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Hemorrhoids are swollen blood vessels located in and around the lowest part of the rectum and the anus.
What causes hemorrhoids?
Hemorrhoids are caused by increased pressure on the veins in the lower rectum and anus. This pressure can result from straining during bowel movements, chronic constipation, sitting for long periods, pregnancy, obesity, or a low-fiber diet. Over time, this strain causes the blood vessels to swell and form hemorrhoids.
Hemorrhoid tissue can be internal, forming within the rectum, or external, developing closer to the anus, which often causes more intense discomfort. Depending on their size and location, they may also impact surrounding tissue and muscles, sometimes leading to muscle spasms or complications with hygiene.
For individuals experiencing persistent discomfort, hemorrhoidectomy surgery can be a highly effective way to remove hemorrhoids and restore quality of life. At our private surgical clinic in Montreal, our experienced team offers procedures tailored to each patient’s condition.
If you're considering surgery and would like to better understand the associated costs, please consult our fees page for detailed information.
While many cases resolve with medical treatment, dietary changes, and self-care—like warm baths and over-the-counter hemorrhoid cream—some individuals experience persistent symptoms. When these symptoms of hemorrhoids become chronic or severely impact daily life, hemorrhoidectomy surgery may be the most effective way to remove hemorrhoids and restore comfort.
In cases where conservative treatments for hemorrhoids fail, or when the condition progresses, hemorrhoid surgery becomes a necessary next step. Chronic hemorrhoids may lead to complications such as excessive bleeding, anemia, or even thrombosed hemorrhoids (blood clots), which cause sharp, localized pain during bowel movements.
Additionally, issues in the digestive system, such as constipation, can exacerbate the problem. That’s why it’s important to avoid constipation through adequate hydration, fiber intake, and movement.
In cases where individuals have painful bowel movements without the presence of hemorrhoids, a tear in the thin tissue lining the anus could be the cause, which makes anal fissure surgery a viable option.
The ultimate goal of a hemorrhoidectomy is to increase the quality of life of the patient and to relieve as much pain as possible. If pain is disrupting your daily life and you have exhausted all other options, it may be time to consider surgical treatment options.
Any surgical procedure, whether they be big or small, carries risks. For a hemorrhoidectomy, these typically include:
Risks of Surgery
Routine blood work is usually not needed but may be ordered prior to surgery based on the patient's age and the presence of any existing medical problems.
A hemorrhoidectomy is a minor kind of surgery, and is done on an outpatient basis (you will be able to go home after the surgery is completed). Before your surgery, a nurse or doctor will plan the site, clean the affected area, and consult with you for any questions you may have. Then, the anesthesiologist will numb the area using a local anesthetic (e.g. spinal, epidural), so that you won’t feel any discomfort during the procedure. General anesthesia is reserved for more severe cases, but may be administered under the recommendation of your surgeon.
The procedure itself can last anywhere between 20 to 30 minutes depending on the size of the hemorrhoids at the time of surgery. Your doctor will let you know how long the procedure should last. Consult our surgery guidelines for detailed information about how to prepare for a general surgery procedure.
There are different types of procedures available to treat hemorrhoids surgically, and the choice depends largely on the size, type, and severity of your condition.
The most common technique is the hemorrhoidectomy, typically performed on patients who have large external hemorrhoids, internal hemorrhoids that have prolapsed, or hemorrhoids that have not responded to nonsurgical medical treatment such as rubber band ligation, infrared light therapy, or topical medications.
During a traditional hemorrhoidectomy surgery, once local or general anesthesia is administered, the surgeon removes the hemorrhoid tissue using a scalpel. This method directly excises the swollen veins and surrounding tissue. Depending on the nature of the hemorrhoids, the incision site may be closed with sutures, or in some cases, left open to heal naturally (a technique known as secondary intention healing) to reduce the risk of infection and other postoperative complications.
Another surgical technique that may be considered in select cases is hemorrhoid stapling, also known as stapled hemorrhoidopexy. This procedure doesn’t remove the hemorrhoids themselves; it cuts off their blood supply by repositioning the hemorrhoidal tissue and stapling it higher up inside the anal canal. This results in the hemorrhoids shrinking over time and typically causes less pain during recovery.
While stapled hemorrhoidopexy can be effective for prolapsed internal hemorrhoids, it is generally not suitable for large external hemorrhoids. It also carries its own set of possible risks, including recurrence and rare but serious complications.
Recovery time for a hemorrhoidectomy will vary, but you should feel back to normal within a few weeks. Residual pain or mild discomfort may last up to a week after surgery. Be sure to keep the area clean and dry to avoid the possibility of infection. Itchiness or soreness is common–sitz baths are commonly recommended to relieve discomfort and promote healing–however let your doctor know if you experience swelling or excessive pain.
You will need to arrange for a ride home the day of your surgery and we recommend someone stay with you for the first 24 hours at home. When you leave the facility after surgery, we will want you to go home and rest. Avoid making any other plans on the day of your surgery. Starting the following day, you can increase your activity as you feel up to it.
You will likely be given a prescription for pain medication following your surgery. The recovery nurse will discuss with you to establish a pain control strategy consisting of ice applications and medications. Oftentimes we will recommend taking Tylenol and Advil (same as Motrin, Ibuprofen) or Aleve in addition to the narcotic pain medication you may receive, however, it is important to note that the overuse of nonsteroidal anti-inflammatory drugs (NSAIDs) after a hemorrhoidectomy can increase the risk of bleeding, along with other complications, so they should only be used as directed.
Did you know we have a support group?
Your questions and concerns have most likely been asked and answered in our support group. Moderated by our dietitian's, nurses, and staff. We provide you with reliable patient education and resources to help you throughout this life-changing process.