Sarah Lewis, PharmD
What is a hemorrhoidectomy?
A hemorrhoidectomy is the removal of hemorrhoidal tissue. Hemorrhoidal tissues contain blood vessels that act as cushions by swelling slightly to protect the anal canal during bowel movements.
Anal pressure can cause these tissues to stay swollen. Straining during bowel movements and pregnancy commonly cause too much pressure in the anal canal. Symptoms of hemorrhoids include rectal pain and bleeding.
Internal hemorrhoids occur inside the anal canal. External hemorrhoids occur around the anal opening. A hemorrhoidectomy treats large hemorrhoids that cause pain or bleeding.
A hemorrhoidectomy has risks and potential complications. You may have less invasive treatment options. Consider getting a second opinion about all your treatment choices before having a hemorrhoidectomy.
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Types of hemorrhoidectomy
The types of hemorrhoidectomy procedures include:
Excisional hemorrhoidectomy removes the hemorrhoidal tissue by cutting it. Your surgeon may choose to leave the tissue wound open (open excisional hemorrhoidectomy) or close it with stitches (closed excisional hemorrhoidectomy). Most surgeons prefer the closed technique.
Stapled hemorrhoidopexy removes only a portion of the hemorrhoidal tissues. The remaining hemorrhoidal tissues are lifted back up into the anal canal and stapled into place with a special stapling device. This procedure tends to cause less postoperative pain and has a shorter recovery period. It is not effective for large external hemorrhoids, and hemorrhoids tend to recur more often.
Other procedures that may be performed
Your doctor may perform other procedures in addition to a hemorrhoidectomy. This includes a lateral internal sphincterotomy to open or widen the internal sphincter muscle. It is not a common procedure.
Your doctor may perform this procedure if you have high resting internal sphincter pressure. This makes it difficult to push out stool. The goal of this procedure is to reduce pain after surgery during bowel movements.
Why is a hemorrhoidectomy performed?
Your doctor may recommend a hemorrhoidectomy to treat large hemorrhoids that cause symptoms, such as rectal pain and bleeding. Your doctor may only consider a hemorrhoidectomy for you if other treatment options with less risk of complications are ineffective. Ask your doctor about all of your treatment options and consider getting a second opinion before deciding on a hemorrhoidectomy.
Your doctor may recommend a hemorrhoidectomy under the following conditions:
You have additional anorectal conditions that require surgery.
You have combined internal and external hemorrhoids.
You have grade 3 or 4 prolapsed internal hemorrhoids. Prolapse means that the hemorrhoids are falling out of the anus. Grade 3 prolapse occurs with a bowel movement, but you can manually push the hemorrhoid back through your anus. A grade 4 prolapse cannot be put back.
You’ve had minimally invasive procedures or other treatments that have not corrected the problem.
You have significant amounts of bleeding from your hemorrhoids
You have a strangulated internal hemorrhoid. This occurs when the anal sphincter traps the hemorrhoid and cuts off blood supply to the tissue.
You have a hemorrhoid with blood clots (thrombosed external hemorrhoid) that recur after less invasive procedures.
Who performs a hemorrhoidectomy?
The following specialists can perform a hemorrhoidectomy:
General surgeons specialize in the surgical treatment of a variety of diseases, disorders and conditions.
Colon and rectal surgeons are general surgeons with extra training in the surgical treatment of intestinal and rectal conditions.
Proctologists specialize in diseases of the anus, rectum and colon using medical and surgical techniques.
How is a hemorrhoidectomy performed
Your hemorrhoidectomy will be performed in a hospital or outpatient surgery setting.
Your surgeon will insert a retractor into your anus after you have anesthesia. This allows your surgeon to see the hemorrhoids. The hemorrhoids are removed by cutting or stapling. Stitches are placed internally or externally. They are usually absorbable and do not need to be removed. Packing and dressings are then placed over the wounds.
Types of anesthesia that may be used
Your surgeon will perform a hemorrhoidectomy using general anesthesia or regional anesthesia, depending on the specific procedure.
