Hemorrhoid surgery is a procedure to remove hemorrhoids, swollen veins located around the anus. There are several surgical options to treat hemorrhoids, and anesthesia is used for all hemorrhoid procedures to prevent pain during surgery.
Do they put you completely to sleep for hemorrhoid surgery?
Most hemorrhoid surgeries are performed under general anesthesia which puts you completely to sleep. This is done for several reasons:
- Allows the surgeon to fully relax the anal sphincter muscles for better access and visibility.
- Prevents any pain or discomfort during the procedure.
- Reduces motion that could interfere with precision during surgery.
- Provides amnesia so you don’t remember the procedure.
General anesthesia involves giving medications intravenously and/or breathing gases that make you fully unconscious and completely unable to feel pain. It is usually done by an anesthesiologist who monitors you throughout surgery and manages the medications to keep you safely asleep.
When would local anesthesia be used instead?
Less commonly, a hemorrhoid surgery may be done under local anesthesia which numbs the area but keeps you awake. Reasons local anesthesia may be used include:
- You cannot safely undergo general anesthesia due to health issues.
- The particular hemorrhoid surgery is very minor.
- Surgeon preference.
Local anesthesia involves injecting a numbing medication like lidocaine directly around the hemorrhoids and anal area. You are awake but should not feel any pain during the procedure. However, you may feel some pressure or tugging sensations.
What are the different types of hemorrhoid surgery?
There are various surgical procedures that can be used to treat hemorrhoids. The type of surgery depends on the severity of the hemorrhoids:
Hemorrhoidectomy
This surgery removes large, external hemorrhoids that are causing symptoms. It is done under general anesthesia in an operating room and is the most effective and complete surgery for severe hemorrhoids.
Hemorrhoidopexy
Hemorrhoidopexy does not remove the hemorrhoids but helps reposition and anchor hemorrhoid tissue back to its normal anatomical position. It causes less pain than a hemorrhoidectomy but may need to be repeated. It can be done with local or general anesthesia.
Hemorrhoidal artery ligation
This procedure locates and ties off the arteries that supply blood to the hemorrhoids, causing them to shrink. It is less invasive than a hemorrhoidectomy and is done with local anesthesia.
Sclerotherapy
A chemical solution is injected into the hemorrhoid tissue to scar and shrink the hemorrhoids. Only local anesthesia is required but the injections can be painful.
Preparing for hemorrhoid surgery
Proper preparation helps ensure hemorrhoid surgery goes smoothly:
- Your doctor will give you detailed instructions to follow in the days leading up to surgery.
- You will likely need to start a high fiber diet and take stool softeners to avoid constipation and straining after surgery.
- Follow instructions for fasting and stopping medications prior to surgery.
- Arrange for a ride home after surgery as you will be groggy from anesthesia.
- Plan for help around the house as sitting and activities may be limited during recovery.
What to expect during hemorrhoid surgery
Once in the operating room, the surgical team will:
- Give anesthesia medications to make you sleep.
- Position you on your side or abdomen.
- Monitor your vital signs.
- Thoroughly cleanse the anal area.
- Drape surgical area and insert an anal retractor to gain access.
- Perform the surgery with scalpels and other tools.
- Close any incisions with stitches.
- Bandage the area.
The surgery generally takes 30-60 minutes depending on complexity. You will remain asleep throughout.
Recovering after hemorrhoid surgery
Once surgery is complete, you will be moved to a recovery area while the anesthesia wears off. Typical aftercare includes:
- Monitor vital signs until stable.
- Pain management with medications.
- Ice packs applied to the anal area to reduce swelling.
- Laxatives and stool softeners to avoid straining with bowel movements.
- Follow-up appointment to check healing.
You can expect significant pain and discomfort for 1-2 weeks after surgery as the area heals. Sitting may be uncomfortable. Most people take 1-2 weeks off work. Full healing takes about 6-8 weeks.
Risks and complications
Hemorrhoid surgery is generally safe but does carry some risks including:
- Bleeding
- Infection
- Narrowing of the anal canal
- Leakage of stool or mucus
- Recurring hemorrhoids
- Damage to sphincter muscles
Choosing an experienced surgeon can help minimize these risks. Be sure to contact your doctor if you have any concerning symptoms after surgery.
When is hemorrhoid surgery necessary?
Hemorrhoid surgery is typically reserved for large, persistent, or bleeding hemorrhoids that do not improve with other treatments like over-the-counter remedies, lifestyle changes, rubber band ligation, or office procedures. Indications for surgery include:
- Hemorrhoids that cause persistent bleeding or anemia
- Extremely painful large external hemorrhoids
- Prolapsed internal hemorrhoids that bulge out
- Thrombosed external hemorrhoids with blood clots
- Hemorrhoids that recur after other treatments
Your doctor can help determine if hemorrhoid surgery is appropriate for your situation based on a physical exam and your symptoms.
Conclusion
Most hemorrhoid surgeries are performed under general anesthesia which puts you completely asleep and pain-free during the procedure. Although recovery can be painful, the surgery is very effective for severe hemorrhoids that do not respond to other treatments. Proper preparation and following post-op instructions can help speed healing after hemorrhoid surgery.