The surgical removal of tissue associated with symptomatic hemorrhoids is only necessary about 10% of the time. That is good news for most people with hemorrhoids. That means there is a 90% chance that the problem can be resolved using a less invasive method.
Usually when surgery is required it is because there is a large mass of tissue that has not responded to other treatments. Some of the situations which might require surgical elimination of tissue are as follows:
>Internal Hemorrhoids that are grade 4
(prolapsed and remain outside the rectum.)
>Early stages of external hemorrhoids requiring lifting of tissue and stapling excess tissue inside the rectum.
>Evidence of anemia resulting from excessive bleeding.
>Removal of external anal tags comprised of residual hemorrhoidal tissue that inhibits proper cleansing of the area.
>Necrotic or dead tissue resulting from thrombosed external hemorrhoids.
Hemorrhoidectomy may be done using a variety of different instruments and techniques to remove the hemorrhoid. The particular method used is usually based on the preference of the surgeon.
In simple terms, the excess hemorrhoidal tissue is surgically removed and the resulting wound may either be closed with sutures or left open to heal on its own.
Hemorrhoidectomy is performed in an operating room and may be done with the patient completely asleep with a general anesthetic, or under a spinal block (similar to an epidural injection used during childbirth), or with a combination of anesthesia injected locally and intravenous medications for relaxation.
A moderate amount of pain is to be expected following hemorrhoidectomy. To make that pain manageable is the goal in the short term during the healing process. It may be anywhere from two to four weeks before a normal level of activity is resumed. Pain medication will likely be given in a variety and combination chosen by your doctor to best work together to address the pain in different ways.
A sitz bath in warm water up to your abdomen 2-3 times a day for 10-15 minutes will provide some comfort.
Difficulty in urinating can be a problem after surgery of the anorectal region. It is critical that urination be accomplished because permanent damage to the bladder from over stretching can result from failure to void.
This may require a visit to an emergency room for catheterization of the bladder if urination cannot be accomplished normally.
Again the relaxation of a sitz bath may allow you to void while in the bath water.
Another concern for most patients following hemorrhoidectomy is the movement of the bowel. Most colon and rectal surgeons will want you to have a movement with the first 48 hours.
Some bleeding may occur during bowel movements for several weeks following the procedure, but it should cease after the movement.
A diet high in fiber with increased liquid intake should already be in place. A laxative may be prescribed by your doctor to help achieve a bowel movement along with other medications best suited to your circumstance.
Any prolonged bleeding is not normal and requires notification of your doctor.