Hemorrhoid removal. You’ve tried everything else and now you’re left with a treatment option you really don’t want to have to consider. If you have painful and bleeding hemorrhoids, you probably have a lot questions. “How do I know if I need surgery?” “If I do, what are my options?” “What kind of doctor should I see?” “What are the risks?” “What should I expect before, during, and after surgery?” “Will surgery stop hemorrhoids from coming back?” This article answers some of the most frequently asked questions about hemorrhoid removal.
When Should I Have Hemorrhoid Surgery?
If you have substantial bleeding and pain, it’s time to call the doctor. If your doctor diagnoses your problem as thrombosed external hemorrhoids, which means your hemorrhoids contain blood clots, or large internal hemorrhoids, he or she may recommend surgery. Hemorrhoid removal is often accomplished through surgery known as a hemorrhoidectomy.
To determine whether you need surgery, your doctor will perform a rectal examination. The doctor wants to rule out other possible causes of your bleeding and pain. Methods your doctor may use to diagnose your condition include:
Performing an anal examination, by inserting a finger into your anus to feel for a blockage or abnormal growths.
Performing an anoscopy, by looking through a small, lit tube, known as an anoscope, to examine the anal canal and lower rectum.
Inserting a proctoscope, which is a thin tube containing a camera and a light, into the rectum to examine its interior more thoroughly. This procedure is called a proctoscopy.
Performing a sigmoidoscopy, which examines the rectum and the lower part of the colon to search for polyps. The doctor uses a sigmoidscope, which is a flexible tube that can cut off any polyps discovered. Polyps are growths of tissue extending from mucous membranes. They are usually nonmalignant.
Performing a colonoscopy, in which the doctor sees and examines the large intestine and the rectum, using a long, flexible tube called a colonoscope.
Unless there is reason to suspect other problems, your doctor will probably confine the examination to one of the first three methods. If the doctor discovers large internal hemorrhoids or believes your external hemorrhoids warrant surgery, he or she may recommend surgery for hemorrhoid removal.
What Types of Hemorrhoids Surgery Do Doctors Perform?
Doctors, generally, perform one of two types of surgery to complete hemorrhoid removal: stapled hemorrhoidectomy and conventional hemorrhoidectomy. Let’s look briefly at each.
Stapled Hemorrhoidectomy: Procedure for Prolapse and Hemorrhoids (PPH) Stapled hemorrhoidectomy surgeries are often referred to as PPH. This stands for the “procedure for prolapse and hemorrhoids.” Generally, it’s recommended for people who suffer with Grade III or IV hemorrhoids, which means their hemorrhoids have prolapsed, or dropped below the anus.
Basically, the surgery staples prolapsed hemorrhoid tissue back into its original position. Because this position is above what is known as a pain line, fewer nerve endings are involved, resulting in less pain for the patient. The staples cut off the blood flow to the hemorrhoid, which starves it to death.
Benefits to the patient of the procedure include less pain, shorter recovery times, and fewer complaints of post-surgery complications.
Drawbacks to the procedure include a higher incidence of recurring hemorrhoids. Also, some patients complain of pain during bowel movements and internal itching from the staple.
Hemorrhoidectomy: A hemorrhoidectomy actually removes the hemorrhoid, including blood clots and blood vessels that feed the hemorrhoid. It’s usually performed as an outpatient procedure.
Hemorrhoidectomies offer the most success in preventing the return of hemorrhoids, but patients who have them also experience the most significant complications. Complications include incontinence, frequent gas and bloating, and leaking fecal matter.
Other Minimally Invasive Procedures for Hemorrhoid Removal
If you are a candidate for a less serious form of surgery, your doctor may perform what is known as a minimally invasive, or fixative, procedure. These procedures focus on cutting off the blood flow to the hemorrhoid rather than removing the hemorrhoid. The most common forms include:
Excision: In which the blood clot of a thrombosed hemorrhoid is removed
Rubber band ligation: In which rubber bands are placed around internal hemorrhoids, cutting off their blood supply
Sclerotherapy: In which a solution is injected into the hemorrhoid, shutting down entry paths for blood to feed the hemorrhoid
Laser: In which lasers are used to burn and cauterize the ends of hemorrhoid tissue, thereby blocking blood flow to the tissue
Each has a less successful track record in treating Grades III and IV hemorrhoids than hemorrhoidectomy surgery.
What Type of Doctor Removes Hemorrhoids?
Patients who have had good success with their surgery highly recommend letting a colorectal surgeon do the procedure. These surgeons are also known as colon and rectal surgeons or proctologists. Proctologists specialize in treating diseases of the large intestine, which includes the anus, rectum, and sigmoid colon. You can find a board-certified specialist near you by searching the American Society for Colon and Rectal Surgeons (ASCRS) website.
What Should I Expect?
