Hemorrhoids are swollen veins located around the anus or in the lower rectum. They can cause symptoms like itching, bleeding, and pain. Many people are able to manage their hemorrhoid symptoms with at-home treatments, but sometimes hemorrhoid surgery is necessary. Hemorrhoid surgery is usually considered when other treatments have failed or for hemorrhoids that are particularly large or painful. Determining who is a good candidate for hemorrhoid surgery requires looking at the type and severity of a person’s hemorrhoids as well as their medical history.
What are the different types of hemorrhoids?
There are two main types of hemorrhoids:
- Internal hemorrhoids – these form inside the rectum and are not visible from outside. They can protrude through the anus and become prolapsed hemorrhoids.
- External hemorrhoids – these form underneath the skin around the anus and are visible. They are often very painful.
Hemorrhoids are also classified by their severity:
- Grade 1: No prolapse, only visible when straining
- Grade 2: Prolapse during straining but goes back inside by itself
- Grade 3: Prolapse but must be pushed back inside
- Grade 4: Permanently prolapsed and cannot be pushed back inside
When is surgery recommended for internal hemorrhoids?
Many internal hemorrhoids can be managed with over-the-counter treatments and lifestyle changes. Surgery may be recommended in the following situations:
- Prolapsed internal hemorrhoids (grade 3-4) that cannot be easily pushed back inside
- Very large internal hemorrhoids
- Internal hemorrhoids that continue to cause symptoms despite home treatments
- Internal hemorrhoids that bleed frequently
- Presence of blood clots (thrombosed hemorrhoids) that cause severe pain
If you have mild to moderate internal hemorrhoids (grade 1-2), surgery can usually be avoided by using stool softeners, fiber supplements, topical ointments, sitz baths, and other conservative measures.
When is surgery recommended for external hemorrhoids?
Like internal hemorrhoids, many external hemorrhoids respond well to over-the-counter remedies and lifestyle changes. Hemorrhoid surgery may be an option for external hemorrhoids if:
- The hemorrhoid is very painful and interferes with sitting and using the bathroom
- You have a blood clot (thrombosed external hemorrhoid) that is very painful
- The hemorrhoid bleeds frequently
- The hemorrhoid persists despite trying conservative treatments for several weeks
Smaller, less severe external hemorrhoids can typically be managed without surgery by using topical ointments, sitz baths, ice packs, and OTC pain medications.
What procedures are used?
Some common hemorrhoid surgery procedures include:
- Hemorrhoidectomy – The hemorrhoid tissue is cut out in surgery. This works for both internal and external hemorrhoids but has a long recovery time.
- Hemorrhoidopexy – The internal hemorrhoid is stapled back into place. This only works for internal hemorrhoids.
- Hemorrhoid artery ligation – The arteries feeding the hemorrhoid are tied off to shrink it.
- Sclerosis – Chemicals are injected to shrink the hemorrhoid.
The procedure used depends on several factors like the location (internal or external), grade, and your preference. Your surgeon will help determine the best operation based on your situation.
What are the risks and complications?
All surgeries carry some risks, including:
- Pain
- Bleeding
- Infection
- Scarring
- Recurrence of hemorrhoids
- Leakage
- Narrowing of the anal opening
- Incontinence (rare)
Make sure to talk to your surgeon about the types of risks and complications specific to the procedure they recommend. Knowing the possible risks can help you weigh the potential benefits vs risks.
Who is NOT a good candidate for hemorrhoid surgery?
Surgery may not be indicated in the following situations:
- Mild internal hemorrhoids that can be treated with other methods
- Pregnant women
- People with weakened immune systems
- People who have Crohn’s disease or other conditions that could make surgery risky
- People who are not healthy enough for surgery
- People who are allergic to anesthesia
- People who have not tried more conservative treatments first
It’s important to try other hemorrhoid treatments before resorting to surgery, unless your hemorrhoids are very severe. Surgery also poses higher risks for some people, so non-surgical options are preferred in those cases.
What should you do before considering hemorrhoid surgery?
If you are considering hemorrhoid surgery, be sure to:
- See a doctor to get an accurate diagnosis and grade your hemorrhoids
- Try recommended at-home treatments and lifestyle changes
- Discuss all alternative treatment options with your doctor
- Talk to your doctor about the risks and benefits of surgery
- Ask about what to expect during recovery
- Check with your insurance company about coverage for hemorrhoid procedures
Trying non-surgical treatments first and having thorough discussions with your doctor can help determine if hemorrhoid surgery is right for your situation.
Conclusion
The best candidates for hemorrhoid surgery are those with large, persistent, or painful hemorrhoids who have not had success with other treatments. The specific procedure depends on whether you have internal or external hemorrhoids. Surgery is not usually recommended for smaller, mild hemorrhoids that can heal with home treatments. It’s important to discuss hemorrhoid surgery thoroughly with your doctor so you understand the potential benefits, risks, and recovery process.