Determining Whether A Hemorrhoid Surgery Is Good For You

If you're suffering from hemorrhoids but are afraid to seek treatment or even talk about it, you're not alone. 

A significant proportion of the American population experience hemorrhoids at some point in life, but many avoid seeking treatment due to the stigma associated with the condition. Your hemorrhoids can be a sensitive topic to discuss with anyone.

But, according to the National Institute of Diabetes and Digestive and Kidney Diseases, hemorrhoids are a common condition affecting nearly 5%¹ of American adults. So, is hemorrhoid surgery worth it?

Although hemorrhoids can be painful, most people don't require surgery to remove them. Other treatments and home remedies can be effective in removing them. However, the remedies may not lead to positive outcomes. In that case, you may consider surgery.

You may have heard horror stories about hemorrhoid surgeries, but expert gastroenterologists at HealthMatch can help you with effective remedies for hemorrhoids. They will also help you answer the question — is hemorrhoid surgery worth it? 

What are hemorrhoids?

You have probably heard someone tell a horrific story regarding their hemorrhoid surgery experience. This is perhaps the last thing you wish your loved one or a friend to experience. But what are hemorrhoids?

Hemorrhoids are swollen, bulging veins in your anorectal region, including the lower rectum and anus. They can manifest in two ways, each with different symptoms. 

External hemorrhoids manifest as bumps or bulges around the anus that can cause significant discomfort. Internal hemorrhoids develop in the lower rectum region with no pain-sensitive nerves. Internal hemorrhoids may remain unnoticed for a long time unless you experience rectal bleeding. 

What are non-surgical hemorrhoid treatments?

Hemorrhoids aren't always dangerous, and many people may live with them for a period without treatment. However, they can be severe enough to cause pain and bleeding. In such cases, your doctor may consider surgery. 

Fortunately, surgery is not always the only option in hemorrhoid removal. Other non-invasive treatments are often used to remove the swelling and the discomfort associated with the condition.

If you have hemorrhoids, your doctor will likely first recommend home remedies and lifestyle modification treatments. Regular exercise, eating food rich in fiber, drinking water regularly, and taking fiber supplements are some common treatments for non-severe hemorrhoids. Your doctor can also recommend topical medicine to reduce the symptoms.

Other minimally invasive treatments may include:

Sclerotherapy (injection)

Sclerotherapy² is often considered a treatment procedure for grade one and two (mild to moderate) hemorrhoids. Here, your doctor may conduct a physical or digital rectal examination to determine the severity of the hemorrhoids.

Then, the doctor gently inserts a proctoscope into the anus. This is a short tube with a light that helps the doctor view the membranes lining the anorectal region. 

With the help of the proctoscope, the doctor injects a liquid chemical, such as zinc chloride, quinine, or polidocanol, around the bulging hemorrhoids. The injected chemical shrinks the hemorrhoids by damaging blood vessels to reduce blood flow to the hemorrhoids. 

This procedure may need to be repeated over a few weeks, depending on your reaction to the treatment to remove all the enlarged hemorrhoids.

After the treatment, you may experience mild pain, bleeding, or pressure in the anus. In rare cases, sclerotherapy may lead to infection or swelling. In addition, this is not a permanent solution, and the hemorrhoids may reappear in two to three years. 

Rubber band ligation (banding)

Banding involves placing a rubber band at the base of enlarged external hemorrhoids, which cuts off blood flow to the hemorrhoids and causes the swelling to shrink and fall in three to five days. The shrunken hemorrhoids detach from the body and are excreted in the stool painlessly. This procedure is mainly used to treat grade two hemorrhoids but can also be used in grade three hemorrhoids. 

Like sclerotherapy, rubber band ligation has to be repeated for a few weeks to cut off all enlarged vessels. This procedure is more advantageous in treating grade two hemorrhoids than surgery. You'll experience less pain, and you'll return to your normal schedule within a short time. 

However, you may experience pain, abscesses, and bleeding after treatment. It is also not a permanent solution, as the hemorrhoids may enlarge again.

Coagulation

Coagulation may be used to stop the bleeding if you have internal hemorrhoids that cause bleeding. Here, the doctor uses an electric light current or infrared light that creates scar tissue on the swellings, restricting blood flow to hemorrhoids, and forcing them to fall off. 

What are the surgical treatments for hemorrhoids?

Although not all people with hemorrhoids require surgery, surgery may be necessary for treating internal hemorrhoids that protrude outside the anal canal. This often happens when the prolapse cannot be pushed back and causes substantial discomfort or pain. 

So, is hemorrhoid surgery worthwhile? If your hemorrhoids are bleeding, painful, and long-lasting, or you are experiencing anal leakage, seek medical attention to determine whether you need hemorrhoid surgery. 

Surgical hemorrhoid treatments include:

Hemorrhoidectomy (Hemorrhoid Removal)

Hemorrhoidectomy is often performed on large external hemorrhoids and prolapsed internal hemorrhoids that cause substantial bleeding and pain. It may also be performed when the hemorrhoids return after non-invasive treatments. 

The procedure aims to remove the hemorrhoids. The patient is given a spinal block or a local anesthetic. During the process, the surgeon administers the anesthesia, gently opens the anus, and makes small incisions in the tissues around the hemorrhoids. Although this is the most invasive and painful hemorrhoid treatment procedure, it permanently removes the swollen tissues, including severe grade three hemorrhoids. 

