Hemorrhoidectomy is a surgical procedure to remove hemorrhoids, which are swollen veins in the anal region. They are a common, painful, and uncomfortable condition that can affect anyone. The procedure is performed under general anesthesia or spinal anesthesia so the procedure itself does not cause pain.
What is a hemorrhoidectomy?
A hemorrhoidectomy is a surgical procedure that involves the removal of hemorrhoids, which are enlarged blood vessels in the anus and lower rectum. Hemorrhoids can cause discomfort, anal pain, and bleeding. While they are common and usually harmless, in certain circumstances, a hemorrhoidectomy may be the best option.
Hemorrhoids occur when veins around the anus or rectum are dilated with blood. They can be caused by factors such as pregnancy, aging, chronic constipation, diarrhea, obesity, anal intercourse, and a family history. Symptoms of hemorrhoids include blood in stool, itching or irritation in the anal area, discomfort, pain or soreness in the anal region, lumps protruding from the anal region, swelling in the anal region, and unintentional leakage of feces.
A hemorrhoidectomy is typically not the first line of treatment. It is generally reserved for the most severe cases or when other, less invasive treatment methods have failed. Your healthcare provider might recommend a hemorrhoidectomy if your hemorrhoids are severe, causing itching, bleeding, and pain. They can continue to swell, increasing in size over time. Prolapsed internal hemorrhoids can cause some mild fecal incontinence, mucus discharge, and irritated skin. When the blood supply to internal hemorrhoids is cut off (strangulated), they can become gangrenous.
The procedure involves removing excessive tissue that causes bleeding. It is a simple procedure, but the recovery can be a bit rough. After the procedure, it is important to follow advice to minimize pain and prevent constipation. This includes lifestyle modifications such as getting regular exercise, not straining especially when going to the bathroom, increasing fluid intake, reducing consumption of fats, adding more fiber with fruits, vegetables, and whole grains, and maintaining a healthy body weight.
What are the symptoms of hemorrhoids?
Rectal bleeding: usually only a small amount of bright red blood is released in a painless matter, that is visible after a bowel movement, which can be seen on the toiler pater after wiping following a bowel movement.
Tissue bulging from the anal area: This may appear dark blue to purple if there is a blood clot.
Anal itching or burning sensation
Difficulty cleaning after a bowel movement
Pain and pressure in the rectal area
Feeling the need to have a bowel movement
Fecal leaking
Why would someone have a hemorrhoidectomy?
There are several reasons why someone might undergo a hemorrhoidectomy. One of the primary reasons is the severity of the hemorrhoids. If the hemorrhoids are causing significant discomfort, such as severe itching, bleeding, and pain, a hemorrhoidectomy may be recommended. Hemorrhoids can continue to swell over time, increasing in size and causing additional complications.
Another reason for a hemorrhoidectomy is the occurrence of complications from hemorrhoids. These complications might include prolapse, where the hemorrhoids have fallen down from inside the anus and now stick out of the opening, causing irritation, bleeding, or injury. Prolapse is a gradual process that tends to worsen over time. If the hemorrhoids need to be manually put back in (Grade III), or if they won’t go back in at all (Grade IV), a healthcare provider might recommend removing them.
Thrombosis is another complication that might necessitate a hemorrhoidectomy. This occurs when the hemorrhoid becomes so swollen that the blood inside it clots, cutting off its circulation. Thrombosed hemorrhoids can be extremely painful and sometimes rupture, causing severe bleeding.
Strangulation is a serious complication where Grade IV hemorrhoids that have prolapsed and won’t go back in are trapped in a tight spot, and their circulation has been pinched off. This is an emergency situation as the strangulated tissues eventually die, causing gangrene.
Finally, a hemorrhoidectomy might be performed if the hemorrhoids are recurrent, meaning they don’t go away or keep coming back after less invasive treatments. In such cases, a hemorrhoidectomy can provide a more permanent solution. In conclusion, a hemorrhoidectomy is performed to treat severe or complicated cases of hemorrhoids, providing relief from discomfort and preventing further complications.
