Hemorrhoidectomy Surgery for Treating Hemorrhoids

Surgery is typically the last type of treatment used to control the symptoms and complications that may be present with hemorrhoids. For most patients, the pain and irritation of hemorrhoids pass in one to two weeks. If your hemorrhoid symptoms persist beyond the two-week mark, seek the attention of a physician.

Surgery is considered if medications and less invasive hemorrhoid treatments are ineffective at improving the condition. These treatments range from home remedies, such as applying ice and witch hazel; prescription-numbing medications; and minimally invasive procedures, such as rubber band ligation or the injection of a solution into the blood vessel.

Most patients who qualify for surgery have very large internal hemorrhoids, a combination of internal and external hemorrhoids, very large external hemorrhoids, or hemorrhoids that have not responded favorably to other types of treatment.


Before Surgery

Modern hospital operating room with monitors and equipment
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If you elect to have hemorrhoid surgery, you may be asked to stop taking any medications that can increase bleeding in the week before surgery. Those medications can include over-the-counter pain relievers, such as ibuprofen and aspirin, and any prescription blood-thinning medications.

On the day prior to surgery, you will be asked to perform bowel prep. This may mean drinking a solution that will remove all stool from your digestive tract by causing you to have bowel movements, or you may be asked to give yourself an enema.

Your physician will answer any questions about the surgery and discuss the risks of hemorrhoid surgery with you. These risks are specific to hemorrhoid surgery, in addition to the general risks of surgery and the risks of anesthesia.

The severity of your hemorrhoid(s), the types of hemorrhoids present (including external, internal or prolapsed hemorrhoids), the type of anesthesia you receive, and your general health will all contribute to your personal level of risk.


During Surgery

Hemorrhoid surgery is performed using one of two types of anesthesia: general anesthesia or spinal anesthesia, which is also known as regional anesthesia. Once you are in the operating room, the anesthesia provider, who may be a nurse or a physician, will give the medication to ensure that you feel no pain. You may be awake but feeling no pain if you elect spinal anesthesia, or asleep if you choose a general anesthetic.

Once the anesthesia medications are given, the procedure begins. The surgeon will identify hemorrhoid, and, if necessary, pull it down through the anus so it can be operated upon. Once the surgeon has access to the tissue, it will be tied off with a suture to prevent bleeding. This is best described as a small tourniquet that cuts off the blood flow to hemorrhoids. The hemorrhoid is then cut away from the other tissue.

There are multiple techniques that may be used to remove hemorrhoids, including a scalpel, a laser, or electrocautery. Once the hemorrhoid tissue is removed, it may be sewn closed or left open to heal on its own, depending upon your surgeon's preference. This technique may be repeated if there is more than one hemorrhoid present.

Once the procedure to remove the hemorrhoid is completed, but you are still under anesthesia, you will be given a local anesthetic, which will numb the surgical area for eight to 12 hours. This medication will significantly improve your pain level during the first few hours of your recovery.

You may stay in the hospital overnight, or you may be able to return home once you wake from anesthesia completely. You may experience some difficulty with urination after surgery. Some difficulty is expected, but a complete inability to urinate should be considered an emergency and treatment should be sought.


Recovering After Surgery

Pain is to be expected after hemorrhoid surgery, especially when having a bowel movement or urinating. It may be severe at times but should diminish steadily in the week following surgery.

Your surgeon may prescribe pain medication in addition to other methods of pain relief, including ice packs and sitz baths.

Approximately 5% of all patients have additional hemorrhoids develop after having surgical treatment. Many hemorrhoids can be prevented with lifestyle changes and other interventions. Your surgeon may recommend several ways to prevent future hemorrhoids from forming.

Hemorrhoids Doctor Discussion Guide

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