• Physical exam
• Rectal exam
• Anoscopy—the visual examination of the inside of the anus using a short tube (anoscope) to help keep the sphincter open
• Sigmoidoscopy —the use of a specialized endoscope (a tube attached to a viewing device) to examine the inside of the anus, rectum, and lower intestine

Leading up to the procedure:

• Do not eat or drink anything after midnight.
• Your doctor will order a laxative for you. It will cleanse your colon and rectum.
• Arrange for someone to take you home after the surgery.
• Talk to your doctor about your medicines, even non-prescription medicines. You may be asked to stop taking some medicines up to one week before the procedure, like:
  • Aspirin or other anti-inflammatory drugs
  • Blood thinners, like warfarin (Coumadin) or heparin
  • Clopidogrel (Plavix)

• Spinal anesthesia —You will be numb from the mid-abdomen down.
• General anesthesia —You will be asleep.

Discuss these options with your doctor before the day of your surgery.

• If your doctor says it is okay, take sitz baths as recommended. Sitz baths will help relieve discomfort and clean the area. For a sitz bath, sit in warm water for 10-15 minutes. Pat the area dry. Do not wipe or rub vigorously. You may be advised to take a sitz bath every four hours and after every bowel movement. Devices are available to place on top of the toilet to make this process easier.
• Move your bowels as soon as you feel the urge.
• Do not strain, bear down, or hold your breath during a bowel movement.
• Do not sit on the toilet for long periods of time.
• To prevent constipation and straining during bowel movements, use a stool softener, exercise, drink plenty of fluids, and eat plenty of high-fiber foods ( fruits, vegetables, beans, and whole grain).
• Apply creams or ointments as directed by your doctor.
• Avoid heavy lifting for two or three weeks.
• Use stool softeners.
• Take pain medicine as needed.

Complete recovery will take 2-3 weeks. If your hemorrhoids come back, let your doctor know.