TEM: Transanal Endoscopic Microsurgery
Bowel Prep
Follow these steps to clean your bowel before surgery. Please note that “Clear” means no sediment, it does not mean colorless.
2 days before surgery, eat breakfast but then drink only clear liquids.
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Try to drink at least one bottle of Resource®, Boost Breeze®, or Special K20® protein water each day for 2 days before surgery. Mix GoLYTELY® with warm drinking water to top of line on bottle and shake. It will be clear. Do not add any flavorings. Store in the refrigerator. Use within 48 hours.
Okay to add Crystal Light® powder mix to each glass.
1 day before surgery, drink only clear liquids all day.
- 9am: Take 4 bisacodyl tablets with water. Do not chew or crush. Do not take within 1 hour of taking an antacid or other morning medicine. It is okay to do this step earlier in the day.
- As soon as you have a bowel movement, start to drink the GoLYTELY. Drink 1 8oz glass every 10 minutes until half the bottle is gone – or your stools are clear. If you see sandy particles in the toilet water, drink a cup at a time until they are gone and it looks clear. Do not sip slowly. It works better if you drink quickly.
- 1 hour after you finish the GoLYTELY, take the 1st dose of antibiotics.
- 3-4 hours later, take the 2nd dose of antibiotics.
- At 10 pm, take the last dose of antibiotics.
You should keep drinking clear liquids until bedtime. Shower before going to bed.
Morning of surgery (at least 1 hour before leaving home)
- Give yourself a Fleets® phosphate enema. Shower again.
Note: You may feel some cramps in your lower abdomen while drinking the GoLYTELY®. If you have steady stomach pain, get light-headed and dizzy, do not have any bowel movements at all or can’t drink the GoLYTELY®, call the clinic at 608-890-5000. This is a 24 hour number.
After hours and on weekends ask for the doctor on call for Dr. ____________. Tell them your problem.
Toll free number: 1-855-342-9900
Do not take any of your scheduled medicines for 1 hour before or after drinking the bowel prep as they will not be absorbed.
You will be told if you need to take any potassium.
After Surgery
Rectal Care
1. Take a sitz bath at least three to four times a day and after each bowel movement for two days and then as needed. A sitz bath is sitting in warm water to soothe your rectum. You can use a plastic device that fits on your toilet or sit in the bathtub. This helps healing and lessens pain and rectal spasms. Sit in the water for at least 10 – 20 minutes.
2. For the first few days, clean around the rectum after a bowel movement by spraying area with warm water. You may want to use baby wipes to gently clean the rectum.
3. You may have yellowish-red drainage from the rectum for at least 7 – 14 days. Sanitary pads in your underwear can prevent soiling. The drainage will become less and become lighter in color over time. You can expect more bloody drainage after a bowel movement, with increased activity, and after 10 days when the sutures begin to dissolve.
Activities
- Do not lift more than 20 pounds until it is okayed by your doctor.
- Avoid standing or sitting for more than an hour at a time for a few days.
- Do not drive while taking narcotic pain pills.
- Sexual activity may be resumed when okayed by your doctor.
- Check with your doctor before you return to work. Your time off work may be longer if your job involves heavy labor or sitting for long periods of time.
Pain
At first, you will feel pressure rather than pain. Or you may feel like you need to quickly get to the bathroom. This is normal and will improve with time. You will have pain pills to take at home if needed.
Diet after Surgery
You may be on a low fiber diet for the first few weeks with stool softeners (docusate sodium) as needed. This will avoid bulky stool stretching the incision. After 2 – 3 weeks, you may increase the amount of fiber in your diet. This may include a bulk fiber laxative like Metamucil®. Your doctor will talk to you about your diet.
Be sure to drink at least 8-10 (8 oz.) glasses of fluid a day. Fluids with caffeine do not count.
Low fiber foods are recommended for about 2 weeks. Avoid high fiber foods until they are okayed by your doctor. See the chart on the last pages of this handout.
When to Call the Doctor
- Problems having a bowel movement.
- Unable to control bowel movements.
