Hemorrhoid surgery

Hemorrhoid surgery is the removal of swollen veins around the anus (hemorrhoids). Hemorrhoids can be inside or outside of the skin around the rectum.

Hemorrhoids can be surgically removed using a special stapler or sutures (stiches). You may be sedated and pain-free (local or spinal anesthesia) or asleep and pain-free (general anesthesia). After the hemorrhoid is removed, you may have stitches that dissolve on their own and gauze packing to reduce bleeding.

Smaller hemorrhoids may not need surgery. These procedures are often done in an outpatient clinic or your doctor's office, with minimal or no anesthesia.

To treat your hemorrhoids, your doctor may:

• Give you a chemical shot to reduce swelling
• Place a rubber band around the hemorrhoid to cut off the blood supply to it
• Shrink the hemorrhoid with infrared light or a laser, or freeze it with liquid nitrogen

Hemorrhoid removal may be recommended when nonsurgical treatment (fiber-rich diet, laxatives, stool softener, suppositories, medications, warm baths) has not provided adequate relief from:

• Persistent itching
• Anal bleeding
• Pain
• Blood clots (thrombosis of the hemorrhoids)
• Infection

Risks for any surgery are:

• Bleeding
• Infection

Risks for any anesthesia are:

• Reactions to medications
• Breathing problems, pneumonia
• Heart problems

The outcome is usually very good in the majority of cases. Preventive measures such as adherence to a high fiber diet, and avoiding constipation must be taken to prevent recurrence.

The patient may experience considerable pain after surgery as the anus tightens and relaxes. Medications to relieve pain may be used. To avoid straining, stool softeners will be used. Avoid any straining during bowel movement or urination. Soaking in a warm bath can bring additional comfort. Expect complete recovery in about 2 weeks.

Nelson H, Cima RR. Anus. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 51.