What causes hemorrhoids?
Straining during bowel movements
Chronic constipation or diarrhea
Inadequate fiber intake
Prolonged sitting (especially sitting on the toilet)
Lifting heavy objects frequently
Pregnancy
Weakening of the supporting tissues in the anus and rectum that occurs with aging
Tumors
How are hemorrhoids diagnosed?
Your doctor may check your history and do a physical examination of your rectum and anus to diagnose hemorrhoids. Although external hemorrhoids are visible on examination, you may need a digital rectal exam in which your doctor may insert a gloved finger into your rectum.
Digital examination
Your doctor inserts a gloved, lubricated finger into your rectum. They feel for anything unusual, such as growth.
Visual inspection
Because internal hemorrhoids are often too soft to be felt during a rectal exam, your doctor might examine the lower portion of your colon and rectum with an anoscope, proctoscope, or sigmoidoscope.
Other tests to diagnose hemorrhoids include:
Anoscopy to examine the anus
Rigid proctosigmoidoscopy to examine the lining of the rectum and lower colon
Sigmoidoscopy or colonoscopy to examine the colon
What types of treatment are used for hemorrhoids?
Home treatment
There are a few ways to relieve the mild pain, swelling, and inflammation of hemorrhoids at home:
Eating high-fiber foods: Eating more fruits, vegetables, and whole grains. By doing so, you’ll soften the stool and increase its bulk, which will help avoid the straining which can worsen symptoms of existing hemorrhoids.
Using topical treatments: Apply hemorrhoid creams or use pads containing witch hazel or a numbing agent.
Soaking regularly in a warm bath: Soak your anal area in plain warm water for 10 to 15 minutes two to three times a day.
Taking oral pain relievers: You can use acetaminophen, aspirin, or ibuprofen temporarily to help relieve your discomfort.
These home treatments can make hemorrhoid symptoms go away in a week. But in case you’re having severe pain or bleeding or none of the mentioned treatments give you relief, you should see your doctor.
Medications
In case your hemorrhoid is only causing mild discomfort, your doctor may suggest creams or pads containing lidocaine, which can temporarily relieve pain and itching. Remember not to use steroid cream for more than a week unless directed by your doctor, cause it can thin your skin.
External hemorrhoid thrombectomy
In case a painful blood clot (thrombosis) is formed within an external hemorrhoid, a procedure can be done to remove your hemorrhoid to prompt relief. If this procedure is done within 72 hours of developing a clot, can be most effective.
Minimally invasive procedures
For persistent bleeding or painful hemorrhoids, some procedures are available which can be done in your doctor’s office, and don’t usually require anesthesia.
Rubber band ligation: During this 1 or 2 tiny rubber bands will be placed around the base of an internal hemorrhoid to cut off its circulation. Afterward hemorrhoid withers and falls off within a week. The banding itself can be uncomfortable and cause bleeding, usually starting 2-4 days after the procedure.
Injection (Sclerotherapy): This refers to a chemical solution being injected into the hemorrhoid tissue to shrink it. The injection will have no pain but may be less effective than rubber banding.
Coagulation (Infrared, laser, or bipolar): Coagulation techniques use laser or infrared light or heat. They cause small, bleeding internal hemorrhoids to harden and shrivel. Coagulation has few side effects and usually causes little discomfort.
Surgical procedures
Only a small percentage of people with hemorrhoids require surgery. However, if other procedures haven't been successful or you have large hemorrhoids, your doctor might recommend one of the following:
Hemorrhoid removal (Hemorrhoidectomy)
Hemorrhoidectomy is the most effective and complete way to treat severe or recurring hemorrhoids. This procedure is done under local anesthesia combined with sedation, spinal anesthesia, or general anesthesia. After this procedure, you may have temporary difficulty emptying your bladder, which can result in urinary tract infections. Most people have some pain after the procedure, which medications can relieve. Soaking in a warm bath also might help.
