In majority of the patients hemorrhoids can be managed through minor dietary and lifestyle changes or by using non surgical procedures without performing a surgery. But, severe hemorrhoids (stage III and IV) need hemorrhoids surgery to obtain permanent relief from hemorrhoid symptoms.
Removal of inflamed veins surrounding the anus is termed as hemorrhoidectomy or hemorrhoids surgery. The surgery is performed generally on an outpatient basis. Either general anesthesia or local anesthesia may be given depending on the requirement.
Different types of surgical procedures used to treat hemorrhoids
Dilation: This method is based on the assumption that increased pressure exerted by the anal sphincter is responsible for development of hemorrhoids. So, to relieve this pressure anal sphincter is forcefully dilated by stretching the anal canal. But, this procedure damages the sphincter making it hard for the patient to control the stool. Hence, this surgical procedure is rarely used.
Doppler ligation: This procedure is an advanced technique similar to rubber band ligation. In this method a single artery supplying blood to the hemorrhoid tissue is ligated. The artery is identified using an illuminated anoscope and Doppler probe that measures blood flow. Ligation of the artery ceases blood supply to the hemorrhoid tissue causing it to shrink. This is highly expensive compared to rubber band ligation.
Sphincterotomy: In this procedure only a part of anal sphincter is removed to reduce pressure exerted by sphincter in the anal canal. Like dilation technique this procedure also increases the risk for incontinence of stool. Hence, this technique is also rarely used.
Atomizing Hemorrhoids: This is the most latest technique to remove hemorrhoids. In this procedure hemorrhoid tissue is reduced in to small particles using a special tool called Atomizer Wand. After breaking the tissue the wand vacuums the particles immediately. This technique results in very less bleeding and faster recovery compared to other surgical techniques. The risk of formation of anal tags is also less. But, Atomizer Wand is yet to receive patents.
Hemorrhoidectomy: Patients with third degree or fourth degree hemorrhoids are often treated by cutting the hemorrhoids surgically (Hemorrhoidectomy). In this surgical procedure, hemorrhoid tissue and the surrounding prolapsed anal canal lining is removed. Normally the surgery is performed using conventional surgical tools.
Stapled hemorrhoidectomy or procedure for prolapsed and hemorrhoids (PPH): This is the most commonly used surgical method to treat third and fourth degree hemorrhoids. In this method the sloppy expanded tissue supporting the hemorrhoids is removed so as to correct the prolapsed hemorrhoids. This method corrects even the external hemorrhoids along with internal hemorrhoids. In few cases along with stapling of the sagged tissue external hemorrhoids are also removed. Stapling cuts blood supply to the inflamed tissue and reduces its size. Once the tissue heals completely, sutures fall off and get eliminated through stools. Stapled hemorrhoidectomy can be done in about 30 minutes and is less painful than conventional hemorrhoidectomy. But, this procedure is associated with increased rate of prolapse and recurrence of hemorrhoids compared to traditional hemorrhoidectomy.
Conventional hemorrhoidectomy is used to remove very large external and internal hemorrhoids. In few cases a combination of conventional hemorrhoidectomy and stapled hemorrhoidectomy are used. External hemorrhoids are excised by surgical hemorrhoidectomy and internal hemorrhoids are treated with stapled hemorrhoidectomy.
Issues with hemorrhoids surgery
Hemorrhoids surgery treats hemorrhoids efficiently. But, it is associated with certain post operative issues.
- Post operative pain: Severe pain persists for about a week after surgery. Powerful pain medications such as narcotics and non-steroidal anti-inflammatory drugs are used to reduce the pain and inflammation after surgery. Patient cannot attend work for about two to four weeks after surgery.
- Pain while urinating. The problem of urinary retention is observed in about 5% of patients. If urine retention is severe a catheter is used to empty the bladder.
- Reactions due to anesthesia.
- Incontinence of stool in cases of removal or damage to anal sphincter. Patient passes stool or gas involuntarily.
- Damage to rectal wall if too much of tissue is drawn while stapling.
- Infection at the site of surgery.
- Swelling of skin bridges.
- Hemorrhage: In few patients bleeding is observed about 7 to 14 days after surgery. Very less percent (1-2%) of patients experience this problem.
- Formation of blood clots in external hemorrhoids that were not removed during surgery.
- Narrowing of the anus due to scarring during surgery.
- 1% patients may also develop anal fissures.
- Minor incontinence of stools.
- Recurrence of hemorrhoids.
- Risk of pelvic sepsis.
Hemorrhoids surgery : Precautions
Measures to be taken before hemorrhoids surgery:
- Inform the doctor if you are using medicines to treat other medical conditions.
- If you are pregnant.
- Stop using medicines containing aspirin, ibuprofen, warfarin and any other drugs that could interfere with clotting of blood.
- Do not drink or eat anything the night before the surgery.
Precautions to be taken after hemorrhoids surgery
- Taking pain medications and other drugs as prescribed by the physician to relieve pain and promote faster healing.
- Avoid activities that could exert pressure on the anal nerve until you recover completely. This includes avoiding standing or sitting for long hours and straining to pass the stools.
- Taking fiber rich diet to increase the bulk of stools and also ease the bowel movements.
- Drinking plenty of water at least eight to ten glasses a day.