If you or someone you know has ever experienced hemorrhoids, then you know the pain and discomfort that comes with this condition. For those living with hemorrhoids, daily activities can be challenging, and one’s quality of life may begin to diminish if left untreated. Even simple tasks like sitting, walking, or using the bathroom can turn into painful ordeals, leading to anxiety and frustration.
Many individuals suffer in silence, unaware effective treatments are available. While lifestyle changes and over-the-counter remedies can temporarily relieve some, others may find their hemorrhoid symptoms persist or even worsen over time. However, as Dr. D’Angelo, a board certified general surgeon with the Premier Surgical Network, reassures, “Hemorrhoid surgery could be the key for many to finally find relief.”
Several factors determine which of the different types of hemorrhoid surgery is best, and understanding the differences can empower patients to make the most informed decisions about their health.
Why Consider Hemorrhoid Surgery?
Hemorrhoid surgery is often considered when other non-surgical treatments have failed to alleviate persistent symptoms such as chronic pain, itching, or discomfort over a period of months. Hemorrhoid surgery is also recommended for recurrent bleeding that could lead to anemia, prolapsed hemorrhoids that are grade III or IV and cannot be reinserted, or continually prolapse.
“Surgery may also be necessary for patients with extremely painful thrombosed hemorrhoids, large internal hemorrhoids that cannot be effectively treated non-surgically, strangulated hemorrhoids, and mixed hemorrhoids that involve both internal and external sites,” explains Dr. D’Angelo.
There are several benefits of surgical intervention over non-surgical options. Some of these include:
- Addresses complications: Surgery can effectively treat complications like thrombosis or strangulation that non-surgical methods cannot resolve.
- Comprehensive treatment: Surgery can address multiple hemorrhoids at once, including both internal and external.
- Cost-effective in the long run: While initially more expensive, surgery can be more cost-effective than ongoing non-surgical treatments for chronic cases.
- Immediate relief: Surgical removal of problematic hemorrhoids can quickly relieve symptoms.
- Improved quality of life: Surgery can dramatically improve daily comfort and overall well-being for those with severe symptoms.
- Permanent solution: Surgery often provides a long-term or permanent fix, whereas non-surgical treatments may require repeated applications.
- Reduced recurrence: The likelihood of hemorrhoids recurring in the same location is significantly lower after surgery.
It is important to note while surgery offers these benefits, it also carries risks and requires recovery time. The decision to undergo hemorrhoid surgery should always be made in consultation with a healthcare provider, weighing the potential benefits against the risks for each case.
Types of Hemorrhoid Surgery
Conventional Hemorrhoidectomy
This procedure is typically prescribed for large, prolapsing internal hemorrhoids (grade III or IV), extensive external hemorrhoids, or when less invasive treatments have failed. To perform this surgery, the surgeon makes incisions around the anus to excise the swollen blood vessels, either leaving the wounds open or closing them with sutures.
Recovery from a conventional hemorrhoidectomy procedure typically takes 2-4 weeks, with significant pain in the first week gradually subsiding. Patients usually return to normal activities within 2-3 weeks, though full healing may take up to 6 weeks.
While associated with more post-operative pain and longer recovery, conventional hemorrhoidectomy remains the gold standard for severe cases due to its effectiveness and low recurrence rates.
Stapled Hemorrhoidopexy
A stapled hemorrhoidopexy procedure is commonly prescribed for internal, prolapsing hemorrhoids (grade III or early IV) that have not responded to non-surgical treatments. It is favored for its quicker recovery and less postoperative pain but may not be suitable for large external hemorrhoids.
A stapled hemorrhoidopexy uses a circular stapling device to treat hemorrhoids. The surgeon removes a ring of tissue above the hemorrhoids and staples the remaining tissue, lifting the hemorrhoids and reducing its blood supply. Compared to a conventional hemorrhoidectomy, recovery is typically quicker, with patients often returning to normal activities within 7-10 days, though full recovery may take 2-3 weeks.
Rubber Band Ligation
Rubber band ligation is a minimally invasive procedure for treating grade I to III internal hemorrhoids that have not responded to conservative treatments. It is ideal for patients seeking a non-surgical option with quick recovery, but may not be suitable for very large or external hemorrhoids. Multiple sessions might also be needed for complete treatment. This procedure is typically performed by a Gastroenterologist.
During a rubber band ligation procedure, the doctor places a small rubber band around the hemorrhoid's base, cutting off its blood supply and causing it to shrink and fall off within 1-2 weeks. The procedure is quick, often performed in-office without anesthesia. Recovery is also typically fast, with most patients returning to normal activities within a day. Mild discomfort may last a few days, with complete healing in 1-2 weeks.
Laser Hemorrhoid Surgery
Laser hemorrhoid surgery uses focused laser energy to remove or shrink hemorrhoids. Performed under local anesthesia, the laser beam seals blood vessels and promotes tissue coagulation. It is suitable for both internal and external hemorrhoids. This hemorrhoid surgery recovery time is typically less than traditional methods, with patients returning to normal activities within a few days to a week. Full healing usually occurs in 2-3 weeks. This procedure is commonly prescribed for grade II to III hemorrhoids that have not responded to conservative treatments. It is ideal for patients seeking a less invasive option with quicker recovery and potentially less postoperative pain. Laser surgery is often recommended for multiple hemorrhoids or recurrent cases, but very large or severely prolapsed hemorrhoids might still require traditional surgery. The choice depends on the hemorrhoids' characteristics, patient health, and availability of laser technology and expertise.