Hemorrhoid stapling
This procedure, called stapled hemorrhoidopexy, blocks blood flow to hemorrhoidal tissue. It is typically used only for internal hemorrhoids. Stapling generally involves less pain than hemorrhoidectomy and allows for an earlier return to regular activities.
Hemorrhoidectomy candidates
Most people with hemorrhoids don’t require hemorrhoidectomy. Since all surgeries carry risk, your doctor will likely recommend nonsurgical treatments first. Surgical removal of hemorrhoids may be an option if:
Less invasive methods haven’t worked for you
Your hemorrhoids are severe and causing a lot of discomfort
Internal hemorrhoids are strangulated
External hemorrhoids are swollen due to a clot
You have both internal and external hemorrhoids
You need surgery for other anorectal conditions
Other considerations are your age, overall health, and how well you can be expected to react to surgery.
What happens before a hemorrhoidectomy?
Before a hemorrhoidectomy, there are several steps that both the patient and the healthcare provider undertake to ensure the procedure is safe and effective.
The surgeon will discuss the risks and benefits of the procedure with the patient. This is an important step as it allows the patient to make an informed decision about whether to proceed with the surgery. The surgeon will also obtain the patient’s informed consent for the procedure.
Next, the healthcare provider will review the patient’s current medications. Certain medications may need to be stopped before the surgery to reduce the risk of complications. For instance, medications that thin the blood can increase the risk of bleeding during the procedure.
The patient is also asked to stop eating and drinking within eight hours before the procedure. This is to ensure that the patient’s stomach is empty, reducing the risk of aspiration (inhaling stomach contents into the lungs) during anesthesia.
In addition to these preparations, the healthcare provider may also perform a physical examination and order certain tests to assess the patient’s overall health. These tests can include blood tests, imaging studies, and other diagnostic procedures to evaluate the patient’s cardiovascular and respiratory health.
The patient may also be given specific instructions on how to prepare the surgical area. This can include using an enema or other bowel preparation methods to clean out the rectum and lower colon.
Finally, the patient will be given instructions on what to bring to the hospital, when to arrive, and what to expect on the day of the surgery. This can help to alleviate any anxiety or uncertainty the patient may have about the procedure.
In conclusion, the preparation for a hemorrhoidectomy involves a series of steps designed to ensure the safety and effectiveness of the procedure. These steps involve discussions with the healthcare provider, medication review, fasting, physical examination, diagnostic tests, surgical area preparation, and preoperative instructions.
What happens during hemorrhoidectomy surgery?
During a hemorrhoidectomy, the patient is placed under anesthesia, so they won’t feel or notice what’s happening. The procedure begins with the surgeon locating the hemorrhoids. Once the hemorrhoids are located, the surgeon will cut out (excise) the affected tissue. This involves removing the entire hemorrhoid, which is an enlarged blood vessel in the anus.
The blood vessels are then sealed to prevent bleeding. This is an important step as it helps to ensure that the area heals properly and reduces the risk of complications. The procedure is relatively simple, but it requires a high level of skill and precision on the part of the surgeon.
During the procedure, the surgeon may use various instruments to remove the hemorrhoids. These can include a scalpel, a laser, or a device that uses heat or electricity to cut and cauterize the tissue. The choice of instrument depends on the surgeon’s preference and the specific circumstances of the case.
Once the hemorrhoids have been removed, the surgeon will close the incisions. This is usually done using sutures, although in some cases, the incisions may be left open to heal naturally. The entire procedure typically takes about an hour, although the exact duration can vary depending on the complexity of the case.
After the procedure, the patient is taken to a recovery room where they are closely monitored until the effects of the anesthesia wear off. Once the patient is awake and stable, they are usually allowed to go home.
