“Healing takes time. Despite all the medical advances, the greatest part of your recovery depends on your own inner healing power. The body heals on its own timeline. Worrying thoughts never speed up healing.” — Criswell Freeman One of the most important goals of the surgical team is to ensure that patients recover safely, comfortably, and efficiently — returning to their daily lives as soon as possible. However, the surgical process does not begin in the operating room, nor does it end with hospital discharge. It begins when a surgical diagnosis is made and ends when the patient returns to normal life. Therefore, preoperative preparation is as important as the surgery itself and the postoperative care process.
🔹 What Are the Key Components of Preoperative Preparation? Preoperative preparation includes four major areas:
- Psychological preparation
- Physiological (medical) preparation
- Legal preparation
- Preoperative patient education
🧠 Psychological Preparation Surgery can be a major source of both physical and emotional stress. Stress and anxiety can negatively impact many systems in the body — especially the immune system. Therefore, reducing pre-surgical anxiety is just as important as physical preparation. The fear of the unknown is one of the most common sources of anxiety before surgery. This includes concerns about pain, cancer, organ loss, anesthesia, risk of death, job security, or being away from loved ones and daily activities. The best way to reduce this fear is through clear and open communication with your surgical team. Knowing what to expect can help you feel more in control. Techniques like deep breathing, meditation, visualization, and positive thinking may also help reduce stress.
💉 Physiological (Medical) Preparation Being a candidate for surgery is not enough — the patient must also be medically fit for surgery. The overall health status must be evaluated thoroughly, considering: • The condition requiring surgery • Any underlying diseases (e.g., diabetes, hypertension) • Past surgeries or illnesses • Nutritional status • Presence of infections • Organ function (e.g., heart, lungs, kidneys) • Current medications Age alone is not a contraindication for surgery. What matters most is overall health and functional status. If you have known medical conditions, your doctors will coordinate with specialists to ensure your health is optimized before surgery. Medication adjustments will also be managed by your healthcare providers.
📄 Legal Preparation Patients must be informed about the surgical procedure and its potential risks before giving consent. This includes both verbal and written explanations. You will be asked to sign an informed consent form. If the patient is a minor, lacks decision-making capacity, or is unconscious, the consent will be obtained from a legal guardian or family member.
📘 Preoperative Education Education helps patients better understand what to expect and actively participate in their recovery. One of the most important components is preoperative breathing exercises. 🫁 Breathing Exercises
- Diaphragmatic Breathing: o Lie on your back with a pillow under your head and knees. o Place one hand on your upper chest, the other on your belly. o Inhale slowly through your nose while counting to two. You should feel your belly rise under your hand.
- Pursed-Lip Breathing: o Inhale through your nose while counting to two. o Exhale slowly through pursed lips (as if whistling), counting to seven.
- Coughing Exercises: o Inhale and hold your breath for two seconds. o Cough twice to help clear your lungs. o Pause to catch your breath before repeating.
💊 Medication Adjustments Before Surgery Always consult your doctors about any medications you’re taking. Below are general guidelines: • Heart and blood pressure medications: Usually continued unless otherwise directed. Even if fasting is required, you may take these with a small sip of water. • Aspirin and similar medications: Continued only if medically necessary. Otherwise, stop at least three days before surgery. • Other blood thinners: Usually stopped before surgery and temporarily replaced with safer alternatives. Your care team will guide this transition. • Diabetes medications: Often paused during the surgical period due to changes in nutrition and activity.
🧴 Skin Preparation You do not need to shave or apply any cosmetic products. A simple shower with regular soap is sufficient the night before surgery. Please do not remove body hair yourself.
🦵 Preventing Blood Clots (Anti-Embolic Measures) Preventive measures are taken to avoid deep vein thrombosis (DVT) and pulmonary embolism, such as compression stockings, early mobilization, and anticoagulant medications when necessary.
🩺 Surgical Site Verification For surgeries involving paired organs (e.g., hernia repair), the correct side must be confirmed in advance. This includes: • Verbal confirmation by both the doctor and nurse • Marking the surgical side on your body • For colorectal surgeries, marking of the potential stoma site
🥗 Nutritional Preparation Before Surgery A healthy diet can speed up recovery. You should: • Eat foods rich in vitamins, minerals, and proteins • Consume iron- and calcium-rich foods • Stay well-hydrated • Follow any additional nutritional support recommended by your doctor • If you have diabetes, ensure good blood sugar control Preoperative Fasting Instructions: • Stop solid foods, milk, and dairy products at least 6 hours before surgery • Water is allowed up to 2 hours before anesthesia • Do not chew gum on the day of surgery • If you need to take oral medication, it can usually be taken with up to 30 ml of water, unless told otherwise Rectal Bleeding Should Never Be Ignored Rectal bleeding is a common but important symptom that can appear in several ways: blood on the stool, blood in the toilet bowl or on the toilet paper, or simply noticing bright red blood during or after bowel movements. Bright red bleeding is usually assumed to originate from the anus or rectum, the last part of the large intestine. There are many benign (non-cancerous) and malignant (cancerous) conditions of the colon, rectum, and anus that can cause rectal bleeding. However, here is the critical point: In any patient presenting with rectal bleeding, colorectal and anal cancers must first be ruled out. Even if a benign condition such as hemorrhoids (piles) is found during examination, that does not eliminate the possibility of a more serious underlying disease. Benign anorectal conditions are common in the general population, and their presence does not guarantee that bleeding is harmless. For instance, a patient with rectal bleeding may indeed have visible hemorrhoids on examination, but the real source of the bleeding could be a tumor higher up in the rectum or colon. Unfortunately, it is not uncommon for such patients to be misdiagnosed and treated with hemorrhoid creams for months — only to receive a cancer diagnosis much later.
So How Can We Rule Out a Serious Cause of Rectal Bleeding? Through digital rectal examination (also known as rectal palpation) and endoscopic evaluation. The extent of the endoscopic examination depends on the patient’s age and individual risk factors for colorectal cancer. For example: • In patients under 45 years old with no risk factors and a benign cause of bleeding (e.g., hemorrhoids), it may be sufficient to perform a limited endoscopy to examine only the anus and rectum. This procedure is called a rectoscopy. • In patients with higher risk or those over 45, a more comprehensive examination, such as a colonoscopy, may be needed to evaluate the entire colon and rectum.
Bottom line: If you experience rectal bleeding, it should be thoroughly evaluated — regardless of how minor it may seem. Only after ruling out serious conditions can a diagnosis of a benign cause, such as hemorrhoids, be safely made.
