula tunnel into the rectum, and then out through the anus. It is then tied in a loop and can be either gradually tightened (suture) or left alone (silastic) for a number of weeks. This allows the fistula to heal without cutting sphincter muscle which could lead to fecal incontinence.
This surgical procedure is usually reserved for treating more complex anal fistulas. A flap of healthy rectal tissue is raised and then pulled down over the fistula opening inside the rectum and sutured into place. With this opening covered, the fistula can heal without cutting any sphincter muscle.
A fistula plug is a conical-shaped, biologically engineered material that is placed into the fistula tunnel or tract. The material “talks” to the body and signals surrounding tissue to grow into and across the plug, thus closing the tract and healing the fistula. The plug is typically used for deeper fistulas with longer tracts. The two main advantages are that no sphincter muscles are cut and that patients are able to go home the same day.

TRANSANAL EXCISION OF RECTAL LESIONS

For one reason or another, some rectal lesions (e.g. polyps) are not able to be removed when visualized on either colonoscopy or sigmoidoscopy. In select patients, Dr. Tarlowe can excise these lesions via the anus with minimal postoperative pain. Nearly all patients go home that same day or the next morning.

PREPARATIONS

Administer one (1) or two (2) Fleet enemas as instructed by Dr. Tarlowe approximately one hour before you leave for your appointment. Follow the instructions on the box. Fleet enemas can be purchased over the counter at almost any pharmacy. You do not need to fast. If you are having a rubber band ligation, DO NOT take any aspirin, ibuprofen or other blood thinning medications one week prior to the procedure.
Purchase two (2) Fleet enemas. One week before your procedure, DO NOT take any Vitamin E, iron tablets, aspirin, ibuprofen or other blood thinning medications unless instructed by the doctor. Do not eat any solid food after 7 PM the night before your procedure. Administer the first enema as directed on the box at 10 PM. Do not eat or drink anything after midnight. On the day of your procedure, you may take your morning medications with small sips of water. DO NOT take any diabetic medication. The second enema should be administered approximately one hour prior to leaving for the hospital..
Purchase one (1) 10 ounce bottle of Magnesium Citrate and two (2) Fleet enemas from any pharmacy. Do not eat any solid food after 7 PM the night before your procedure. Drink the bottle of Magnesium Citrate at 7 PM and then administer the first enema at 10 PM as directed on the box. Do not eat or drink anything after midnight. On the day of your procedure, you may take your morning medications with small sips of water. DO NOT take any diabetic medication. The second enema should be administered approximately one hour prior to leaving for the hospital.
Purchase one (1) large bottle of Miralax (238 grams or 8.3 oz.), four (4) Dulcolax tablets and one (1) 64 ounce bottle of any sports drink such as Gatorade or Powerade (any color but RED). DO NOT take any Vitamin E, iron tablets, aspirin, ibuprofen or other blood thinning medications one week prior to your procedure unless instructed by the doctor.

  • On the day before your exam, you may eat normally until 12 PM but please avoid red meat, beets, raw fruits and vegetables. After 12 PM, you may only have clear liquids which include:
    water, any clear fruit juice without pulp, soft drinks, clear broth, plain Jello, flavored ices (nothing red or purple), hard candy, coffee & tea (without milk, cream or non-dairy creamer). No solid foods, milk or milk products allowed.
  • At 1:00 PM, take the four (4) Dulcolax tablets with any clear liquid mentioned above. Be sure to drink plenty of liquids as this promotes the activity of the laxative and prevents dehydration.
  • Mix the bottle of Miralax into the 64 ounce bottle of the chosen sports drink. Shake the bottle until the powder is dissolved and then place it in the refrigerator as it tastes better cold.
  • At 5:00 PM, start drinking an 8 ounce glass of the Miralax every 10-15 minutes until the entire 64 ounce bottle is finished. You should try to complete this in approximately 2 hours.
  • Do not eat or drink anything after midnight.
  • On the day of your procedure, you may take your morning medications with small sips of water. DO NOT take any diabetic medication.
  • You must arrange for someone to take you home.
Purchase two (2) 10 ounce bottles of Magnesium Citrate. DO NOT take any Vitamin E, iron tablets, aspirin, ibuprofen or other blood thinning medications one week prior to your procedure unless instructed by the doctor.

  • On the day before your exam, you may eat normally until 12 PM but please avoid red meat, beets, raw fruits and vegetables. After 12 PM, you may only have clear liquids which include:
    water, any clear fruit juice without pulp, soft drinks, clear broth, plain Jello, flavored ices (nothing red or purple), hard candy, coffee & tea (without milk, cream or non-dairy creamer). No solid foods, milk or milk products allowed.
  • At 4:00 PM, drink the first bottle of Magnesium Citrate followed by at least two (2) 8 ounce glasses of water or any other clear liquid mentioned above. Be sure to drink plenty of liquids as this promotes the activity of the laxative and prevents dehydration
  • At 7:00 PM, repeat this procedure with the second bottle of Magnesium Citrate.
  • Do not eat or drink anything after midnight.
  • On the day of your procedure, you may take your morning medications with small sips of water. DO NOT take any diabetic medication.
  • You must arrange for someone to take you home.
Pre-op Instructions for Colonoscopy and Surgery

Dr. Tarlowe will provide you with a prescription to purchase the bowel prep kit at your local pharmacy. One week before your procedure, DO NOT take any Vitamin E, iron tablets, aspirin, ibuprofen or other blood thinning medications unless instructed by the doctor.

  • On the day before your exam, you may eat normally until 12 PM but please avoid red meat, beets, raw fruits and vegetables. After 12 PM, you may only have clear liquids which include:
    water, any clear fruit juice without pulp, soft drinks, clear broth, plain Jello, flavored ices (nothing red or purple), hard candy, coffee & tea (without milk, cream or non-dairy creamer). No solid foods, milk or milk products allowed.
  • At 12:00 PM, take the two (2) tablets included in the kit and then prepare the HalfLytely┬« as instructed (you may want to put it in the refrigerator as it tastes better cold). Be sure to drink plenty of liquids as this promotes the activity of the laxative and prevents dehydration. Begin drinking the mixture at 6:00 PM, one 8 ounce glass at a time, every 10-15 minutes until it is finished.
  • Do not eat or drink anything after midnight
  • On the day of your procedure, you may take your morning medications with small sips of water. DO NOT take any diabetic medication.
  • If you are having a colonoscopy or other outpatient procedure, you must arrange for someone to take you home.