- Increased pain and bleeding with bowel movements.
- Large amounts of bright red blood from the rectum that does not stop with pressure applied to the rectum for 10 minutes.
- Temperature greater than 100.4° F. Take your temperature once a day for 1 week.
- Foul-smelling drainage from the rectum.
- Excess swelling in and around the rectum.
- Pain not controlled by pain pills.
- Problems passing urine.
Phone Numbers
Surgery Clinic: 608-263-7502. This is a 24 hour number.
After hours, weekends or holidays Ask for the doctor on call for Dr. ________________. Leave your name and phone number with the area code. The doctor will call you back.
Toll Free: 1-855-323-8942
Low Fiber Foods
Food Group |
Foods Recommended |
Foods to Avoid |
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Breads, Grains, Pastas, Rice
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White breads, rolls, biscuits, muffins, and crackers without seeds and nuts White Rice White Pasta
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Any bread product or pasta made with whole grains or bran. Any product made with seeds, dried fruit, coconut, or nuts. Brown rice Wild rice. Check food labels and avoid any products with more than 2 grams of fiber per serving.
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Cereals |
Check labels on cereal boxes and choose cereals with less than 1 grams of fiber per serving, such as corn flakes or rice krispies. Refined cooked cereals limited to ½ cup servings, e.g. cream of wheat, farina, and quick cooking oatmeal.
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Whole grain or bran cereals All cereal with more than 1 gram fiber per serving. Granola Cereal bars |
Fruits – fresh, frozen, or canned - limit to ½ cup servings
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Apples, peeled Apricots, peeled Avocado, ripe Banana (1/2 ), ripe Cherries, sweet Mandarin oranges Melons Peaches, peeled
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Dried fruits All other fruits that are high in fiber such as all berries, dates, figs, pears, whole oranges, prunes. |
Vegetables – fresh, frozen, or canned - limit to ½ cup servings |
Asparagus tips, cooked Carrots, cooked Cucumber, peeled and seeded Lettuce, tender leaf lettuce Potatoes, peeled and cooked Sweet potatoes, cooked Winter squash, cooked Zucchini, peeled and seeded
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All others |
Beans and Lentils |
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All dried beans such as kidney, garbanzo, black, navy, and pinto beans. Soy beans Lentils
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Meats, Poultry, Fish |
Tender meats, poultry and fish that are cooked. |
Meat, poultry, or fish that are fried with a crisp crust. Tough meats or meats with gristle. Meat products made with whole grains, nuts, or seeds such as some sausages or lunch meats. Soy meat substitutes such as Boca burgers. |
Eggs |
Eggs, cooked in any way |
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Dairy |
Milk, cheese, yogurt, sour cream, and any dairy products as tolerated. |
Dairy products with added nuts, seeds, or fruits.
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Beverages |
Coffee and tea Cocoa Carbonated beverages Fruit juices without pulp (except prune juice) |
Prune juice Smoothies made with fruits or grains |
Fats |
Butter and margarine Vegetable oil Olive oil Salad dressings made without fruits, nuts, or seeds Meat gravies |
Any fats or salad dressings with added fruits, dried fruits, seeds, or nuts. |
Desserts and Sweets |
Sugar, honey, molasses, corn syrup. Jelly Sherbet, frozen yogurt, ice cream, and popsicles made without fruits, seeds, or nuts. Cookies, pastries, pies, puddings, custards, and candy made without fruit, seeds, or nuts. |
Jams, preserves, and marmalade. Any made with fruit, dried fruit, nuts, seeds, or coconut. |
Miscellaneous |
Salt, pepper, ketchup, mustard, vinegar, herbs, and other spices as tolerated. Cream sauces Smooth peanut butter and nut butters, limited to 1 tablespoon per serving. |
Nuts and seeds Olives Pickles Soups, casseroles, and other mixed dishes made with high fiber fruits, vegetables, or grains. |
The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any duplication or distribution of the information contained herein is strictly prohibited.
Last Updated: 04/24/2013
Copyright © 03/22/2010 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#7002
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