Hemorrhoid Surgery Guide 101 - Top Info and Tips for Hemorrhoid Surgery
Posted on 17 January 2018 by Maryanne Johnson
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Hemorrhoids are a common problem that many people face at one point during their lifetime. The swollen veins lead to bothersome symptoms in the anus, such as pain, itching, burning, and bleeding.
While many hemorrhoids resolve on their own, and some require at-home treatment, there are a few different types of surgical treatments that help resolve serious hemorrhoid cases (1).
Here’s a closer look at hemorrhoid surgery.
What Types of Hemorrhoid Surgery Are Most Popular?
There are several different types of hemorrhoid surgery. Some hemorrhoid surgeries can be done in a hemorrhoid doctor’s office. They are performed without anesthetic. These include:
- Banding - This office procedure is the most common type of hemorrhoid surgery. It is often used to treat internal hemorrhoids. Also know as rubber band ligation, banding is performed in a doctor’s office. A tight band is placed around the base of the hemorrhoid. The purpose of the band is to cut off the blood supply to the hemorrhoid, causing it to die. Most instances of banding require two or more procedures. Patients return to the office after two months for a second, and sometimes third, procedure. Banding is an effective surgery for hemorrhoids and carries very little side effects (2).
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- Sclerotherapy - While not as popular as banding, sclerotherapy is also a common procedure. It involves injecting a chemical into the hemorrhoid. The chemical stops any bleeding a patient may experience from their hemorrhoid. The chemical’s purpose is to shrink the hemorrhoid. There are little risks involved with Sclerotherapy, and the procedure involves little to no pain. This procedure is most common in treating small, internal hemorrhoids (3).
- Coagulation therapy- This surgery is also called infrared photocoagulation. The treatment uses infrared light, heat, or cold to shrink the hemorrhoid by causing it to retract. The procedure causes only mild discomfort (4).
- Hemorrhoidal Artery Ligation - This procedure, also known as HAL, locates the blood vessels that cause the hemorrhoid. Using ultrasound, the procedure identifies these vessels and closes them off (5).
For hemorrhoids that are not resolved through procedures available in a doctor’s office, other types of surgery are available in a hospital. These are performed under anesthesia. These include:
- Hemorrhoidectomy - This is the most common invasive surgery used to treat hemorrhoids. A hemorrhoidectomy treats large external hemorrhoids or internal hemorrhoids that have prolapsed. The surgery takes place in a hospital and is done under anesthesia. Based on the doctor’s preference, it can be done under general anesthesia, regional anesthesia, or local anesthesia. During the surgery, a doctor will cut out the large hemorrhoids. The surgery can be quite painful and carries a risk of infection (6).
- Hemorrhoidopexy - This procedure is also known as stapling. It is a same day surgery performed in the hospital under anesthesia. Stapling is most effective in prolapsed hemorrhoids. The surgeon staples the prolapsed hemorrhoid back in place and cuts off the blood supply. This allows the tissue to shrink and be reabsorbed (7).
How Much Is Hemorrhoid Surgery? What Does it Typically Cost?
The cost of hemorrhoid surgery varies based on the type of surgery performed. Infrared coagulation generally ranges from $400-$500, but it generally requires four treatments. This brings the entire cost of treatment to $1,600 to $2,000.
Hemorrhoidectomy surgery ranges from $2,900 to $4,900. Most insurance policies do cover the cost of hemorrhoid surgery.
Common Causes of Hemorrhoid Surgery
- Chronic cases of hemorrhoids
- Hemorrhoids that burst and bleed
- Hemorrhoid infections
- Large prolapsed hemorrhoids
- Large thrombosed hemorrhoids
- A hemorrhoid that won't go away
External Hemorrhoid Surgery
The most common surgery for external hemorrhoids is a hemorrhoidectomy. External hemorrhoids are a result of distended vascular tissue. Thrombosed external hemorrhoids can result in a hemorrhoidectomy because it can be a quick solution to the problem (8).
There are many ways to treat an external hemorrhoid before surgery is necessary. Lifestyle changes include diet, exercise, and your everyday routines.
For example, if you stand or sit for an extended period, you may want to change your daily habits to reduce the risk of hemorrhoids.
Avoiding constipation is a behavioral modification you can make to reduce your risk of hemorrhoids (9).
In addition to lifestyle changes, there are many at-home treatments available for external hemorrhoids. Hemorrhoid creams, suppositories, and wipes are available to help reduce the swelling associated with hemorrhoids and eliminate the side effects.
Sitz baths and ice packs are options that have been proven to be very effective, according to University of California, Berkeley (10).
When these efforts do not work, non-surgical treatments are available. Rubber band ligation and sclerotherapy are two popular options. In some cases, however, surgical treatment may be necessary.
Hemorrhoidectomy is the most common surgical treatment for external hemorrhoids, especially large external hemorrhoids. Through a hemorrhoidectomy, patients treat hemorrhoids permanently through the “cutting out” of the hemorrhoid.
Hemorrhoidectomy for external hemorrhoids involves a surgical procedure that places an incision in the hemorrhoid. This allows the hemorrhoid to drain or cuts the entire vein causing the hemorrhoid.
While a hemorrhoidectomy is a surgical procedure, its long-term effects far outweigh the down time associated with the surgery.