General anesthesia is a combination of intravenous (IV) medications and gases that put you in a deep sleep. You are unaware of the procedure and will not feel any pain. You may also receive a peripheral nerve block infusion in addition to general anesthesia. A peripheral nerve block infusion is an injection or continuous drip of liquid anesthetic. The anesthetic flows through a tiny tube inserted near your surgical site to control pain during and after surgery.
Regional anesthesia is also known as a nerve block. It involves injecting an anesthetic around certain nerves to numb a large area of the body. You will likely have sedation with regional anesthesia to keep you relaxed and comfortable.
What to expect the day of your hemorrhoidectomy
The day of your surgery, you can generally expect to:
Talk with a preoperative nurse. The nurse will perform an exam and ensure that all needed tests are in order. The nurse can also answer questions and will make sure you understand and sign the surgical consent form.
Remove all clothing and jewelry and dress in a hospital gown. It is a good idea to leave all jewelry and valuables at home or with a family member. Your care team will give you blankets for modesty and warmth.
Talk with the anesthesiologist or nurse anesthetist about your medical history and the type of anesthesia you will have.
A surgical team member will start an IV.
The anesthesiologist or nurse anesthetist will start your anesthesia.
A tube will be placed in your windpipe to protect and control breathing during general anesthesia. You will not feel or remember this or the surgery as they happen.
The surgical team will monitor your vital signs and other critical body functions. This occurs throughout the procedure and your recovery until you are alert, breathing effectively, and your vital signs are stable.
What are the risks and potential complications of a hemorrhoidectomy?
As with all surgeries, a hemorrhoidectomy involves risks and possible complications. Complications may become serious and life threatening in some cases. Complications can develop during surgery or recovery.
General risks of surgery
The general risks of surgery include:
Anesthesia reaction, such as an allergic reaction and problems with breathing
Bleeding, which can lead to shock
Blood clot, in particular a deep vein thrombosis that develops in the leg or pelvis. A blood clot can travel to your lungs, heart or brain and cause a pulmonary embolism, heart attack, or stroke.
Infection and septicemia, which is the spread of a local infection to the blood
Potential complications of hemorrhoidectomy
Complications of hemorrhoidectomy include:
Anal stricture (narrowing of the anal canal)
Difficulty urinating or urinary retention
Fecal impaction (hard stool that is trapped in the anal canal)
Fecal incontinence (leaking a small amount of stool)
Pain with bowel movements
Recurrence of hemorrhoids
Reducing your risk of complications
You can reduce the risk of certain complications by following your treatment plan and:
Avoiding straining during bowel movements. This may require a stool softener, increasing the fiber in your diet, and drinking eight to 10 glasses of water a day.
Ensuring that all members of you care team are aware of any allergies
Following activity, dietary and lifestyle restrictions and recommendations. This includes avoiding heavy lifting and strenuous activity as recommended by your doctor.
Informing your doctor or radiologist if you are nursing or if there is any possibility of pregnancy
Notifying your doctor right away of any concerns, such as bleeding, fever, increase in pain, or wound redness, swelling or drainage
Taking your medications exactly as directed
Telling all members of your care team if you have any allergies
How do I prepare for a hemorrhoidectomy?
You are an important member of your own healthcare team. The steps you take before surgery can improve your comfort and outcome.
You can prepare for a hemorrhoidectomy by:
Answering all questions about your medical history and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.
Cleansing your intestines as directed by your doctor. This may include a combination of enemas, laxatives, and not eating solid foods or drinking on the day or night before the procedure.
Getting preoperative testing as directed. Testing varies depending on your age, health, and specific procedure. Preoperative testing may include a chest X-ray, EKG (electrocardiogram), blood tests, and other tests as needed.
Losing excess weight before the surgery through a healthy diet and exercise plan.
Not eating or drinking before surgery as directed. Your surgery may be cancelled if you eat or drink too close to the start of surgery because you can choke on stomach contents during anesthesia.
Stopping smoking as soon as possible. Even quitting for just a few days can be beneficial and help the healing process.
Taking or stopping medications exactly as directed. This may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners.
