Hemorrhoidectomy

What is a hemorrhoidectomy?

A hemorrhoidectomy is a surgical procedure to remove hemorrhoids. Hemorrhoids are enlarged blood vessels in your anus (butthole) that can sometimes cause uncomfortable symptoms, like anal pain and bleeding.

Hemorrhoids are common, and usually harmless. Most won’t require any medical treatment, let alone surgery. But in certain circumstances, for certain hemorrhoids, hemorrhoidectomy is the best option.

How common is hemorrhoidectomy surgery?

Hemorrhoidectomy is uncommon. Only about 5% of people develop symptoms with hemorrhoids. Of these, only 30% seek medical treatment. Of those who seek treatment, only 10% will need hemorrhoidectomy surgery.

Why would someone have a hemorrhoidectomy?

Your healthcare provider might recommend hemorrhoidectomy surgery if your hemorrhoids are more complicated than average. Complications that might require a hemorrhoidectomy include:

• Prolapse. This means that your hemorrhoids have fallen down from inside your anus and now stick out of the opening, where they’re more likely to irritate you, bleed or get injured. Prolapse is a gradual process that also tends to worsen over time. At first, hemorrhoids may only briefly emerge from your anus when you’re having a bowel movement (Grade II hemorrhoids). But if you need to put them back in manually (Grade III), or if they won’t go back in at all (Grade IV), your provider might recommend removing them.
• Thrombosis. This is when your hemorrhoid has become so swollen that the blood inside it clots, cutting off its circulation. Thrombosed hemorrhoids have a purple-blue hue. They can be extremely painful. Sometimes they can rupture, causing severe bleeding. If you don’t seek treatment right away, it’ll eventually heal on its own. But in the painful first 72 hours, you might prefer surgery.
• Strangulation. Grade IV hemorrhoids that have prolapsed and won’t go back in are also called incarcerated hemorrhoids. An incarcerated hemorrhoid is at risk of strangulation. Strangulation means that it’s trapped in a tight spot and its circulation has been pinched off. This is an emergency. Unlike thrombosis, strangulation won’t resolve on its own. The strangulated tissues eventually die, causing gangrene.
• Recurrence. Sometimes hemorrhoids don’t go away or keep coming back after less invasive treatments. This can really impact your long-term quality of life. Where other treatments fail, hemorrhoidectomy has a 95% success rate. Even if you don’t have any other complications, you might choose hemorrhoidectomy to take care of these hemorrhoids once and for all.

Is hemorrhoidectomy a major surgery?

The operation itself isn’t very long or complicated, but the recovery period can be. This varies from person to person. Recovery can be difficult, and it can take between two and eight weeks.

Your recovery time will depend on how much pain and how many other complications you have. Pain and slow healing are common complaints, but they seem to be declining as surgical techniques evolve.

What happens before a hemorrhoidectomy?

Your surgeon will discuss the risks and benefits of the procedure and obtain your informed consent. They’ll also discuss your current medications and which ones to stop taking before your surgery.

They’ll ask you to stop eating and drinking within eight hours before the procedure. Your anal canal will need to be clear, so if you have constipation, they might give you an enema before the procedure.

What happens during hemorrhoidectomy surgery?

You’ll be under anesthesia for the procedure, so you won’t feel or notice what’s happening. Your surgeon will locate your hemorrhoids, cut out (excise) the affected tissue and seal the blood vessels.

They may close the wounds by bringing the edges back together (closed hemorrhoidectomy) or leave them open (open hemorrhoidectomy), depending on where they’re located and how wide they are.

Surgeons have different methods of excising and resealing the tissue and blood vessels. The traditional way is to cut with a scalpel, seal the blood vessels and close the wound with dissolvable stitches.

More recently, surgeons have begun using an electrothermal device to both cut and seal the tissues and blood vessels. The electrothermal energy promotes healing of the tissues, leading to faster recovery.

What happens after the hemorrhoidectomy procedure?

You’ll be able to go home the day of surgery, though you’ll need someone else to drive you. It’ll take a few hours for the anesthesia to wear off completely. As it wears off, you’ll start to feel pain.

