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Hemorrhoid surgery

Definition

Hemorrhoid surgery is the removal of swollen veins around the anus (hemorrhoids). Hemorrhoids can be inside (internal) or outside of (external) the skin around the rectum.

Alternative Names

Hemorrhoidectomy

Description

Hemorrhoids can be surgically removed using a special stapler or sutures (stiches). You may be sedated and pain-free (local or spinal anesthesia) or asleep and pain-free (general anesthesia). After the hemorrhoid is removed, you may have stitches that dissolve on their own and gauze packing to reduce bleeding.

Smaller hemorrhoids may not need surgery. Hemorrhoid surgery is often done in an outpatient clinic or your doctor’s office, with little or no anesthesia.

To treat your hemorrhoids, your doctor may:

• Give you a chemical shot into the hemorrhoid to reduce swelling (sclerotherapy)
• Place a rubber band around the hemorrhoid to cut off the blood supply to it
• Shrink the hemorrhoid with infrared light or a laser, or freeze it with liquid nitrogen
• Perform minor surgery to treat the hemorrhoid (hemorrhoidectomy)

Why the Procedure Is Performed

Most small hemorrhoids can be managed with lifestyle changes and diet.

Your doctor may recommend hemorrhoid removal when nonsurgical treatment (such as a high-fiber diet, laxatives, stool softener, suppositories, medications, and warm baths) do not make your symptoms go away.

Typical symptoms are:

• Anal bleeding
• Blood clots (thrombosis of the hemorrhoids)
• Infection
• Pain
• Persistent itching

Risks

Risks for any surgery are:

• Bleeding
• Infection

Risks for any anesthesia are:

• Reactions to medications
• Breathing problems, pneumonia
• Heart problems

Risks for hemorrhoid surgery are:

• Leaking a small amount of stool (long-term problems are rare)
• Problems passing urine because of the pain

Before the Procedure

Always tell your doctor or nurse:

• If you could be pregnant
• What drugs you are taking, even drugs or herbs you bought without a prescription

Several days before surgery, you may be asked to stop taking aspirin, ibuprofen (Advil, Motrin, naproxen (Aleve, Naprosyn), warfarin (Coumadin), and any other drugs that make it hard for your blood to clot.

On the day of the surgery:

• If you are having general anesthesia, and you will usually be asked not to drink or eat anything after midnight the night before the surgery.
• Take the drugs your doctor told you to take with a small sip of water.
• Your doctor or nurse will tell you when to arrive.

After the Procedure

You may have a lot of pain after surgery as the anus tightens and relaxes. You may be given medications to relieve pain.

To avoid straining, you will need to use stool softeners. Avoid any straining during bowel movements or urination. Eat more fiber to ease bowel movements. Drink 8 to 10 glasses of water a day.

Gradually return to your normal activities. Avoid lifting, pulling, or strenuous activity until your bottom has healed.

Soaking in a warm bath can give you more comfort. You may be given a container to give yourself "sitz baths" (sitting in 3 to 4 inches of warm water) a few times a day.

You should have a complete recovery in about 2 weeks.

Outlook (Prognosis)

The outcome is usually very good for most people. Eating a high-fiber diet, drinking plenty of water, and avoiding constipation may help prevent hemorrhoids from coming back. However, you may still develop new hemorrhoids.

References

Nelson H, Cima RR. Anus. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 51.