Questions to ask your doctor
Facing surgery can be stressful. It is common for patients to forget some of their questions during a doctor’s office visit. You may also think of other questions after your appointment. Contact your doctor with concerns and questions before a hemorrhoidectomy and between appointments.
It is also a good idea to bring a list of questions to your appointments. Questions can include:
Why do I need a hemorrhoidectomy? Are there any other options for treating my condition?
What type of hemorrhoidectomy procedure will I need?
How long will the surgery take? When can I go home?
What restrictions will I have after the surgery? When can I return to work and other activities?
What assistance will I need at home?
How should I take my medications?
How will you treat my pain?
When should I follow up with you?
How should I contact you? Ask for numbers to call during and after regular hours.
What can I expect after a hemorrhoidectomy?
Knowing what to expect can help make your road to recovery after a hemorrhoidectomy as smooth as possible.
How long will it take to recover?
You will stay in the recovery room after surgery until you are alert, breathing effectively, and your vital signs are stable. You may have a sore throat if a tube was placed in your windpipe during surgery. This is usually temporary, but tell your care team if you are uncomfortable.
You must be able to urinate before you can go home. Urinary retention is a common and potentially serious complication of a hemorrhoidectomy. Patients typically go home on the same day, but a hospital stay of one day may be needed.
Recovery after surgery is a gradual process. Recovery time varies depending on the procedure, type of anesthesia, your general health, age, and other factors. Full recovery takes two to four weeks.
Will I feel pain?
Pain control is important for healing and a smooth recovery. There will be discomfort after your surgery. Your doctor will treat your pain so you are comfortable and can get the rest you need. Your doctor will probably recommend that you use a sitz bath treatment several times a day. A sitz bath is a warm water bath that you sit in up to your hips. You use it for cleaning and healing sore tissue. The water may contain medication to relieve pain and itching.
Call your doctor if your pain gets worse or changes in any way because it may be a sign of a complication.
When should I call my doctor?
It is important to keep your follow-up appointments after a hemorrhoidectomy. Contact your doctor for questions and concerns between appointments. Call your doctor right away or seek immediate medical care if you have:
Bleeding after a bowel movement that will not stop or is heavier than expected
Breathing problems, such as shortness of breath, difficulty breathing, labored breathing, or wheezing
Change in alertness, such as passing out, dizziness, unresponsiveness, or confusion
Fever. A low-grade fever (lower than 101 degrees Fahrenheit) is common for a couple of days after surgery and not necessarily a sign of a surgical infection. However, you should follow your doctor's specific instructions about when to call for a fever.
Inability to urinate or have a bowel movement
Leg pain, redness or swelling, especially in the calf, which may indicate a blood clot
Pain that is not controlled by your pain medication
Unexpected drainage or pus coming out of your rectum
How might a hemorrhoidectomy affect my everyday life?
A hemorrhoidectomy may cure your hemorrhoids or reduce your symptoms. It will not prevent hemorrhoids from coming back. You can make changes in everyday life that may help prevent or delay recurrence of hemorrhoids including:
Drinking plenty of water
Eating a high-fiber diet
Getting regular exercise and physical activity
Maintaining a healthy weight
Going when you feel the urge to have a bowel movement
Taking a fiber supplement as directed by your healthcare provider
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- Hemorrhoidectomy and Related Procedures. UCSF. http://colorectal.surgery.ucsf.edu/conditions--procedures/hemorrhoidectomy.aspx.
- Hemorrhoids. BetterMedicine. http://www.bettermedicine.com/article/hemorrhoids-1.
- Hemorrhoids & Fissure-in-Ano. American Society of Colon & Rectal Surgeons. http://www.fascrs.org/physicians/education/core_subjects/2008/hemorrhoids_fissure_in_ano/.
- Hemorrhoids: Expanded Version. American Society of Colon & Rectal Surgeons. http://www.fascrs.org/patients/conditions/hemorrhoids/expanded_version/.
- Pile, JC. Evaluating postoperative fever: A focused approach. Cleveland Clinic Journal of Medicine. 2006;73 (Suppl 1):S62. http://ccjm.org/content/73/Suppl_1/S62.full.pdf.