Hemorrhoid Surgery: Indications and Risks

Hemorrhoids are a normal part of our body and we are generally unaware about their existence. The internal Hemorrhoids are blood vessels that supply the wall of the anus, while the external Hemorrhoids are the veins that run around the anal opening. Straining while defecating may damage the surface of the internal Hemorrhoid and cause it to bleed. The strain may sometimes push the internal Hemorrhoid outside the anus resulting in a prolapsed internal Hemorrhoid which may cause pain and irritation. External Hemorrhoids when irritated may itch or bleed, they are symptomatic when there is a formation of clot in them which leads to pain and bleeding. Nearly 50% of the population in USA will be affected by Hemorrhoids at least once by the age of 50.

Types of Hemorrhoid surgery

The treatment of Hemorrhoids depends upon severity and patient choice. Your doctor will suggest a surgical approach when other none surgical methods have failed. The surgical methods are:

• Rubber band ligation
• Sclerotherapy
• Infra red photocoagulation
• Electrocoagulation
• Hemorrhoidectomy
• Hemorrhoid stapling

Hemorrhoid surgery Procedure

Surgical treatment for Hemorrhoids can be divided into two major parts; one that does not require anaesthesia and one that does require anaesthesia.

Procedures without anaesthesia

• Rubber band ligation: a procedure used to treat bleeding or prolapsed internal Hemorrhoid. Your doctor will place a rubber band at the base of the Hemorrhoid, this cut off the blood supply to the bleeding or prolapsed Hemorrhoid which shrivels and falls off in about a week.
• Sclerotherapy: used to treat internal Hemorrhoids, the doctor injects a solution into the tissue which leads to formation of a scar tissue. The scar tissue cuts off the blood supply to the internal Hemorrhoid which causes it to shrivel and fall off.
• Infrared photocoagulation: your doctor focuses infra red light on the internal Hemorrhoid, the heat produced causes formation of scar tissue which cuts off the blood supply to the Hemorrhoid which causes it to shrink.
• Electrocoagulation: the doctor sends a small electric current into the Hemorrhoid which causes the formation of a scar tissue which cuts off the blood supply often shrinking the Hemorrhoid.

Procedures with anaesthesia

Hemorrhoidectomy: after a discussion you and your surgeon will decide which form of anaesthesia will be best suited for you. You will be making an informed choice to choose between general anaesthesia, local anaesthesia and regional anaesthesia. To begin the procedure your surgeon will administer you the anaesthetic. After the effects set in the surgeon will remove the external Hemorrhoids with the help of a scalpel, electrocautery pen or a harmonic scalpel. On completion of the surgery you will be taken to the recovery room where you will be monitored until the effect of anaesthesia wears off. You will be allowed to return home after that.

Hemorrhoidopexy: after administration of the anaesthesia a surgical stapler is used to staple the prolapsed internal Hemorrhoid into its place inside the rectum or cut off it’s blood supply. This causes the Hemorrhoid to shrink.

Indications for Hemorrhoid surgery

Hemorrhoid surgeries are indicated by the doctor if the non surgical methods for controlling the symptoms of Hemorrhoids have failed. Other conditions where it is suggested:

• Thrombosed external Hemorrhoid: in this condition a blood clot gets lodged into the external Hemorrhoid leading to excessive pain accompanied by bleeding
• Prolapsed internal Hemorrhoids
• Large and severely symptomatic external Hemorrhoids
• Patients with substantial external skin tags
• Combined internal and external Hemorrhoids.

Preparation for Hemorrhoid surgery

Before the Hemorrhoid surgery your doctor would like to obtain a detailed history and physical examination which may include external examination of anus, digital rectal examination and anoscopy. Your doctor would also like to know about all the medications that you are taking and may ask you to stop taking some of them before the procedure, like blood thinning medication and over-the-counter pain relief medication. You will be instructed to perform an enema before you come to the hospital for the procedure to ensure that your lower bowel has been cleared of faecal material.

Risks of Hemorrhoid surgery

The complications following these procedures may be:

• Bleeding
• Infection at site of surgery
• Chronic longitudinal ulcers
• Pain during bowel movements
• Slippage of rubber band after rubber band ligation
• Swelling or redness in the rectal area
• Formation of an anal fissure or fistula
• Fever.

Recovery after Hemorrhoid surgery

After the surgery you will experience anal and rectal pain, your doctor will prescribe medicines to help with this symptom. Some individuals find sitz bath (a shallow bath of warm water) helpful in pain relief. You will be advised to drink plenty of water, 8 to 10 glasses a day and eat high fibre food to prevent straining while defecating. Your doctor might also prescribe a stool softener or a laxative. It is advisable to arrange for someone o drive you home after the surgery. You will be instructed to avoid lifting heavy weights or engaging in strenuous exercise for a few days after the surgery. A ring shaped cushion may help you sit upright more comfortably after the surgery. Contact your doctor immediately if you experience any of the following:

• Sever anal pain and bleeding
• Fever
• Abdominal pain.

Resources

• https://www.niddk.nih.gov/
• www.fascrs.org