What is hemorrhoidectomy?

Activity

• Rest when you feel tired.
• Be active. Walking is a good choice.
• Allow your body to heal. Don't move quickly or lift anything heavy until you are feeling better.
• You may take showers and baths as usual. Pat your anal area dry when you are done.
• You will probably need to take 1 to 2 weeks off work. It depends on the type of work you do and how you feel.

Diet

• Follow your doctor's instructions about eating after surgery.
• Start adding high-fiber foods to your diet 2 or 3 days after your surgery. This will make bowel movements easier. And it lowers the chance that you will get hemorrhoids again.
• If your bowel movements are not regular right after surgery, try to avoid constipation and straining. Drink plenty of water. Your doctor may suggest fiber, a stool softener, or a mild laxative.

Medications

• Your doctor will tell you if and when you can restart your medicines. He or she will also give you instructions about taking any new medicines.
• If you stopped taking aspirin or some other blood thinner, your doctor will tell you when to start taking it again.
• Be safe with medicines. Read and follow all instructions on the label.
  • If the doctor gave you a prescription medicine for pain, take it as prescribed.
  • If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine.
• If your doctor prescribed antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics.
• You may apply numbing medicines before and after bowel movements to relieve pain.

Other instructions

• Sit in a few inches of warm water (sitz bath) for 15 to 20 minutes 3 times a day and after bowel movements. Then pat the area dry. Do this as long as you have pain in your anal area.
• Avoid sitting on the toilet for long periods of time or straining during bowel movements.
• Keep your anal area clean.
• Support your feet with a small step stool when you sit on the toilet. This helps flex your hips and places your pelvis in a squatting position. This can make bowel movements easier after surgery.
• Use baby wipes or medicated pads, such as Tucks, instead of toilet paper after a bowel movement. These products do not irritate the anus.
• If your doctor recommends it, use an over-the-counter hydrocortisone cream on the skin in your anal area. This can reduce pain and itching after surgery.
• Apply ice several times a day for 10 minutes at a time.
• Try lying on your stomach with a pillow under your hips to decrease swelling.

Surgery usually cures a hemorrhoid. But the long-term success of hemorrhoid surgery depends a lot on how well you are able to change your daily bowel habits to avoid constipation and straining. About 5 out of 100 people have hemorrhoids that come back after surgery.

Surgery can be stressful. This information will help you understand what you can expect. And it will help you safely prepare for surgery.

Preparing for surgery

• You may need to empty your colon with an enema or laxative. Your doctor will tell you how to do this.
• Be sure you have someone to take you home. Anesthesia and pain medicine will make it unsafe for you to drive or get home on your own.
• Understand exactly what surgery is planned, along with the risks, benefits, and other options.
• If you take a medicine that prevents blood clots, your doctor may tell you to stop taking it before your surgery. Or your doctor may tell you to keep taking it. (These medicines include aspirin and other blood thinners.) Make sure that you understand exactly what your doctor wants you to do.
• Tell your doctor ALL the medicines, vitamins, supplements, and herbal remedies you take. Some may increase the risk of problems during your surgery. Your doctor will tell you if you should stop taking any of them before the surgery and how soon to do it.
• Make sure your doctor and the hospital have a copy of your advance directive. If you don’t have one, you may want to prepare one. It lets others know your health care wishes. It’s a good thing to have before any type of surgery or procedure.

Pain, bleeding, and not being able to urinate (urinary retention) are the most common side effects of hemorrhoidectomy.

Other relatively rare risks include the following problems.

Early problems

• Bleeding from the anal area
• Collection of blood in the surgical area (hematoma)
• Not being able to control the bowel or bladder (incontinence)
• Infection of the surgical area
• Stool trapped in the anal canal (fecal impaction)

Late problems

• Narrowing (stenosis) of the anal canal
• Return of hemorrhoids
• An abnormal passage (fistula) that forms between the anal or rectal canal and another area
• Rectal prolapse, which happens when the rectal lining slips out of the anal opening

Recovery takes about 2 to 3 weeks.

• You can expect some pain after surgery. If your doctor gave you a prescription medicine for pain, take it as prescribed. Ask your doctor what over-the-counter medicines are safe for you.
• Some bleeding is normal, especially with the first bowel movement after surgery.
• Some doctors may recommend that you take an antibiotic (such as metronidazole) after surgery to prevent infection and reduce pain.
• Follow-up exams with the surgeon usually are done 2 to 3 weeks after surgery to check for problems.

After you have hemorrhoids removed, you can expect to feel better each day. Your anal area will be painful or ache for 2 to 4 weeks. And you may need pain medicine. It is common to have some light bleeding and clear or yellow fluids from your anus. This is most likely when you have a bowel movement. These symptoms may last for 1 to 2 months after surgery.

After 1 to 2 weeks, you should be able to do most of your normal activities. But don't do things that require a lot of effort. It is important to avoid heavy lifting and straining with bowel movements while you recover.

Hemorrhoidectomy is surgery to remove hemorrhoids. You will be given general anesthesia or spinal anesthesia so that you will not feel pain.

Incisions are made in the tissue around the hemorrhoid. The swollen vein inside the hemorrhoid is tied off to prevent bleeding. Then the hemorrhoid is removed. The surgical area may be sewn closed or left open. Medicated gauze covers the wound.

Surgery can be done with a knife (scalpel). Or it may be done with a tool that uses electricity (cautery pencil) or with a laser.

You will most likely go home the same day (outpatient).

Doppler-guided hemorrhoidectomy is a procedure that uses a scope with a special probe. The scope locates the hemorrhoidal arteries so that less tissue is removed. Some studies show that it is less painful. But more long term studies are needed to compare it with other procedures.

After the surgery

Right after the surgery, when you are still under anesthesia, you will be given a long-acting local anesthetic. It should last 6 to 12 hours to provide pain relief after surgery. If you are not going to stay overnight in the hospital after surgery, you will leave only after the anesthesia wears off and you have urinated. Inability to urinate (urinary retention) sometimes occurs because of swelling (edema) in the tissues or a spasm of the pelvic muscles.

Homorrhoidopexy

There is a procedure that uses a circular stapling device to remove hemorrhoidal tissue and close the wound. No incision is made. In this procedure, the hemorrhoid is lifted and then "stapled" back into place in the anal canal. This surgery is called stapled hemorrhoidopexy. People who have stapled surgery may have less pain after surgery than people who have the traditional hemorrhoid surgery. But the stapled surgery costs more. And people who have stapled surgery are more likely to have hemorrhoids come back and need surgery again.

• Follow the instructions exactly about when to stop eating and drinking. If you don't, your surgery may be canceled. If your doctor told you to take your medicines on the day of surgery, take them with only a sip of water.
• Take a bath or shower before you come in for your surgery. Do not apply lotions, perfumes, deodorants, or nail polish.
• Do not shave the surgical site yourself.
• Take off all jewelry and piercings. And take out contact lenses, if you wear them.

At the hospital or surgery center

• Bring a picture ID.
• You will be kept comfortable and safe by your anesthesia provider. The anesthesia may make you sleep. Or it may just numb the area being worked on.
• The surgery will take 30 minutes to 1 hour.

Hemorrhoidectomy may be done when you have:

• Very large internal hemorrhoids.
• Internal hemorrhoids that still cause symptoms after nonsurgical treatment.
• Large external hemorrhoids that cause a lot of discomfort and make it hard to keep the anal area clean.
• Both internal and external hemorrhoids.
• Had other treatments for hemorrhoids (such as rubber band ligation) that have not helped.