Hemorrhoidectomy

What is a hemorrhoidectomy?

A hemorrhoidectomy is surgery to remove hemorrhoids. Hemorrhoids are swollen veins in the lower rectum and anus. They can cause pain, bleeding, and itching.

When is it used?

Hemorrhoidectomy is one method of treating hemorrhoids. It is usually used only for severe hemorrhoids or when other treatments do not help. Examples of other treatments are:

• to try to prevent constipation by increasing the fiber in your diet, drinking more water, and getting regular exercise
• to try anesthetic ointments or sitz baths
• to have tight bands placed around the hemorrhoids to cut off their blood supply
• to destroy the hemorrhoids with freezing, electrical or laser heat, or infrared light
• to inject a chemical solution to shrink the hemorrhoid.

You should ask your healthcare provider about these choices.

How do I prepare for this procedure?

Plan for your care and recovery after the procedure. Ask someone to drive you home after the surgery. Allow for time to rest for a few days and arrange for friends or family to help you with your day-to-day needs.

Follow your healthcare provider's instructions about not smoking before and after the procedure. Smokers heal more slowly after surgery. They are also more likely to have breathing problems during surgery. For this reason, if you are a smoker, you should quit at least 2 weeks before the procedure. It is best to quit 6 to 8 weeks before surgery.

Follow any other instructions your provider gives you. Eat a light meal, such as soup or salad, the night before the procedure. Do not eat or drink anything after midnight and the morning before the procedure. Do not even drink coffee, tea, or water.

What happens during the procedure?

You are given regional or general anesthesia. The regional anesthetic will make you feel temporarily numb from the chest down so that you have no pain during the procedure. The general anesthetic will relax your muscles, put you to sleep, and prevent you from feeling pain.

The healthcare provider will put an anoscope (a tubelike instrument for examining the lower rectum and anal canal) into your anus. Your provider will remove the swollen veins.

Depending on the size and location of the removed hemorrhoids, your healthcare provider may sew the wounds closed or leave them open to heal.

What happens after the procedure?

In most cases you will go home that day. In some cases you may stay in the hospital 1 to 2 days, depending on your age, health, and other circumstances.

Follow your healthcare provider's instructions for caring for yourself as you recover. Most likely, you will need to take sitz baths and put ointments on the anal area. A "donut" pillow may help you sit more comfortably for the first few days after surgery. Ask your provider what medicine you can take for pain after the procedure.

You may have trouble passing urine and controlling gas and bowel movements for a few days after this operation.

Avoid all heavy lifting for 2 to 3 weeks. You may return to work in a few days or weeks, depending on the type of work.

You will need to avoid getting constipated. Your provider will probably recommend taking a stool softener and laxative. Ask your provider what foods you should eat and which foods you should avoid while you recover. It's important to eat a healthy diet, but you need to try to avoid constipation and diarrhea while you are healing.

What are the benefits of this procedure?

You will be relieved of the itching, painful, and bleeding hemorrhoids.

What are the risks associated with this procedure?

• There are some risks when you have general anesthesia. Discuss these risks with your healthcare provider.
• Regional anesthesia may not numb the area quite enough, and you may feel some minor discomfort. Also, in rare cases, you may have an allergic reaction to the drug used in this type of anesthesia. Regional anesthesia is considered safer than general anesthesia.
• You may have trouble urinating.
• The wound may scar and leave a smaller opening in the anus, making it harder to pass bowel movements.
• Any hemorrhoids that were not removed may become inflamed.
• The hemorrhoids could come back.
• You may have infection or bleeding.

You should ask your healthcare provider how these risks apply to you.

When should I call my healthcare provider?

Call your provider right away if:

• You have more bleeding after surgery than your provider says to expect.
• You cannot urinate.
• You develop a fever.
• You have pain that is not relieved by your pain medicine.
• You cannot pass bowel movements.

Call during office hours if:

• You have questions about the procedure or its results.
• You want to make an appointment for a follow-up office visit.

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