Surgical Procedures for Hemorrhoids

What are the Surgical Procedures for Hemorrhoids

Surgical procedures can be used to treat hemorrhoids. Hemorrhoids are swollen veins that are inside the rectum (internal hemorrhoids) or around the anus (external hemorrhoids). They are caused by increased pressure in the anal area. This pressure may result from straining to have a bowel movement (constipation), diarrhea, pregnancy, obesity, anal sex, or sitting for long periods of time.

Hemorrhoids can cause symptoms such as pain and bleeding. Surgery may be needed if diet changes, lifestyle changes, and other treatments do not help your symptoms. Various surgical methods may be used. Three common methods are:

  • Closed hemorrhoidectomy. The hemorrhoids are surgically removed, and the surgical cuts (incisions) are closed with stitches (sutures).
  • Open hemorrhoidectomy. The hemorrhoids are surgically removed, but the incisions are allowed to heal without sutures.
  • Stapled hemorrhoidopexy. The hemorrhoids are removed using a device that takes out a ring of excess tissue.

Tell a health care provider about:

  • Any allergies you have.
  • All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
  • Any problems you or family members have had with anesthetic medicines.
  • Any blood disorders you have.
  • Any surgeries you have had.
  • Any medical conditions you have.
  • Whether you are pregnant or may be pregnant.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

  • Infection.
  • Bleeding.
  • Allergic reactions to medicines.
  • Damage to other structures or organs.
  • Pain.
  • Constipation.
  • Difficulty passing urine.
  • Narrowing of the anal canal (stenosis).
  • Difficulty controlling bowel movements (incontinence).

What happens before the procedure?

  • Ask your health care provider about:
    • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
    • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines before your procedure if your health care provider instructs you not to.
  • You may need to have a procedure to examine the inside of your colon with a scope (colonoscopy). Your health care provider may do this to make sure that there are no other causes for your bleeding or pain.
  • Follow instructions from your health care provider about eating or drinking restrictions.
  • You may be instructed to take a laxative and an enema to clean out your colon before surgery (bowel prep). Carefully follow instructions from your health care provider about bowel prep.
  • Ask your health care provider how your surgical site will be marked or identified.
  • You may be given antibiotic medicine to help prevent infection.
  • Plan to have someone take you home after the procedure.

What happens during the procedure?

  • To reduce your risk of infection:
    • Your health care team will wash or sanitize their hands.
    • Your skin will be washed with soap.
  • An IV tube will be inserted into one of your veins.
  • You will be given one or more of the following:
    • A medicine to help you relax (sedative).
    • A medicine to numb the area (local anesthetic).
    • A medicine to make you fall asleep (general anesthetic).
    • A medicine that is injected into an area of your body to numb everything below the injection site (regional anesthetic).
  • A lubricating jelly may be placed into your rectum.
  • Your surgeon will insert a short scope (anoscope) into your rectum to examine the hemorrhoids.
  • One of the following hemorrhoid procedures will be performed.

Closed Hemorrhoidectomy

  • Your surgeon will use surgical instruments to open the tissue around the hemorrhoids.
  • The veins that supply the hemorrhoids will be tied off with a suture.
  • The hemorrhoids will be removed.
  • The tissue that surrounds the hemorrhoids will be closed with sutures that your body can absorb (absorbable sutures).

Open Hemorrhoidectomy

  • The hemorrhoids will be removed with surgical instruments.
  • The incisions will be left open to heal without sutures.

Stapled Hemorrhoidopexy

  • Your surgeon will use a circular stapling device to remove the hemorrhoids.
  • The device will be inserted into your anus. It will remove a circular ring of tissue that includes hemorrhoid tissue and some tissue above the hemorrhoids.
  • The staples in the device will close the edges of removed tissue. This will cut off the blood supply to the hemorrhoids and will pull any remaining hemorrhoids back into place.

Each of these procedures may vary among health care providers and hospitals.

What happens after the procedure?

  • Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored often until the medicines you were given have worn off.
  • You will be given pain medicine as needed.

Surgical Procedures for Hemorrhoids, Care After

Refer to this sheet in the next few weeks. These instructions provide you with information about caring for yourself after your procedure. Your health care provider may also give you more specific instructions. Your treatment has been planned according to current medical practices, but problems sometimes occur. Call your health care provider if you have any problems or questions after your procedure.

What can I expect after the procedure?

After the procedure, it is common to have:

  • Rectal pain.
  • Pain when you are having a bowel movement.
  • Slight rectal bleeding.

Follow these instructions at home:

Medicines

  • Take over-the-counter and prescription medicines only as told by your health care provider.
  • Do not drive or operate heavy machinery while taking prescription pain medicine.
  • Use a stool softener or a bulk laxative as told by your health care provider.

Activity

  • Rest at home. Return to your normal activities as told by your health care provider.
  • Do not lift anything that is heavier than 10 lb (4.5 kg).
  • Do not sit for long periods of time. Take a walk every day or as told by your health care provider.
  • Do not strain to have a bowel movement. Do not spend a long time sitting on the toilet.

Eating and drinking

  • Eat foods that contain fiber, such as whole grains, beans, nuts, fruits, and vegetables.
  • Drink enough fluid to keep your urine clear or pale yellow.

General instructions

  • Sit in a warm bath 2–3 times per day to relieve soreness or itching.
  • Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

  • Your pain medicine is not helping.
  • You have a fever or chills.
  • You become constipated.
  • You have trouble passing urine.

Get help right away if:

  • You have very bad rectal pain.
  • You have heavy bleeding from your rectum.
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