Internal Hemorrhoid Surgery
Internal hemorrhoids do not often come with side effects. Because they are located in an area that is void of pain-sensing nerves, internal hemorrhoids often go unrecognized until they present with symptoms of hemorrhoid bleeding (11).
In some cases, however, internal hemorrhoids become prolapsed. This means that they push past the opening of the anus, and are unable to be pushed back in. When an internal hemorrhoid becomes prolapsed, Hemorrhoidopexy, or stapling, is the best surgical option for treatment.
A hemorrhoidopexy is performed under the observation of a surgeon and anesthesia (12).
With prolapsed internal hemorrhoids, the prolapsed hemorrhoid is stapled back in place. This often cuts off the blood supply. The hemorrhoid tissue then shrinks and is reabsorbed to eliminate the internal hemorrhoid.
Thrombosed Hemorrhoid Surgery
External hemorrhoids are common amongst patients. The swelling of an external hemorrhoid often results in discomfort, itching, burning, and bleeding. In some cases, an external hemorrhoid might become engorged and result in a thrombosed hemorrhoid.
A thrombosed hemorrhoid is a hemorrhoid that has formed a blood clot. Thrombosed hemorrhoids often present themselves as bluish-purplish discolored hemorrhoids accompanied by severe, and sometimes incapacitating hemorrhoid pain.
The most common treatment for thrombosed hemorrhoids is surgical excision, also known as a hemorrhoidectomy (13).
During a hemorrhoidectomy, your doctor will create a surgical incision in the vein causing the hemorrhoid. The thrombosed hemorrhoid will be removed, reducing symptoms and eliminating the likelihood of recurrence and complications.
Hemorrhoid Surgery Recovery Time
After hemorrhoid surgery, recovery time may vary. Each day, you should expect to feel better than the last. For two to four weeks following hemorrhoid surgery, you can expect your anus to ache.
Bleeding and clear or yellow fluids from the anus are a common side effect of hemorrhoid surgery. These symptoms may even last for one to two months after surgery.
One to two weeks following surgery, you should be able to resume normal activities (14).
You should, however, avoid any activities that require a lot of effort or carrying or lifting a large amount of weight.
Straining during bowel movements is another activity you will want to avoid post-hemorrhoidectomy. Follow-up care after hemorrhoidectomy is an important part of the treatment.
When you follow doctor’s orders, your recovery time will be on the shorter end of the spectrum.
There are many different causes of hemorrhoids. Make sure you discuss these with your doctor to ensure your hemorrhoids don't come back after surgery. Otherwise, you wasted a lot of time, money, and pain for nothing.
Hemorrhoid Surgery Recovery Overview
Hemorrhoid surgery recovery involves nursing your surgical injuries. After your hemorrhoid surgery, you should change your daily routines.
Rest is an important part of recovery (15).
You can use pain relievers and anti-inflammatory medication to resume normal activity. You should follow directions from your doctor regarding medications and post-op treatment.
Hemorrhoid surgery recovery depends on your particular case and how well you follow the after-care instructions your doctor provides.
What to Expect After Hemorrhoid Surgery
After hemorrhoid surgery, you can expect to go through a period of pain that becomes better and better each day. For two to four weeks, you may experience pain in the anal area.
During the first week you may require prescription pain medication, followed by a period of over-the-counter medication.
After surgery you should rest when you feel tired. When advised, activity is good. Walking is a great way to get the blood flowing and get yourself moving after surgery.
Avoid heavy lifting at all costs. While you may take showers and baths as you normally do, try to pat your anal area dry to avoid irritation.
Post-surgery, you can expect to take one to two weeks off of work, to avoid hemorrhoid complications, especially if you are a candidate for bleeding (16).
After surgery, you should start adding high fiber foods to your diet. You should also plan to increase your hydration. High fiber diets will make bowel movements easier and lower your change of recurring hemorrhoids (17).
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Talk to your doctor for other ideas of how to handle post-operative routines after hemorrhoid surgery.
Is Hemorrhoid Surgery Okay When Pregnant?
Because of the risks and complications of surgery, most professionals do not recommend hemorrhoid surgery when pregnant.
Experiencing hemorrhoids when pregnant is very common. Discuss the treatment options you have with your doctor.
You can use products like hemorrhoid wipes and creams to give temporary relief.
Is Hemorrhoid Surgery Painful?
In most cases, hemorrhoid surgery is very painful. You can expect to deal with a bit of pain after surgery, as well. Although the surgery is painful, it should eliminate hemorrhoid pain fairly quickly.
Surgery is a great option to reduce long-term pain associated with hemorrhoids. Post-hemorrhoidectomy, you can expect to deal with pain for one to two weeks. After this, you hemorrhoid will likely be healed.
There are many reports of hemorrhoids returning after surgery. Straining during bowel movements is a common cause of hemorrhoids coming back after you've gone under the knife (18).
That is why it is important to address what causes your hemorrhoids. If you address the causes and work on preventing them, you can get long term hemorrhoid relief.
Can Hemorrhoids be Removed?
Yes, there are numerous surgical options available that can remove hemorrhoids in their entirety.
A hemorrhoidectomy is a conventional surgery that eliminates hemorrhoid by cutting them away, and in a stapled hemorrhoidectomy, the inserted staples cut off the supply of blood, forcing the hemorrhoid to fall off.
Other in-office procedures have the same goal, like a rubber band ligation, where the banding around the hemorrhoidal column, strangling it.