Hemorrhoids occur when a vein in the anus or rectum becomes swollen. They are classified as either prolapsed, internal or external. So, when is surgical treatment needed for hemorrhoids? If a patient does not respond to non-surgical treatments, surgery may be considered. Also, if a patient has very large, painful or bleeding hemorrhoids, surgery may be considered.
Hemorrhoidectomy is a type of surgical procedure that a doctor may recommend to remove hemorrhoids. Patients will not feel any pain because they will be administered spinal or general anesthesia for the procedure. Incisions will be made around the hemorrhoid and the vein that is swollen inside of it is tied off so that bleeding is prevented. The hemorrhoid is then removed. The doctor will then either leave the area open or close the area. The wound is covered with medicated gauze. Most patients will go home the same day as long as they urinate while in the recovery area of the hospital.
Patients are often sent home with a prescription pain medication and antibiotic. It is normal to have some bleeding after this procedure. This is especially true with the first bowel movement. Patients will normally see their doctor about two to three weeks after the surgery for a follow-up.
This procedure is successful for most patients, but about five percent of patients do experience a recurrence.
Risks include bleeding, pain and urinary retention. Relatively rare early problems may include anal bleeding, bowel or bladder incontinence, fecal impaction, hematoma and surgical area infection. Relatively rare late problems may include anal canal narrowing, fistula, hemorrhoid recurrence and rectal prolapse.
Procedure for Prolapse and Hemorrhoids (PPH)
PPH is primarily done for prolapsed hemorrhoids and uses a circular stapling device. The purpose of the procedure is to take the prolapsed tissue and then pull it into a device. This then allows any excess tissue to be removed and the surgeon can staple any hemorrhoidal tissue that remains. This puts the hemorrhoidal tissue back to the anatomical position it was originally in.
Patients often report less pain with this procedure compared to other surgical procedures for hemorrhoids. Recovery is also generally faster. Risks are rare, but they include rectal wall damage, pelvic sepsis, persistent fecal urgency and pain and short and long-term sphincter dysfunction. In some cases, the procedure is not successful.
Other Surgical Procedures
Some doctors choose to perform a laser procedure. The purpose is to burn away hemorrhoidal tissue with a laser beam. Sclerotherapy is done to try and shrink and destroy a hemorrhoid. This involves using a special chemical solution. A doctor will inject it around the blood vessel that is responsible for supplying the hemorrhoid. Rubber band ligation is a procedure meant to cut off the blood supply to the hemorrhoid in hopes of killing it. It involves placing a rubber band around a hemorrhoid's base.
American Academy of Family Physicians. (2010). Hemorrhoids: Reducing the Pain and Discomfort. Retrieved on May 17, 2011 from the American Academy of Family of Physicians: https://familydoctor.org/online/famdocen/home/common/digestive/basics/090.html
WebMD. (2008). Hemorrhoidectomy for Hemorrhoids. Retrieved on May 17, 2011 from WebMD: https://www.webmd.com/a-to-z-guides/hemorrhoidectomy-for-hemorrhoids
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