Most patients go home the same day after the hemorrhoidectomy procedure. Although recovery takes approximately two weeks, it may take around three to six weeks to feel normal.  

Stapling

This is a more advanced and modern procedure in treating grade three hemorrhoids. It's an effective technique for severe internal and external hemorrhoids, particularly in cases of prolapses. 

During the procedure, a surgeon places a staple on protruding hemorrhoids to cut off the blood supply, causing the hemorrhoids to shrink. As a result, hemorrhoids move to regions with fewer nerve endings. 

While the procedure takes less time than a hemorrhoidectomy, it is performed in an outpatient setting, and anesthesia is required. 

Stapling involves fewer incisions than conventional surgical procedures, and the healing period is shorter. 

Nonetheless, the procedure doesn't provide a permanent solution as the hemorrhoids may return. Additionally, stapling cannot be used for large external hemorrhoid treatment. 

When is it time to consider hemorrhoid surgery?

If your hemorrhoids have become a nuisance to your normal life, it may be time to seek medical treatment. Many hemorrhoid patients don't require surgical procedures. However, your doctor may recommend surgery to remove hemorrhoids under certain conditions, including: 

• You have external and internal hemorrhoids

• You have grade three and four (moderate to severe)  internal hemorrhoids protruding on the outer anus

• You have another anorectal health condition that requires a surgical treatment

• Your hemorrhoids reoccur after a non-invasive treatment

• The doctor notices a strangulated internal hemorrhoid during the examination

• Hemorrhoids cause significant bleeding and pain

You will also be taken through consultation to help you understand the surgical procedure.

Who is not a good candidate for hemorrhoid surgery?

In most cases, you may not qualify for a hemorrhoid removal surgery for the following reasons:

• You're pregnant

• A change in dietary and lifestyle can help remove the hemorrhoids

• You're taking some drugs, such as blood thinners, that can increase the risk of bleeding

• Your hemorrhoids are small enough for less invasive treatments

• You recently suffered from a severe infection

In these cases, your doctor may also recommend the most effective alternative procedure to alleviate the problem.

What to expect before, during, and after the hemorrhoid removal surgery

Like most other treatments, your gastroenterologist will inform you of what to do before the procedure and what to expect during and after the surgery.

Before the surgery, your doctor will need to know whether you're taking any medicine and whether you have other medical conditions that could affect the surgery. You need to avoid any alcoholic drinks before the procedure. 

Days before the surgery, the doctor may request you to:

• Temporarily stop taking blood thinners. They will provide alternative medications that cannot affect the procedure.  You should also speak to the doctor who prescribed the blood thinner about your upcoming procedure.

• Quit smoking to hasten the healing process

• Inform your provider when you have any flu, fever, cold, or another illness that may force them to postpone the surgery

• Follow the doctor's instructions on when to stop eating and drinking before the procedure

During the surgery:

• The care provider will administer local anesthesia before the start of the surgery

• The hemorrhoids are cut off, and dissolvable stitches are employed to seal the cut

Many people go home the same day after the procedure. However, if the wound is severe, the doctor may recommend you stay in the hospital for a night. The wound may take two to three weeks to heal.

You may need help doing basic chores during the first few days after the surgery, and you'll need to avoid lifting or pulling heavy objects. You can also hasten your recovery by:

• Avoiding sitting for long durations

• Eating fiber-rich foods

• Drinking plenty of water

• Taking a sitz bath

• Avoiding constipation

The lowdown

According to NIDDK, 1 in 20 Americans has hemorrhoids. However, most people avoid talking about it, even with their doctors, due to embarrassment. As a result, most people don't realize when hemorrhoid surgery is necessary. 

Is hemorrhoid surgery worth it? While hemorrhoid surgery is important for severe hemorrhoids, it's not always necessary. Non-invasive procedures such as sclerotherapy, coagulation, or rubber band ligation can treat grade one and two hemorrhoids.

Hemorrhoidectomy and stapling are the most effective surgical procedures for treating hemorrhoids. So if other less invasive procedures have failed, your doctor can help you determine when hemorrhoids require surgery. 

In addition, following instructions before, during, and after the procedure will enhance fast healing. For instance, plenty of water, a fiber-rich diet, and fiber supplements can facilitate healing. 

Nonetheless, effective hemorrhoid treatment requires experienced surgical experts. At HealthMatch, our gastroenterologists can help. They understand when hemorrhoid surgery is worthwhile and can guide you through treatment and the healing journey.

FAQs

How long should I rest after hemorrhoid surgery?

Avoid strenuous activities for one to two weeks after the surgery.

How soon can you poop after the surgery?

Some patients don't have any bowel movements for up to three days after hemorrhoid surgery.

How should I sleep after hemorrhoid surgery?

It's important to sleep on your stomach to reduce anal pain. Also, placing a pillow under your hips will prevent rolling.

What is the most painful day after hemorrhoidectomy?

After the procedure, the worst pain may be on days 2–8.

How long does hemorrhoid surgery take?

The surgery takes approximately 30–60 minutes, although you may not realize it due to the anesthesia.