Hemorrhoid Surgery (Hemorrhoidectomy)

What is a hemorrhoidectomy?

A hemorrhoidectomy is surgery to remove hemorrhoids by cutting them out.

When is it used?

Hemorrhoids are swollen veins in the lower rectum and anus. The anus is at the end of the rectum. It is the opening through which bowel movements pass from your body.

Hemorrhoids can cause pain, bleeding, and itching. Your healthcare provider may recommend surgery if your hemorrhoids are severe or if other treatments are not helping. Removing the hemorrhoids should relieve your symptoms.

Instead of this procedure, other treatments may include:

• trying to prevent constipation by increasing the fiber in your diet, drinking more water, and getting regular exercise
• relieving pain with anesthetic ointments, sitz baths, or cold packs
• destroying the hemorrhoids with freezing, electrical or laser heat, or infrared light
• shrinking the hemorrhoid by injecting a chemical around the swollen vein
• destroying hemorrhoids by having tight bands placed around them to cut off their blood supply

You may choose not to have treatment. Ask your healthcare provider about your choices for treatment and the risks

How do I prepare for this procedure?

• Make plans for your care and recovery after you have the procedure. Find someone to give you a ride home after the procedure. Allow for time to rest and try to find family or other people to help with your day-to-day tasks while you recover.
• Follow your provider's instructions about not smoking before and after the procedure. Smokers may have more breathing problems during the procedure and heal more slowly. It is best to quit 6 to 8 weeks before surgery.
• Some medicines (like aspirin) may increase your risk of bleeding during or after the procedure. Ask your healthcare provider if you need to avoid taking any medicine or supplements before the procedure.
• You may or may not need to take your regular medicines the day of the procedure, depending on what they are and when you need to take them. Tell your healthcare provider about all medicines and supplements that you take.
• Your provider will tell you when to stop eating and drinking before the procedure. This helps to keep you from vomiting during the procedure.
• Follow any instructions your healthcare provider gives you.
• Ask any questions you have before the procedure. You should understand what your healthcare provider is going to do and what you should expect during recovery.
• Your healthcare provider will ask you to sign a consent form for this procedure. The consent form will state the reason you are having the procedure; what happens during the procedure; and any possible benefits, risks, or alternatives.

What happens during the procedure?

The surgery may be done in an outpatient clinic or hospital.

You will be given regional or general anesthesia to keep you from feeling pain. Regional anesthesia numbs part of your body while you stay awake. General anesthesia relaxes your muscles and you will be asleep.

The healthcare provider will put a scope into your anus to look at the hemorrhoids. Your provider will make cuts in the tissue around the hemorrhoids and tie off the swollen veins inside the hemorrhoids. Then your provider will remove the hemorrhoids.

Depending on how big the hemorrhoids were and where they were, your provider may sew the cuts closed or leave them open to heal.

The procedure usually takes less than an hour.

What happens after the procedure?

After the surgery you may stay in a recovery area for at least a few hours to make sure that the anesthesia has worn off and that there is no bleeding problem. In most cases you will go home the same day. In some cases you may stay in the hospital 1 to 2 days, depending on your age, health, and other circumstances.

Ask a friend or family member to drive you home and be with you the first 1 to 2 days after surgery. They can help you get up and get to the bathroom, take your pain medicines, run the water for your sitz baths, and get food and water for you.

Ask your healthcare provider what medicine you can take for pain after the procedure. If you keep having pain after the procedure and the medicine you have doesn’t help, tell your provider. Your provider will try to find medicine that helps. This is also important because if you’re having severe pain, it may mean you are having a complication, such as infection, and need to be checked by your provider.

Swelling around the surgery site may cause trouble passing urine and controlling gas and bowel movements for a few days after this operation.

Your healthcare provider may recommend the following to care for yourself as you recover:

• Take sitz baths by sitting in a bathtub of warm water for 15 to 20 minutes. This helps keep the area clean and increases blood flow to the area to help healing. Ask your provider how often you should do this.
• Ask your provider about ointments to put on the anal area.
• Use a “donut” pillow to help you sit more comfortably for the first few days after surgery.

Ask your provider what foods you should eat and which foods you should avoid while you recover. It’s important to eat a healthy diet, but try to avoid foods that might cause constipation or diarrhea while you are healing. If diet and extra fluids are not enough to avoid constipation, your provider may recommend a stool softener or a laxative.

Ask your healthcare provider:

• how long it will take to recover
• what activities you should avoid, including lifting, and when you can return to your normal activities
• how to take care of yourself at home
• what symptoms or problems you should watch for and what to do if you have them

Make sure you know when you should come back for a checkup.

What are the risks of this procedure?

Your healthcare provider will explain the procedure and any risks. Some possible risks include:

• Anesthesia has some risks. Discuss these risks with your healthcare provider.
• You may have infection or bleeding.
• You may have trouble urinating.
• You may have scar tissue that makes the opening in the anus smaller. This can make it harder to pass bowel movements.
• Any hemorrhoids that were not removed may get irritated.
• The hemorrhoids may come back.

Every procedure or treatment has risks. Ask your healthcare provider how these risks apply to you. Be sure to discuss any other questions or concerns that you may have.