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Hemorrhoidectomy

(Hemorrhoid Removal)

Pronounced: HEM-roy-DEK-tuh-mee
by Daus Mahnke, MD

Definition

A hemorrhoidectomy is an operation to remove hemorrhoids. Hemorrhoids are swollen (dilated) veins located in or around the anus and rectum. Hemorrhoids can cause discomfort, pain, or bleeding.

Hemorrhoid

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Reasons for Procedure

Hemorrhoidectomy is used to treat painful, swollen hemorrhoids. The procedure is most often done for the following reasons:

  • Hemorrhoid symptoms do not get better with other therapies
  • Severely bleeding hemorrhoids
  • Severely painful hemorrhoids
  • Hemorrhoid containing a blood clot (thrombosed hemorrhoid)
  • Hemorrhoids that protrude through the anus (prolapsed hemorrhoids)

Possible Complications    TOP

Complications are rare, but no procedure is completely free of risk. If you are planning to have a hemorrhoidectomy, your doctor will review a list of possible complications, which may include:

  • Infection
  • Bleeding
  • Constipation
  • Recurrence of hemorrhoids
  • Narrowing of the anal canal
  • Loss of bowel or bladder control
  • Adverse reaction to local anesthetic

Factors that may increase the risk of complications include:

  • Smoking
  • Bleeding disorder
  • Advanced age
  • Prior anal surgery

What to Expect    TOP

Prior to Procedure

Your doctor may do the following:

  • Physical exam
  • Rectal exam
  • Anoscopy—the visual examination of the inside of the anus using a short tube (anoscope) to help keep the sphincter open
  • Sigmoidoscopy —the use of a specialized endoscope (a tube attached to a viewing device) to examine the inside of the anus, rectum, and lower intestine

Leading up to the procedure:

  • Do not eat or drink anything after midnight.
  • Your doctor will order a laxative for you. It will cleanse your colon and rectum.
  • Arrange for someone to take you home after the surgery.
  • Talk to your doctor about your medicines, even non-prescription medicines. You may be asked to stop taking some medicines up to one week before the procedure, like:
    • Aspirin or other anti-inflammatory drugs
    • Blood thinners, like warfarin (Coumadin) or heparin
    • Clopidogrel (Plavix)

Anesthesia

Your surgery will be done using either:

Discuss these options with your doctor before the day of your surgery.

Description of the Procedure

An anoscope will be inserted into your anus. The doctor will be able to see the hemorrhoids through the scope.

An incision will be made around each hemorrhoid. The swollen vein inside the hemorrhoid will be tied off so that it does not bleed. The hemorrhoid will then be removed. The wounds will either be stitched closed or left open to heal.

There are other variations of this procedure. Ask your doctor to describe which procedure will be used.

Immediately After Procedure

You will be monitored in a recovery area for a few hours.

How Long Will It Take?

About 1-2 hours

How Much Will It Hurt?

You should not feel pain during the procedure. After the procedure, you might have pain in the area. Your doctor will give you pain medicine if you need it.

Post-procedure Care

Ask your doctor about when it is safe to shower, bathe, or soak in water. Be sure to follow your doctor's instructions, which may include:

  • If your doctor says it is okay, take sitz baths as recommended. Sitz baths will help relieve discomfort and clean the area. For a sitz bath, sit in warm water for 10-15 minutes. Pat the area dry. Do not wipe or rub vigorously. You may be advised to take a sitz bath every four hours and after every bowel movement. Devices are available to place on top of the toilet to make this process easier.
  • Move your bowels as soon as you feel the urge.
  • Do not strain, bear down, or hold your breath during a bowel movement.
  • Do not sit on the toilet for long periods of time.
  • To prevent constipation and straining during bowel movements, use a stool softener, exercise, drink plenty of fluids, and eat plenty of high-fiber foods ( fruits, vegetables, beans, and whole grain).
  • Apply creams or ointments as directed by your doctor.
  • Avoid heavy lifting for two or three weeks.
  • Use stool softeners.
  • Take pain medicine as needed.

Complete recovery will take 2-3 weeks. If your hemorrhoids come back, let your doctor know.

Call Your Doctor    TOP

After arriving home, contact your doctor if any of the following occurs:

  • Passing large amounts of blood
  • Signs of infection, including fever and chills
  • Pain that you cannot control with the medicines you have been given
  • Constipation or trouble urinating
  • An aching feeling develops in the area between the rectum and the genitals

In case of an emergency, call for medical help right away.

RESOURCES:

American Gastroenterological Association
http://www.gastro.org/
American Society of Colon and Rectal Surgeons (ASCRS)
http://www.fascrs.org/

CANADIAN RESOURCES:

The Canadian Association of Gastroenterology
http://www.cag-acg.org/
The College of Family Physicians of Canada
http://www.cfpc.ca/english/cfpc/home/default.asp?s=1

References:

Khatri VP, Asensio JA. Operative Surgery Manual. Philadelphia, PA: WB Saunders; 2003.
Townsend CM. Sabiston Textbook of Surgery. 17th ed. St. Louis, MO: WB Saunders; 2004.
Yamada T. Textbook of Gastroenterology. 4th ed. Philadelphia, PA: Lippincott, Williams, and Wilkins; 2003.
6/2/2011 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/ : Mills E, Eyawo O, Lockhart I, Kelly S, Wu P, Ebbert JO. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144-154.e8.
Last reviewed November 2012 by Marcin Chwistek, MD
Last Updated: 11/26/2012