Hemorrhoidectomy - Hemorrhoid Surgery

Overview

What are hemorrhoids? Hemorrhoids are swollen blood vessels in and around the most exterior part of your rectum and anus. With enough blood flow pressure and build-up of blood, these swollen veins can protrude from the walls and lining of the rectum and anus. Most hemorrhoids occur inside the rectum(internal hemorrhoids), but some originate closer to the anus (external hemorrhoids), causing significant pain, uncomfortable itching, and potential bleeding, especially with bowel movements. 

Hemorrhoids usually go away on their own given enough time, a change of diet (adding more fiber to soften the stool), and with the help of other home treatment options, such as soaking in warm baths and applying over-the-counter medicines, such as hemorrhoid cream. However, some patients experience recurrent worsening episodes of pain and bleeding, requiring surgery to remove the hemorrhoids and improve their quality of life. 

Why?

Untreated persistent hemorrhoids can cause excessive bleeding, which, in advanced circumstances, can lead to fatigue and dizziness.. Moreover, external hemorrhoids can get thrombosed (i.e. a blood clot), which can lead to severe pain, particularly during bowel movements. 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.

Any surgical procedure, whether they be big or small, carries risks. For a hemorrhoidectomy, these typically include:

What to expect prior to your 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 anesthesia (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. Typically, your doctor will give you a heads up on how long the procedure should last. Consult our surgery guidelines for detailed information about how to prepare for a general surgery procedure. 

The procedure

There are different types of hemorrhoidectomy – notably, whether or not your hemorrhoids are prolapsed will help to determine which surgical procedures are most suitable for you. Hemorrhoidectomies are usually performed on patients who have large external hemorrhoids, internal hemorrhoids that have prolapsed, or ones that are not responding to nonsurgical treatment.

Once anesthesia has been administered (local or general), your surgeon will cut out the large hemorrhoids using a scalpel. Sutures may be used to close the incision site depending on the severity of the condition. In some cases, the wound is left open (secondary intention healing) to reduce the risk of post-operative complications, such as infection. 

After the procedure

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.