Hemorrhoid surgery

Hemorrhoids also commonly known as piles are the swollen blood tissues at the anus/rectum that cause discomfort and pain. Hemorrhoids are caused by the excessive straining of the anal vessels during the bowel movement. Hemorrhoids generally dissolve by themselves in one to two weeks. Hemorrhoids can be controlled by the intake of high-fiber food and plenty of water.

There are different types of hemorrhoids as follows:

  • Internal hemorrhoids are the swollen veins found inside the anal track. This type of hemorrhoid is mostly painless and causes slight bleeding.
  • External hemorrhoids are the small swelling of the anal veins that occurs directly on the surface of the anus. They occur as hard lumps that cause pain when you strain your lower part of the body.
  • Prolapsed hemorrhoids are the same as internal hemorrhoids but differ in the fact that the enlarged anal vessels prolapse and stick out of the anus. Prolapsed hemorrhoids occur in 4 grades. This hemorrhoid also causes pain and discomfort during stool passing.
  • Thrombosed hemorrhoids are the blood clots that occur within the hemorrhoidal tissue. It causes intense pain and swelling. This type of hemorrhoid required immediate medical attention.

Medical experts treat hemorrhoids by incorporating lifestyle changes or by prescribing over-the-counter medications. In certain cases, hemorrhoid surgery becomes necessary to avoid life-threatening complications.

Types of hemorrhoid surgery

Hemorrhoid surgery is performed to shrink the size of hemorrhoid or to make it disappear. This can be done in two ways – reducing the blood flow to hemorrhoids or removing hemorrhoids. Hemorrhoid surgery can be categorized into two main types based on the use of anesthesia –anesthetic fewer surgeries and anesthetic surgeries.

Anesthetic fewer surgeries:

Certain surgeries to treat hemorrhoids are performed without the use of anesthesia. These are known as anesthetic fewer surgeries. Some of those are as follows:

Sclerotherapy:

Sclerotherapy is a procedure where the hemorrhoids are chemically treated by injecting a chemical into the hemorrhoid. The chemical causes the shrinkage of hemorrhoids and stops further bleeding. Patients undergoing Sclerotherapy experience little pain during the injection. This procedure is recommended for patients with small internal hemorrhoids who take blood thinners as their skin can’t be cut open.

Rubber band ligation:

The rubber band ligation also called the banding procedure is used to treat internal and prolapsed hemorrhoids. In this method, the doctor uses a band and tightens it around the hemorrhoid thus cutting off the blood supply to the hemorrhoid. This causes hemorrhoids to wear off in some days and subsequently fall off. Banding is performed in two or more procedures with a time gap of two months. This method is painless and the patient may feel only slight pressure at the anal opening. Patients who take blood thinners should avoid this procedure as it may lead to excessive bleeding.

Hemorrhoidal artery ligation & Recto Anal Repair (HAL – RAR):

This is a recent treatment procedure where the Doppler sensor is pushed into the anus to find and tie the arteries supplying blood to hemorrhoids. Hemorrhoid shrinks sooner and becomes non-noticeable after the surgery. This procedure is effective and nearly painless. This method is also known as the Transanal Hemorrhoidal Dearterialization (THD). This is a costly procedure.  HAL is recommended for patients for whom the first banding failed.

Coagulation therapy:

This therapy uses infrared light and is hence called infrared photocoagulation. In this method, infrared light, extreme cold, or heat is used to create scar tissue on hemorrhoids. This, in turn, restricts the blood supply to hemorrhoids causing them to fall off. This treatment is done using the anoscopy device at the doctor’s clinic to treat bleeding internal hemorrhoids that are not prolapsed.

Anesthetic surgeries:

Hemorrhoidectomy:

This surgical treatment is done after the administration of local/general/regional anesthesia depending on the doctor’s recommendation. In the case of regional/local anesthesia, a sedative is also used to relax the patient.

Hemorrhoidectomy or piles surgery is recommended when:

  • Internal hemorrhoids are strangulated
  • Other anorectal medical conditions that need immediate surgery
  • Severe thrombosed external hemorrhoids
  • The patient's body doesn’t tolerate or accept non-surgical treatments
  • Hemorrhoids of higher grade occur acutely or mixed hemorrhoids

The doctor cuts open the hemorrhoids and remove them using tools like surgical scissors or laser after the anesthesia starts to take effect. After the removal of hemorrhoid, the patient is kept under monitor for a brief period. This treatment causes pain and also infection in certain cases.

Hemorrhoidopexy:

Hemorrhoidopexy commonly known as hemorrhoidal stapling is used in treating large internal/prolapsed hemorrhoids. External hemorrhoids can’t be treated using this technique. The procedure starts with the administration of an anesthetic to the patient. Then the doctor will staple the hemorrhoidal tissue back to its original location in the anal tract using a special device. Stapling constricts the blood flow to the hemorrhoid tissue and causes the hemorrhoid to shrink. This treatment is painless and has a shorter recovery time compared to a hemorrhoidectomy. The only drawback is that the reoccurrence rate is high in this method.

Post-care recovery

The recovery time for various hemorrhoid treatments varies. Patients can resume all the routine work in 10- 14 days post-surgery. Anal pain after surgery exists for few days. Doctors prescribe medications to reduce the pain. Stool softeners are also prescribed to avoid straining during bowel movements. Patients are advised not to indulge in pulling or heavy lifting activities post-surgery. Sitz baths (Warm saltwater) also aid in temporary relief. Complications after surgery are rare. But, patients experiencing symptoms like – urinary retention, acute constipation, fever, and dizziness after the pile's surgery should seek medical help immediately.

Doctors recommend these follow-up steps to avoid the recurrence of hemorrhoid:

  • A healthy diet such as intake of high fiber food and drinking 7 to 8 glasses of water daily.
  • Following a regular exercise program to maintain the optimal body weight