Before the Surgery: Your doctor will give you a regimen of things to do to prepare for the surgery. This will probably include directions about what and how late you can eat the day before. Your bowels will need to be emptied prior to the surgery, so you will be instructed on how to do this. Because you will be placed under anesthesia during the surgery, you will also need to have someone drive you home later. You will be asked to arrive at the outpatient center by a certain time to be prepped for surgery.
During the Surgery: This depends on the type of surgery you receive. In any type, you will be placed under anesthesia to eliminate pain during the procedure. You may or may not be awake during the procedure.
If you have the stapled hemorrhoidectomy, the doctor will lift the hemorrhoid tissue back in place and then use a circular stapling tool to staple it.
If you have a conventional hemorrhoidectomy, the doctor will
Make an incision in the hemorrhoid tissue.
Remove any blood clots.
Remove the hemorrhoid blood vessels.
Remove the hemorrhoid.
Some doctors use sutures to close the area. Others think healing is more successful when the wound is left open. The doctor will pack the wound with gauze to absorb bleeding.
After the Surgery The surgical staff will keep you in the outpatient center until the anesthesia wears off. When you awaken, you will be asked to urinate. This provides the nurses an important clue about whether you have experienced any problematic swelling or spasms in your pelvic muscles. Your nurse will read to you important instructions and precautions to take for the next few days before releasing you. They will probably include things like:
Don’t drive for the next 24 hours because you’re recovering from the effects of being under anesthesia.
Don’t sign important papers.
Don’t operate any machinery.
Don’t drink any alcohol.
Don’t do any heavy lifting.
At-Home Care: Some people experience complications; some don’t. Once you return home, expect some pain. Your doctor will probably prescribe pain medication and perhaps antibiotics. Avoid any aspirin products for at least two weeks after your surgery. Aspirin can lead to bleeding.
Concentrate on keeping stools soft to avoid inflaming areas that are healing after surgery. This may require that you take stool softeners. Begin eating a healthy, fiber-based diet as soon as possible. Drink lots of fluids to soften fiber bulk and keep your stools soft. Some recommend eating broth or other clear fluids for a couple of days after the surgery to give your body a rest from having bowel movements.
You may experience bleeding with your first few bowel movements. This is not a cause for worry.
While healing, take sitz baths, use ice packs, and sit on a cushion to lessen your discomfort. Wipe yourself with dampened, or medicated, wipes, such as Tucks, after bowel movements and baths. Make sure you dry yourself completely. Apply a zinc oxide cream or petroleum jelly for soothing.
Your doctor will schedule a return office visit about two to three weeks after your surgery to monitor your progress. At that time, your doctor may discuss scheduling a colonoscopy in the near future to check your entire lower digestive tract for any potential problems.
Is It Painful?
Most people experience some pain after the surgery. Many will be able to control it with simple over-the-counter-medications, such as acetaminophen (Tylenol) or ibuprofen (Advil or Motrin). Some will require prescribed medication, such as Percocet.
Common complaints include:
Spasms (Botox is being studied as a possible remedy)
Pain when defecating, especially the first few times after surgery
Internal itching after defecating
An urgency to eliminate frequently
What Are the Risks?
It is estimated that hemorrhoidectomy surgery is successful in about 95 percent of cases. Still, patients can experience some rather unpleasant side effects, including:
Inability to urinate due to swelling and spasms in the pelvic area
Bad reactions to anesthesia
Bloating and gas
How Successful Is It?
The success rate for hemorrhoid removal is about 95%, but this is contingent on the patient making dietary and lifestyle changes. Without these changes, hemorrhoids may recur. For Grade III or IV hemorrhoids, hemorrhoidectomy, or hemorrhoid removal, seems to offer the best long-term results of all the medical procedures. The downside? The procedure costs more, causes many patients more pain, costs patients more time away from work as they recover, and results in a higher rate of complications than other medical treatments.
How Long Does It Take to Recover?
Best case: Expect about a two-week recovery period after undergoing a hemorrhoidectomy. For most patients, it takes at least three weeks, and can take as long as three to six weeks to get back to normal.
What Will It Cost?
Costs vary widely. The best thing to do is consult with your insurance company. If you are not insured, you may encounter the following range of costs:
Rubber band ligation: $500 to $1500
Laser or infrared coagulation: $400 to 500 per treatment, with about four treatments on average needed
Hemorrhoidectomy: $9000 to $12,000
No More Hemorrhoids
As always, the best treatment is prevention. For most people, the key to preventing hemorrhoids is preventing hard stools. Hard stools lead to straining on the toilet; straining leads to hemorrhoids. Hard stools bruise hemorrhoids, leading to bleeding hemorrhoids. Repeated instances of this behavior with no change in diet and lifestyle can lead to surgery. Lesson: eat right and exercise.