You may take over-the-counter (OTC) painkillers, or you may have prescription painkillers to take home with you. You’ll also have detailed instructions for taking care of yourself during your recovery.

What are the advantages of hemorrhoidectomy over other hemorrhoid treatments?

The primary advantage is that it works. Hemorrhoids removed in surgery generally don’t return. While it has a longer recovery time than other treatments, surgery should bring you permanent relief in the end.

A hemorrhoidectomy is also an important option in an emergency. If you have a thrombosed hemorrhoid or a strangulated hemorrhoid, surgery can treat it urgently and prevent worse outcomes.

What are the possible risks or complications of hemorrhoidectomy surgery?

Short-term risks of surgery include:

• Blood clots.
• Adverse reactions to the anesthesia.
• Wound infection.
• Excessive bleeding.

Possible complications during your recovery include:

• Slow healing.
• Excessive pain despite medication.
• Urinary retention due to pain when peeing.
• Constipation due to pain when pooping.

Possible long-term complications that can develop include:

• Narrowing of your anal canal from excessive scarring (anal stenosis).
• Difficulty holding in your bowel movements due to muscle or nerve damage (fecal incontinence).

With careful technique, serious complications are rare.

Who shouldn’t have a hemorrhoidectomy?

Your healthcare provider might not recommend hemorrhoidectomy for you if you have certain medical conditions that could increase your risk of serious complications from the procedure. These include:

• Immunosuppression.
• Inflammatory bowel disease (IBD).
• Bleeding disorders.
• Portal hypertension.

What is the average recovery time for a hemorrhoidectomy?

The average recovery time is two to four weeks. Most people say the pain is gone after two weeks. It might be six to eight weeks before you’re able to resume strenuous exercise or manual labor.

You might have a longer recovery if you have complications, like infection or excessive bleeding. Your healthcare provider will instruct you on caring for your wound to help prevent these complications.

What should I expect during my recovery from hemorrhoidectomy?

After hemorrhoidectomy surgery, you can expect some degree of:

• Bleeding. Some bleeding after a hemorrhoidectomy is normal, especially after having a bowel movement (pooping). You might see blood in your stool or on your toilet paper. You might also see some in your underwear, along with some clear or yellow discharge. You can wear a sanitary pad or gauze to help soak up the fluid. This can last for up to a month. It shouldn’t be a lot of blood. It’s possible to split the wound open if you strain too hard to poop, which could cause more severe bleeding. It’s important to avoid constipation to prevent this. Rarely, some people experience a postoperative hemorrhage, acute bleeding from the blood vessels that were cut in surgery. If you bleed a lot, call your provider.
• Swelling. Swelling after a hemorrhoidectomy is normal. Swelling inside your anus can feel similar to hemorrhoids. You may feel like they’re still there or think they’ve come back, but this isn’t the case. Sometimes a lump or a skin tag will develop at the site of the wound, which can also be deceiving. These generally go away once you’ve healed. Healing time varies for everyone. You can help reduce the swelling by applying ice wrapped in a towel to the wound a few times a day for 10 minutes at a time. It also helps to lie on your stomach with a pillow supporting your hips. See if you can sleep this way.
• Pain. You can expect some pain after a hemorrhoidectomy, and the pain levels people report are relatively high. But you should be able to manage your pain with medications. Healthcare providers usually offer a variety of strategies for managing pain, including oral and topical medications and gentle wound care. To get ahead of the pain after your operation, start your medications before you start to feel it. Most people say the pain is gone after two weeks. See your provider if your pain lasts longer than two weeks, if you’re having trouble managing your pain or if your pain is preventing you from peeing or pooping.

How painful is hemorrhoidectomy recovery on a pain scale?

Healthcare providers assess post-hemorrhoidectomy pain using a visual analog scale (VAS). It rates pain on a scale of one to 10, with 10 being the worst. Pain ratings range from moderate to severe.

Pain is very subjective, and people can experience it differently. There’s not always an apparent reason for this. However, you may be more likely to experience more pain if you have:

• A preexisting disease.
• An infection.
• Constipation.
• Emergency surgery.

