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Hemorrhoid Surgery

 

Key points

  1. Hemorrhoids are swollen blood vessels that can be painful and irritated.
  2. Most people don’t need hemorrhoid surgery, but surgical removal is required for severe cases that don’t resolve with home treatment.
  3. There are five types of surgery you and your doctor might consider.

Hemorrhoids are swollen veins that can be internal, which means they’re inside the rectum. Or they can be external, which means they’re outside the rectum.

Most hemorrhoidal flare-ups stop hurting within two weeks without treatment. Eating a high-fiber diet and drinking 8 to 10 glasses of water per day can usually help you manage the symptoms by promoting softer and more regular bowel movements.

You may also need to use stool softeners to reduce straining during bowel movements, as straining makes the hemorrhoids worse. Your doctor may recommend over-the-counter topical ointments to ease occasional itching, pain, or swelling.

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Complications of hemorrhoids

Complications of hemorrhoids

Sometimes, hemorrhoids can lead to other complications.

External hemorrhoids may develop painful blood clots. If this happens, they’re called thrombosed hemorrhoids.

Internal hemorrhoids may prolapse, which means they drop through the rectum and bulge from the anus.

External or prolapsed hemorrhoids can become irritated or infected and may require surgery. The American Society of Colon and Rectal Surgeons estimates that less than 10 percent of hemorrhoid cases require surgery.

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Symptoms

Symptoms of hemorrhoids

Internal hemorrhoids often cause no discomfort. They may bleed painlessly after a bowel movement. They become a problem if they bleed too heavily or prolapse. It’s typical to see blood after a bowel movement when you have a hemorrhoid.

External hemorrhoids may also bleed after bowel movements. Because they’re exposed, they often become irritated and may itch or become painful.

Another common complication of external hemorrhoids is the formation of blood clots inside the vessel, or a thrombosed hemorrhoid. While these clots aren’t usually life-threatening, they can cause sharp, severe pain.

Proper treatment for such thrombosed hemorrhoids consists of an “incision and drainage” procedure. A surgeon or a doctor in an emergency room can perform this procedure.

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Surgeries without anesthetic

Surgeries without anesthetic

Some types of hemorrhoid surgery can be done in your doctor’s office without anesthetic.

Banding

Banding is an office procedure used to treat internal hemorrhoids. Also called rubber band ligation, this procedure involves using a tight band around the base of the hemorrhoid to cut off its blood supply.

Banding usually requires two or more procedures that take place about two months apart. It’s not painful, but you may feel pressure or mild discomfort.

Banding isn’t recommended for those taking blood thinners because of the high risk of bleeding complications.

Sclerotherapy

This procedure involves injecting a chemical into the hemorrhoid. The chemical causes the hemorrhoid to shrink and stops it from bleeding. Most people experience little or no pain with the shot.

Sclerotherapy is done at the doctor’s office. There are few known risks. This may be a better option if you’re taking blood thinners because your skin isn’t cut open.

Sclerotherapy tends to have the best success rates for small, internal hemorrhoids.

Coagulation therapy

Coagulation therapy is also called infrared photocoagulation. This treatment uses infrared light, heat, or extreme cold to make the hemorrhoid retract and shrink. It’s another type of procedure that’s done at your doctor’s office, and it’s usually performed along with an anoscopy.

An anoscopy is a visualization procedure in which a scope is inserted several inches into your rectum. The scope allows the doctor to see. Most people experience only mild discomfort or cramping during treatment.

Hemorrhoidal artery ligation

Hemorrhoidal artery ligation (HAL), also known as transanal hemorrhoidal dearterialization (THD), is another option to remove a hemorrhoid. This method locates the blood vessels causing the hemorrhoid using an ultrasound and ligates, or closes off, those blood vessels. It’s more effective than rubber banding, but also costs more and results in longer-lasting pain. Depending on the type of hemorrhoid, it’s an option if the first rubber banding fails.

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Surgeries with anesthetic

Surgeries with anesthetic

Other types of surgery need to be performed in a hospital.

Hemorrhoidectomy

A hemorrhoidectomy is used for large external hemorrhoids and internal hemorrhoids that have prolapsed or are causing problems and not responding to nonsurgical management.

This procedure usually takes place in a hospital. You and your surgeon will decide on the best anesthesia to use during the surgery. Choices include:

  • general anesthesia, which puts you into a deep sleep throughout the surgery
  • regional anesthesia, which involves medication that numbs your body from the waist down being delivered by a shot into your back
  • local anesthesia, which numbs only your anus and rectum

You may also be given a sedative to help you relax during the procedure if you receive local or regional anesthesia.

Once the anesthesia takes effect, your surgeon will cut out the large hemorrhoids. When the operation is over, you’ll be taken to a recovery room for a brief period of observation. Once the medical team is sure that your vital signs are stable, you’ll be able to return home.

Pain and infection are the most common risks associated with this type of surgery.

Hemorrhoidopexy

Hemorrhoidopexy is sometimes referred to as stapling. It’s usually handled as a same-day surgery in a hospital, and it requires general, regional, or local anesthesia.

Stapling is used to treat prolapsed hemorrhoids. A surgical staple fixes the prolapsed hemorrhoid back into place inside your rectum and cuts off the blood supply so that the tissue will shrink and be reabsorbed.

Stapling recovery takes less time and is less painful than recovery from a hemorrhoidectomy.

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Aftercare

Aftercare

You can expect rectal and anal pain after having hemorrhoid surgery. Your doctor will probably prescribe a painkiller to ease the discomfort.

You can aid in your own recovery by:

Avoid any activities that involve heavy lifting or pulling.

Some people find that sitz baths help ease postsurgical discomfort. A sitz bath involves soaking the anal area in a few inches of warm salt water several times a day.

Although individual recovery times vary, many people can expect to make a full recovery within about 10 to 14 days. Complications are rare, but please seek medical help if you have a fever, can’t urinate, have pain with urination, or feel dizzy.

When you follow up with your doctor, they’ll probably recommend:

  • diet changes, such as eating foods high in fiber and staying hydrated
  • making lifestyle changes, such as losing weight
  • adopting a regular exercise program

These adjustments will reduce the likelihood of hemorrhoids recurring.

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