Infrared Coagulation
Infrared coagulation (IRC) is another minimally invasive procedure for treating grade I and II internal or smaller hemorrhoids. Unlike the other treatment options, this technique uses infrared light to create scar tissue on the hemorrhoid, cutting off its blood supply and causing it to shrink. It is typically used for small to medium-sized internal hemorrhoids and is less invasive than traditional surgery.
To perform an infrared coagulation procedure, the doctor uses a device emitting infrared light to create scar tissue on the hemorrhoid, cutting off its blood supply and causing it to shrink. The procedure is quick, often performed without anesthesia, and recovery is fast, with most patients returning to normal activities within a day. Mild discomfort may last a few days, with complete healing in 1-2 weeks.
Choosing the Right Procedure
Knowing which treatment option is best for your specific case can be challenging, and that is why it is important to discuss options with your healthcare provider. However, here are some general guidelines you can follow to see which type of hemorrhoid treatment might be best, based on the type and severity of the hemorrhoid a person has:
Grade I (mild internal hemorrhoids):
- Conservative treatments: dietary changes, increased fiber intake, topical creams
- Minimally invasive options: rubber band ligation, infrared coagulation
Grade II (internal hemorrhoids that prolapse but reduce spontaneously):
- Rubber band ligation
- Infrared coagulation
- Sclerotherapy
Grade III (internal hemorrhoids that prolapse and require manual reduction):
- Rubber band ligation (for smaller hemorrhoids)
- Stapled hemorrhoidopexy
- Laser hemorrhoid surgery
Grade IV (large, irreducible prolapsed hemorrhoids):
- Conventional hemorrhoidectomy
- Stapled hemorrhoidopexy (in some cases)
External hemorrhoids:
- Conservative treatments for mild cases
- Surgical excision for severe or thrombosed cases
Mixed hemorrhoids (both internal and external):
- Conventional hemorrhoidectomy
- Laser hemorrhoid surgery
Choosing the Right Procedure
- Older patients or those with medical conditions may prefer less invasive options
- Patients on blood thinners: Avoid procedures with high bleeding risk
- Patients with recurrent hemorrhoids may benefit from more definitive surgical options
Remember, the final decision should always be made in consultation with a colorectal specialist who can assess the case and recommend the most appropriate treatment.
What to Expect After Hemorrhoid Surgery
After hemorrhoid surgery, patients can expect a recovery period that varies depending on the type of procedure performed. “Some degree of pain and discomfort is common and expected right after surgery,” shares Dr. D’Angelo, “particularly with a conventional hemorrhoidectomy.” Pain management typically involves a combination of oral pain medications, topical anesthetics, and sitz baths. Patients may also be prescribed stool softeners and fiber supplements to ease bowel movements and prevent constipation.
Post-surgery patients can also expect to make diet modifications, which often include increasing fiber intake and staying well-hydrated to promote soft stools. Activity restrictions are also usually recommended in the first few days and weeks. However, patients are encouraged to take short walks to promote circulation and prevent blood clots.
Sitting on a soft cushion or donut-shaped pillow for the first week or two can help alleviate pressure on the surgical site. Depending on the procedure, most patients can return to work and normal activities within 1-3 weeks, though full hemorrhoid surgery recovery may take 4-6 weeks. Follow-up appointments with the surgeon are also necessary to monitor healing and address complications.
After hemorrhoid surgery, patients should also be vigilant for signs of complications. Here are some key symptoms to watch for:
- Difficulty urinating: Inability to urinate or pain during urination may signal urinary retention, a possible complication.
- Excessive bleeding: While some bleeding is normal, heavy or continuous bleeding that soaks through bandages quickly is a concern.
- Foul-smelling discharge: This could be a sign of infection at the surgical site.
- High fever: A temperature over 101°F (38.3°C) could indicate an infection.
- Severe or increasing pain: Pain that worsens over time instead of gradually improving, especially if it i's accompanied by fever.
Patients experiencing any of these or other unusual symptoms should immediately contact their healthcare provider. It is always better to err on the side of caution and seek medical advice if there are concerns about the healing process or any unusual symptoms following hemorrhoid surgery.
Preventing Hemorrhoid Recurrence
While hemorrhoid surgery can provide significant relief for those suffering from severe or persistent hemorrhoids, it is crucial to understand long-term management extends beyond the operating room. To prevent hemorrhoid recurrence, patients must make lasting lifestyle and dietary modifications.
Equally important is the commitment to follow-up care after any hemorrhoid treatment. Attending all scheduled post-operative appointments allows healthcare providers to monitor healing, address any concerns, and make necessary adjustments to the treatment plan.
For those currently dealing with hemorrhoids, searching “hemorrhoid surgery near me” and consulting with a specialist, such as a colorectal surgeon or proctologist, is invaluable in determining the most appropriate treatment option. These experts can comprehensively evaluate the condition, considering factors such as the severity of symptoms, overall health, and personal preferences.
Dr. D’Angelo encourages, “I always remind my patients—hemorrhoids are common, and with the proper care, most people can find relief and prevent future occurrences.”