Surgery for hemorrhoids is reserved for those people who do not respond to more conservative therapies. The important factor to consider is how much trouble the hemorrhoids are causing.
Occassionally, hemorrhoids that become quite large, or bleed so much, will require surgery.
Some internal hemorrhoids protrude so far and become so large that they cannot be removed with either rubber band ligation or infrared coagulation. Also, if the internal hemorrhoids are causing a great deal of pain, discomfort, protrusion and/or bleeding, or if the person does not wish to wait several weeks for treatment to be completed, then surgery would be an option.
The advantage of surgery is that all of the hemorrhoids can be treated at one time. The disadvantage is that while some people have been able to return to work after one week, others will require two to three weeks of recuperation before they feel able to return to work.
Hemorrhoid surgery can be completed using local anesthesia, spinal block or general anesthesia. When local anesthesia is used, the anasthesiologist gives IV medications so that the patient sleeps through the procedure and does not feel or remember any of the procedure. This is a very safe type of anesthesia.
After the anesthesia or spinal block has been administered, the surgeon places a metal scope into the anal canal to see the internal hemorrhoids. He lifts up the excess hemorrhoidal mucosa and removes the bulging internal and external hemorrhoids with scissors or an ultrasonic device which cuts and seals at the same time. There is no difference in the amount of pain afterwards or the outcome of the surgery.
After removing the internal and/or external hemorrhoids, the resulting healing process will secure the tissue to the underlying sphincter muscle to minimize recurrence. If sutures (surgical thread) are used, they will dissolve and do not have to be removed later.
Hemorrhoid surgery is an outpatient procedure, allowing the patient to go home the same day.
After hemorrhoid surgery
After hemorrhoid surgery, it is important to stay well hydrated and to continue with a fiber supplement daily so the bowels move easily with less pain. Warm sitz baths also can help reduce pain following hemorrhoid surgery.
It is normal to have some bleeding after hemorrhoid surgery, but if significant or runs down the leg, the patient should call the surgeon.