Overview

What are hemorrhoids? Hemorrhoids are swollen veins in and around the most exterior part of your rectum and anus. With enough pressure and build-up of blood, these veins can protrude from the walls and lining of the rectum and anus. Most hemorrhoids occur inside the rectum (internal hemorrhoids), but some can be pushed out of the anus (external hemorrhoids) and cause significant amounts of pain and bleeding to sufferers, especially when defecation occurs.

Hemorrhoids usually go away on their own given enough time, a change of diet (adding more fiber to soften stool), and with the help of other home rehabilitation methods such as soaking in warm baths and applying hemorrhoid cream. However, some patients may experience a worsening of the condition with chronic-like experiences. In such cases, surgery may be the best option to remove the hemorrhoids and increase their quality of life.

Why?

Untreated hemorrhoids that do not go away can cause excessive bleeding, dizziness, and fatigue. Moreover, external hemorrhoids can cause thrombosis (blood clotting), which can lead to severe pain for the sufferer.

 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.

All surgeries, whether they be big or small, carry risks. For a hemorrhoidectomy, these typically include:

What to expect prior to your surgery

You may need to take antibiotics before 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, they will numb the area using a local anesthetic 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 a few minutes to an hour 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.

The procedure

There are different types of hemorrhoidectomies – notably, whether or not your hemorrhoids are prolapsed or not will help to determine which surgery is 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.

After the procedure

Recovery time for a hemorrhoidectomy will vary, but you should feel back to normal within a few weeks. Residual pain 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, 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 a pain control plan following surgery specific to you and your needs including activities like ice applied over incisions and a medication regimen. Oftentimes we will recommend taking Tylenol and Advil (same as Motrin, Ibuprofen) or Aleve in addition to the narcotic pain medication.