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Hemorrhoids are swollen veins that can be internal, which means they’re inside the rectum, or external, which means they’re outside the rectum.
Most hemorrhoidal flare-ups stop hurting within 2 weeks without treatment. According to the American Society of Colon and Rectal Surgeons (ASCRS), 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.
In some cases, you may also need to use stool softeners to reduce straining during bowel movements, as straining can make your hemorrhoids worse.
The ASCRS estimates that less than 10 percent of hemorrhoid cases require surgery, but this can become necessary in some cases when external or prolapsed hemorrhoids become too irritated, infected, or when there are complications.
Surgeries for hemorrhoids can be divided into simpler, outpatient, and less invasive procedures you can do without anesthesia and more complex, inpatient surgeries.
Depending on the severity of your symptoms, and whether you have complications, your doctor will determine whether you need surgery and the type of procedure best for you.
The severity of hemorrhoids is classified by grades as follows:
- Grade 1: no prolapse
- Grade 2: prolapse that goes away by itself
- Grade 3: prolapse that you have to push back in on your own
- Grade 4: prolapse that you can’t push in on your own and causes you pain
Surgeries without anesthetic
These types of hemorrhoid surgery can be done in your doctor’s office without anesthesia.
Banding is an office procedure used to treat internal hemorrhoids with a severity of up to Grade 3. 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 2 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. There is typically minimal recovery time. Rarely, additional complications may occur such as pain and infection.
This procedure is intended for treating internal hemorrhoids up to Grade 2. It 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 is also called infrared photocoagulation. This treatment is for Grades 1–3 internal hemorrhoids. It 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 Grades 2 or 3 hemorrhoids.
This method locates the blood vessels causing the hemorrhoid using an ultrasound and ligates, or closes off, those blood vessels.
Research shows this method may be as effective as the traditional but more invasive method of hemorrhoidectomy but involve less post operative pain.
Surgeries with anesthetic
For these types of surgery, you’ll need to to go to a hospital and receive anasthesia.
A hemorrhoidectomy is used for Grades 3–4 hemorrhoids, large external hemorrhoids, internal hemorrhoids that have prolapsed, or ones that are not responding to nonsurgical management.
You and your surgeon will decide on the best anesthesia to use during the surgery. This may be full anasthesia, sedation, or a spinal block, which is similar to an epidural injection during birth and can allow you to stay awake.
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. There are actually different types of hemorrhoidectomy. These vary in terms of how the doctor approaches the procedure and some may involve more post-operative pain that others.
Generally, however, pain lasts for about 1 week after surgery.
Hemorrhoidopexy is sometimes referred to as stapling. It’s usually handled as a same-day surgery in a hospital, and requires general, regional, or local anesthesia.
Stapling is used to treat prolapsed hemorrhoids, which could be Grades 3–4. 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. Research shows that people take less time to have a bowel movement after this procedure and have fewer unhealed wounds after 4 weeks.
However, there’s also evidence of an increased rate of hemorrhoid and prolapse recurrence.
You can expect rectal and anal pain after having hemorrhoid surgery. You can use both medications and non-pharmaceutical treatments to help you in your recovery.
Your doctor will probably prescribe painkillers to ease the discomfort.
These may include:
- Opioids. Opioids like oxycodone are typically taken every 2–4 hours according to the dosage your surgeon prescribes. Typically it’s no more than one–two pills.
- Nonsteroidal anti-inflammatory drugs (NSAIDS). NSAIDS like ibuprofen are available over-the-counter (OTC) and by prescription in higher dosages. Check with your doctor for your recommended dosage depending on your level or pain and the specific surgery you underwent.
- Ativan. This is a spasm reducing medication that doctors often prescribe for hemorrhoidectomies. You typically take it as needed every 6 hours.
Since opioids are addictive and should be used temporarily, it may be best to begin with NSAIDs and Ativan, should you need it, and only use medications like oxycodone if absolutely necessary.
Opioids can also interfere with your ability to have a bowel movement after surgery, so ask your doctor how soon you can stop them to prevent this side effect.
You can also aid in your own recovery by avoiding any activities that involve heavy lifting or pulling.
Some people find that sitz baths help ease post-surgical discomfort. A sitz bath involves soaking the anal area in a few inches of warm salt water several times a day for about 10–15 minutes each time.
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, working toward a healthier weight
- adopting a regular exercise program
These adjustments will reduce the likelihood of hemorrhoids recurring. Although individual recovery times vary, many people can expect to see symptoms resolve with about 1–2 weeks.
- You pass a bowel movement that is mostly or heavily bloody.
- You’re experiencing severe pain in anal or abdominal areas.
- You have diarrhea.
- You have a fever.
- You’re not able to pass urine.
- You have thrombosed external hemorrhoids.
Rare, but more serious complications may include:
- abscess, which is a painful collection of pus that typically results from a bacterial infection
- sepsis, which is blood poisoning and is life threatening
- peritonitis, which is inflammation of the tissue that lines your abdomen
Complications that may occur later in the post-operative period include:
- recurrent hemorrhoids
- anal stenosis, which causes the anal canal to narrow and makes it harder to have a bowel movement
- skin tags
- late hemorrhage
- constipation (often due to prolonged use of medications)
- fecal incontinence
There’s a variety of surgical treatments for hemorrhoids. Some are outpatient, minimally invasive, and require no anesthetics. Others require hospitalization and anesthesia, and will require post-operative recovery.
Your doctor will examine you to identify the type of hemorrhoids you have and their grade or degree of severity, and determine the best course of treatment.
Should you require surgery with anesthesia, there are medications and non-pharmaceutical things you can do help speed up your recovery. It may be wise to limit the use of opioids to avoid the risk of addiction.