Hemorrhoids, also known as piles, are swollen veins located around the anus or in the lower rectum. They can cause symptoms like itching, bleeding, and discomfort. In many cases, hemorrhoids can be treated with home remedies or minimally invasive procedures. But sometimes, hemorrhoids become so severe that removal becomes necessary.
When should hemorrhoid removal be considered?
Hemorrhoid removal, also known as hemorrhoidectomy, should be considered when:
- Hemorrhoids are large and very painful
- Prolapse occurs, which means hemorrhoids bulge out of the anus
- Thrombosis happens, which is when a hemorrhoid contains a blood clot
- Bleeding cannot be controlled
- Anemia occurs due to prolonged bleeding
- Significant disruption of daily activities and poor quality of life
- Other treatments have not helped
If hemorrhoids have not responded to other less invasive treatments like over-the-counter remedies, rubber band ligation, or sclerotherapy, then surgery may be warranted. Hemorrhoidectomy is typically reserved for grade 3 or 4 hemorrhoids, which are hemorrhoids that protrude and must be pushed back in, or that cannot be pushed back in.
What procedures are used to remove hemorrhoids?
There are several surgical options for hemorrhoid removal:
- Hemorrhoidectomy: This procedure removes the hemorrhoid and surrounding tissue. It is done under anesthesia and may involve a 1-3 day hospital stay.
- Hemorrhoidopexy: The hemorrhoid is lifted and stapled back into place. This treats prolapse.
- Hemorrhoidal artery ligation: Reduces hemorrhoids by cutting off the blood supply.
- Stapled hemorrhoidopexy: A stapling device pulls protruding tissue back into place and fixes it there.
- Laser, infrared, or bipolar coagulation: Burns away hemorrhoidal tissue.
The specific technique used depends on the severity of the hemorrhoids, the surgeon’s experience, and appropriate candidates based on each procedure. For example, stapling is only done for internal hemorrhoids but not external ones.
How is recovery after hemorrhoid removal surgery?
Recovery looks different depending on the specific procedure:
- Hemorrhoidectomy: This most invasive option has the longest recovery. There is typically bleeding for up to 2 weeks and bowel movements will be painful. Most people need 1-2 weeks off work. It may take 4-6 weeks for symptoms to resolve fully.
- Hemorrhoidopexy and stapled hemorrhoidopexy: These procedures involve less pain and faster recovery than hemorrhoidectomy. They involve less tissue removal. Bowel movements may be less painful and most people return to normal activities within 1 week.
- Non-excision techniques like ligation and coagulation: These treatments involve minimal pain, bleeding, and allow a return to most activities within 1-3 days.
To help manage recovery after hemorrhoid removal:
- Pain medicine and Sitz baths can provide relief
- Fiber supplements make bowel movements less painful
- Refraining from straining during bowel movements
- Staying hydrated and active helps prevent constipation
What are the risks and complications of hemorrhoid removal?
As with any procedure, there are some risks with hemorrhoid removal surgery. These include:
- Pain – This is to be expected after hemorrhoid surgery, but chronic pain can happen in some cases
- Bleeding – Typically lasts 1-2 weeks but very severe bleeding may require treatment
- Infection – Uncommon but may require antibiotics
- Anal stenosis – Scar tissue causes the anus to narrow and tighten
- Recurrence – Hemorrhoids can come back, requiring further treatment
- Leakage – Some patients have temporary difficulty controlling bowel movements
- Urinary retention – Difficulty urinating temporarily
Following your surgeon’s instructions can help reduce risks and prevent complications after hemorrhoid removal. Make sure to discuss any concerns thoroughly before choosing surgery.
When should I consider seeing a doctor?
You may need to see a doctor if:
- Hemorrhoid symptoms are persistent or severe
- Hemorrhoids frequently bleed
- Lumps around the anus are noticed
- Significant pain or swelling occurs
- Symptoms disrupt sleep or daily activities
- Symptoms last longer than 1-2 weeks despite home treatments
- You develop fever, chills, or rectal pain, which may indicate infection
A doctor can properly diagnose hemorrhoids using a physical exam, anoscopy to view the anal canal, or endoscopy for those inside the rectum. They may recommend treatment options like banding, sclerotherapy, infrared coagulation, or surgery if hemorrhoids are severe enough to warrant removal.
What questions should I ask my doctor about hemorrhoid removal?
Questions to ask your doctor about hemorrhoid removal surgery include:
- What procedure do you recommend for my hemorrhoids?
- How many hemorrhoid surgeries like this have you performed?
- What are the risks and complications I should be aware of?
- How long is the recovery time and what should I expect during it?
- What type of pain management will I have after surgery?
- How can I prevent hemorrhoids from returning after surgery?
- Will surgery correct any prolapse or leakage issues I’ve been having?
- Are there any lifestyle changes I’ll need to make after surgery?
- How much post-surgical follow up will I need and what will it involve?
Don’t hesitate to ask any other questions you may have about the procedure, required preparation, costs and insurance coverage, or recovery details.
What preparations should I make for hemorrhoid removal surgery?
To prepare for hemorrhoid removal surgery:
- Make transportation arrangements for getting home after surgery
- Stock up on soft, high fiber foods to eat after surgery
- Get any prescriptions like pain medicine or laxatives filled
- Plan for help around the house while recovering
- Purchase a donut pillow for comfort sitting after surgery
- Arrange time off work for recovery
- Set up a space at home for recovering and doing Sitz baths
- Stop taking blood thinning medications before surgery as recommended
- Follow any other directions from your surgeon for bowel preparation
Make sure you understand all of the pre-operative instructions so that you are fully prepared for hemorrhoid removal and the recovery period.
What are the costs of hemorrhoid removal surgery?
The costs for hemorrhoid removal surgery can include:
- Surgeon’s fees – From $2000-$5000 on average depending on the procedure
- Anesthesia fees – Around $1000-$1500 for an anesthesiologist
- Operating room costs – Average of $1500-$3000 per case
- Hospital stay – Around $1000/day for an inpatient stay
- Follow up visits – May involve additional costs
Total costs can range from around $3500 for simple procedures to over $10,000 for extensive hemorrhoidectomy. Location, complexity, insurance coverage, and length of hospital stay impact costs. Discuss costs with your provider and insurance company before scheduling hemorrhoid removal.
Conclusion
Hemorrhoid removal surgery is a last resort for severe cases of hemorrhoids that do not respond to other treatments. This invasive procedure requires anesthesia and involves risks, considerable recovery time, and high costs. It may be recommended if hemorrhoids are significantly impacting quality of life or other treatments have not helped. Have an open and thorough discussion with your doctor to decide if hemorrhoidectomy or other hemorrhoid procedures are right for your situation.