Typically, the most significant pain occurs with your first bowel movement after hemorrhoidectomy surgery. Pain usually improves after three days and continues to improve for the next two weeks.

What improves hemorrhoidectomy pain?

Healthcare providers continue to explore new strategies for reducing post-hemorrhoidectomy pain. Some research suggests that people experience less post-hemorrhoidectomy pain with:

• Electrosurgery. Using electrothermal and cautery devices for cutting and sealing the tissues and blood vessels appears to result in faster healing with less pain after surgery.
• Local anesthesia. Anesthesia applied directly to the site of the surgery, combined with other types, appears to result in less postoperative pain.
• Methylene blue. Injection of a blue dye surgeons sometimes use can improve pain at the site of the surgery as a side effect. Methylene blue has a temporary numbing effect on the nerves.
• Topical GTN ointment. GTN ointment (glyceryl trinitrate) is a prescription medication that reduces muscle spasms in your anus. It also improves blood flow and promotes faster healing.

In addition to the care you receive from your healthcare provider, you can also improve your pain levels and healing time by taking good care of yourself at home. Your provider will advise you on self-care.

How do you poop after a hemorrhoidectomy?

Pooping can be painful after a hemorrhoidectomy, especially the first time. It gets easier as you heal. You can improve your pain levels and your healing time by preventing constipation and straining.

For some people, this is a chronic problem that likely contributed to getting hemorrhoids in the first place. For others, it’s a problem that can develop after surgery and with the use of pain medications.

Healthcare providers suggest that you:

• Gradually add fiber to your diet. Try eating high-fiber foods or take fiber supplements.
• Avoid spicy foods. Spices can burn on the way out.
• Drink plenty of water. Hydration is essential, especially as you add more fiber to your diet.
• Try unfiltered apple juice or prune juice. These have natural laxative properties.
• Use laxatives as needed. There are several types. Ask your provider what they advise.
• Don’t read on the toilet. Sitting on the commode too long is associated with constipation.
• Use a step stool. Elevating your feet helps position your hips to make bowel movements easier.
• Use gentle wipes. Baby wipes or medicated pads can help protect your tender tissues.
• Use topical anesthetic. Apply lidocaine cream to help numb your wound before pooping.

How do you heal from a hemorrhoidectomy?

Healing from a hemorrhoidectomy takes time, but you can help the process along by taking good care of your wound and your body during your recovery. For aftercare, healthcare providers recommend:

• Sitz baths. Soak your bottom in 3 or 4 inches of warm water a few times a day.
• Ice. Apply an ice pack wrapped in a towel to your wound for 10 minutes a few times a day.
• Medications. Your provider will suggest a combination of oral and topical pain medications.
• Rest. Don’t push yourself too hard to go back to your usual activities. Give yourself time to heal.
• Preventing constipation. Use every trick in the book if necessary.
• Long-term changes. Make your constipation prevention strategies a habit to prevent new hemorrhoids.

When should I contact my healthcare provider after a hemorrhoidectomy?

Schedule a follow-up appointment with your provider a few weeks after your hemorrhoidectomy. They’ll check to make sure you’re healing well. Call them sooner if you have any unusual symptoms, like:

• Fever.
• Excessive bleeding.
• Excessive pain.
• Your wound is red and hot to touch.
• Difficulty peeing.
• Difficulty pooping.

A note from Cleveland Clinic

Hemorrhoidectomy surgery has a bit of a reputation for being rough, which might make it daunting to consider. But if you’re ready to be done with your hemorrhoids once and for all, it’s worth considering.

The hemorrhoidectomy experience has been gradually improving as surgeons adopt new tricks and techniques to make your recovery more comfortable. Its reputation isn’t necessarily up to date.

Nevertheless, it’s likely to be a little rough some of the time. Knowing what to expect and preparing ahead of time for your recovery can help to make this period pass as smoothly as possible.

Keep in mind that recovery is temporary, while hemorrhoid pain and irritations can be ongoing. Most people say they don’t regret having hemorrhoidectomy surgery and that the relief at the end is worth it.