Hemorrhoids are very common and can cause pain, bleeding and difficulty with hygiene. When non-operative measures fail to control symptoms, surgery may be offered to control your symptoms.
Hemorrhoids, also known as piles, are swollen blood vessels in the lower part of the anus and rectum. Irritation begins after the walls of these vessels stretch and can cause bleeding, protruding tissue or prolapse.
External hemorrhoids are located below to the dentate line
Internal hemorrhoids are located above to the dentate line
Mixed hemorrhoids are located both above and below the dentate line
Nearly three out of four adults will have hemorrhoids from time to time.
- Hemorrhoids are associated with conditions that increase pressure in the hemorrhoidal venous plexus, such as straining during bowel movements secondary to constipation. Other associations include obesity, pregnancy, chronic diarrhea, anal intercourse, cirrhosis with ascites, pelvic floor dysfunction, and a low-fiber diet
- Fortunately, effective options are available to treat hemorrhoids. Many people get relief with home treatments and lifestyle changes.
- Types of hemorrhoids – these are classified based on location in relation to the dentate line (your surgeon can see this on exam)
- External hemorrhoids – Located under your skin near the opening of your anus that cause pain and itching
- Internal hemorrhoids – Located on the inside of your anal canal and usually don’t cause pain, but can cause bleeding, itching, pressure and leaking mucus
- Grade I-IV based on if the internal hemorrhoids protrude “out”, and how often.
- Mixed hemorrhoids – both above and below the dentate line
Signs and symptoms of hemorrhoids usually depend on the type of hemorrhoid.
Hemorrhoidal bleeding is almost always painless and is usually associated with a bowel movement. The blood is typically bright red and coats the stool at the end of defecation or may drip into the toilet.
Patients may complain of mild fecal incontinence, mucus discharge, wetness, or a sensation of fullness in the perianal area due to a prolapsed internal hemorrhoid.
Irritation or itching of perianal skin is a common symptom
Sudden onset of pain and a palpable “lump” from thrombosis of a hemorrhoid.
- Digital examination. Your doctor inserts a gloved, lubricated finger into your rectum. He or she feels for anything unusual, such as growths
- Visual inspection. Because internal hemorrhoids are often too soft to be felt during a rectal exam, your doctor might examine the lower portion of your colon and rectum with an anoscope
- Your doctor might want to examine your entire colon using colonoscopy if:
- Your signs and symptoms suggest you might have another digestive system disease
- You have risk factors for colorectal cancer
- You are middle-aged and haven’t had a recent colonoscopy
- First-line conservative treatment of hemorrhoids consists of a high-fiber diet (25 to 35 g per day – see fiber info), fiber supplementation, increased water intake, warm water (sitz) baths, and stool softeners
- Over-the-counter hemorrhoid preparations may be used during acute flares
- Soak regularly in a warm bath or sitz bath. Soak your anal area in plain warm water for 10 to 15 minutes two to three times a day. A sitz bath fits over the toilet. This is especially helpful for pain/swelling during acute flares
- With these treatments, hemorrhoid symptoms often go away within a week.
- Toileting habits
- refrain from straining or lingering (eg, reading) on the toilet.
- have regular physical exercise.
- Avoid medications that can cause constipation or diarrhea
- limit their intake of fatty foods and alcohol, which can exacerbate constipation
- Only a small percentage of people with hemorrhoids require surgery, If more conservative treatment of your hemorrhoids does not provide relief, you may require surgical treatment
Hemorrhoid Banding (AKA Rubber band ligation)
- This procedure is commonly performed in office and you are able to go home the same day.
- This is only able to be done for internal hemorrhoids • Specialized equipment will allow the surgeon to wrap the affected tissue in a rubber band, restricting blood flow to the affected area.
- After about 5-7days, the hemorrhoids dry up and fall off
- The procedure has minimal discomfort and is done in the office
- Complications include, multiple treatments, bleeding, infection, urinary retention, thrombosis of external hemorrhoids
Hemorrhoid removal (Excisional hemorrhoidectomy)
- Your surgeon removes your hemorrhoids surgically
- This is done under general anesthesia in the operating room
- Hemorrhoidectomy is the most effective and complete way to treat severe or recurring hemorrhoids.
- Complications can include temporary difficulty emptying your bladder, urinary tract infections, bleeding, infection, stenosis (scarring of the anus) and incontinence.
- Most people have pain after the procedure for a few weeks which medications, Sitz baths, and stool softeners can help control.
- Hemorrhoid banding is 80-90% successful at controlling symptoms of internal hemorrhoids
- Excisional hemorrhoidectomy is 95% successful at controlling symptoms
What to expect
Preparing for your surgery
- Nothing to eat or drink after midnight the night before your surgery
- You may take am meds (you will be told which ones to take/hold) with a sip of water in the am
- If you smoke; quitting smoking before surgery can decrease your risk of respiratory complications and infections after surgery.
Day of Surgery
- You will receive general anesthesia. The anesthesia provider will meet with you the morning of surgery
- Most people go home within a few hours after surgery
- You will need someone to drive you home and be close for the first night following your surgery
- Norco (the narcotic most commonly prescribed) has Tylenol in it. Either take norco OR Tylenol in addition to the ibuprofen.
- Take stool softeners and/or laxatives as needed (docusate, miralax) to help your bowels stay regular following surgery. Anesthesia and pain medications can contribute to constipation postoperatively.
- Walk around as able. Take deep breaths to fully expand your lungs. This can help prevent pneumonia and blood clots
- Slowly increase your activity. You are typically ready for normal activity by 1-3 weeks after your surgery.
- Most people will be able to return to work or school about 5-7 days after surgery.
- Wound care
- It is normal to have blood with bowel movements. This will slow and eventually resolve
- Wear pad/dressings as needed
When to Call
- Severe or worsening uncontrolled pain
- A fever >101.3
- Continuous vomiting
- Foul smelling drainage, redness or continued bleeding from an incision sites
- Chest pain or trouble breathing (call 911 or go to the ER)
- Any questions or concerns
Patient Information & Documents