Recovery after hemorrhoid removal surgery
Recovery is different for everyone, but you should be able to return to normal activities within 1 to 2 weeks. During this time, you may have some:
Bruising
Irritation
Minor bleeding
Discharge
Soreness
For a faster recovery, you may want to:
Stay well-hydrated
Take pain relievers
Soak in a warm bath
Apply ice packs
Take stool softeners to avoid constipation and straining
What are the advantages of hemorrhoidectomy?
Effectiveness: Hemorrhoids removed in surgery generally do not return. While the recovery time is longer than other treatments, surgery should bring permanent relief in the end. This makes a hemorrhoidectomy a reliable procedure.
Treating complicated hemorrhoids: Complications that might require a hemorrhoidectomy include prolapse, where the hemorrhoids have fallen down from inside the anus and now stick out of the opening, causing irritation, bleeding, or injury. Other complications include thrombosis, where the hemorrhoid has become so swollen that the blood inside it clots, cutting off its circulation. Strangulation, where Grade IV hemorrhoids that have prolapsed and won’t go back in are trapped in a tight spot, and their circulation has been pinched off. This is an emergency situation as the strangulated tissues eventually die, causing gangrene.
Beneficial for recurrent hemorrhoids: Sometimes hemorrhoids don’t go away or keep coming back after less invasive treatments. In such cases, a hemorrhoidectomy can provide a more permanent solution.
Outpatient procedure: This means that patients can usually go home on the same day as the surgery, reducing the inconvenience and cost associated with a hospital stay.
Hemorrhoidectomy offers several advantages, including its effectiveness, ability to treat complicated and recurrent hemorrhoids, and the convenience of being an outpatient procedure.
What are the possible risks of hemorrhoidectomy?
While hemorrhoidectomy is generally safe and effective, as with any surgery, there are potential risks and complications. Including:
Pain: This is the most common complication of a hemorrhoidectomy. The area around the anus is rich in nerve endings, so this procedure can be quite painful. Pain management is a crucial part of post-operative care.
Bleeding: While some bleeding is normal after the procedure, excessive bleeding can lead to anemia and require further treatment.
Infection: Antibiotics may be prescribed to prevent this, but it’s important to watch for signs of infection such as fever, increased pain, swelling, and discharge from the surgical site.
Urinary retention: The inability to urinate, can occur due to the close proximity of the rectum to the urinary tract and the effects of anesthesia. This usually resolves on its own, but in some cases, a catheter may be needed temporarily.
Anal stenosis: A narrowing of the anus, can occur if too much tissue is removed. This can make bowel movements difficult and require further treatment.
Fecal incontinence: The inability to control bowel movements, is a rare but serious complication. This can occur if the anal sphincter is damaged during surgery.
Recurrence of hemorrhoids: To reduce this risk, it’s important to avoid constipation and straining during bowel movements, which can put pressure on the rectal veins.
Reaction to anesthesia: This can range from minor reactions like nausea to serious issues like allergic reactions or breathing problems.
Risk of complications: For example, people with heart or lung disease may have an increased risk of complications from surgery.
It’s important to discuss these risks with your doctor before deciding on a hemorrhoidectomy. They can help you weigh the potential benefits of the procedure against the possible risks based on your specific situation.
Conclusion
In conclusion, a hemorrhoidectomy is a surgical procedure that, while generally safe and effective, carries potential risks and complications. These include pain, bleeding, infection, urinary retention, anal stenosis, fecal incontinence, recurrence of hemorrhoids, reaction to anesthesia, and complications related to underlying conditions. It’s crucial to have a comprehensive discussion with your healthcare provider about these risks before deciding on a hemorrhoidectomy. Each individual’s health situation is unique, and the decision should be made after considering the potential benefits and risks. Ultimately, the goal is to choose the treatment option that best suits the individual’s needs and contributes to their overall health and well-being.
Read more: