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Frequently Asked Questions

Overview

The surgical removal of internal or external haemorrhoids that are extensive or severe is known as hemorrhoidectomy. It is commonly known as piles surgery. Surgical removal hemorrhoidectomy is the most effective treatment, but it is associated with the greatest rate of complications.

Haemorrhoids may occur as internal or external in nature. Internal haemorrhoids form in the anus or rectum whereas external haemorrhoids form outside the anus. Haemorrhoids are also referred to as piles. The different grades of internal haemorrhoids include:

Grade I Haemorrhoids bleed but do not prolapse
Grade II Haemorrhoids prolapse outside the anal canal but resolve on their own
Grade III Haemorrhoids protrude outside the anal canal and are usually reduced manually
Grade IV Haemorrhoid prolapse that cannot be reduced

Generally, piles are caused due to excessive pressure in the lower rectum. It may be caused by continuous constipation, diarrhoea, pregnancy, lifting heavy weights, obesity and straining while passing stool. Patients with piles complain of painless bleeding. External haemorrhoids are painful.

When is the piles surgery recommended?

Patients with grade III and IV haemorrhoids benefit the most from surgical hemorrhoidectomy.

Types of Hemorrhoidectomy:

Closed Hemorrhoidectomy

It involves removing hemorrhoidal bundles with a sharp instrument such as a scalpel, scissors, electrocautery, or even a laser. This is then followed by complete wound closure with absorbable suture. Despite having the most postoperative discomfort and pain, this technique has the best long-term results with the lowest recurrence rates.

Open Hemorrhoidectomy

Hemorrhoidal tissue is removed in the same way as in a closed procedure, but the incision is left open in an open hemorrhoidectomy. When the amount of disease or location makes wound closure difficult or the risk of postoperative infection is high, surgeons may choose open hemorrhoidectomy.

Stapled Hemorrhoidectomy

Stapled hemorrhoidectomy is typically performed on patients with grade III and IV haemorrhoids on whom previous minimally invasive treatments have not worked (injection by sclerotherapy, coagulation using laser). A circular stapling device is used during stapled hemorrhoidectomy to excise a circumferential ring of excess hemorrhoid tissue, thereby lifting haemorrhoids back to their normal position within the anal canal. Stapling also disrupts the blood supply to haemorrhoids. As per studies, stapled hemorrhoidectomy causes less postoperative pain and requires a shorter recovery time than conventional surgery, but it does have a higher recurrence rate.

Rubber Band Ligation

A rubber band is wrapped around the base of the hemorrhoid inside the rectum. The band stops blood flow, and the hemorrhoid dies within a few days.

Lateral Internal Sphincterotomy

Lateral internal sphincterotomy or opening of the inner anal sphincter muscle is sometimes performed during hemorrhoidectomy in patients with high resting sphincter pressures. It is hypothesised to reduce postoperative pain. However, it is not a commonly used procedure.

Procedure

Before the procedure:

  • To reduce the postoperative pain and faecal impaction, the patient must have a high fibre diet and stool softeners for several days prior to the procedure.
  • Lactulose(laxative) taken 4 days prior to surgery reduces postoperative pain.
  • Antibiotic prophylaxis is advised for all clean-contaminated operations.
  • 6-8 hours prior to the surgery, the patient should not consume any solid food items.
  • Enema is given on the day of operation.

During the procedure

  • Hemorrhoidectomy is usually an outpatient procedure.
  • An IV line will be inserted into the patient’s arm for medications to prevent infection, swelling and bleeding. The patient will need either spinal anaesthesia (regional) or general anaesthesia to sleep through the procedure.
  • Once the patient is asleep, the surgeon will insert an anoscope into the anal canal to examine the haemorrhoids closely.
  • Next, a speculum is inserted to display the hemorrhoid to be operated upon.
  • The surgeon will grasp the hemorrhoid with forceps, then remove the tissue with a scalpel or laser and close the wound with dissolvable sutures.
  • Normally, the incision is sutured for faster healing, however in cases with a high infection risk or if the area is very large, sutures are avoided.

After the procedure

  • Once the surgery is done, the patient is transferred to a recovery area where vital signs are monitored.
  • The patient is given pain killers, antibiotics and laxatives.
  • Patient is discharged after being fully awake and stable.
  • It is critical to stay hydrated and maintain a high-fibre diet in order to have easy and painless bowel movements.
  • Warm sitz baths may also help to reduce pain following surgery.
  • It is normal to have some bleeding after surgery, but if a significant amount runs down the leg, a doctor should be informed immediately.

Preventive measures for piles

Here are some tips which can help prevent piles:

High fibre-containing diet

Consuming lots of fruits, vegetables, and whole grain products, makes stool become softer. Thus, reducing strain when the stool size expands. Generally, one must try to consume 30 grams of fibre every day.

Fluid Intake

Always stay hydrated during the day by drinking enough water. Consuming 6-9 glasses of water per day may also be useful. Try reducing the monotony by substituting water with freshly squeezed juices. This helps make stool become softer.

Avoid Straining

The veins in the lower rectum will experience intense pressure if a person is holding their breath or straining to pass faeces which can lead to irritation of the vein.

Stay Active

Regular exercise may help prevent constipation and lessen the extreme pressure in the lower rectum vein. Issues may arise when a person is stays in one position for an extended period of time such as standing or sitting.

Never Hold Back

When you feel the urge to pass the stool, don't hold back. Piles tend to develop as a result of pressure on veins.

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Frequently Asked Questions

1. Is haemorrhoid surgery painful?

A haemorrhoidectomy is a surgical removal of excess hemorrhoidal tissues that is performed on haemorrhoids that are large, extensive, or severe.Haemorrhoid surgery (haemorrhoidectomy) is performed under general anaesthesia or spinal anaesthesia so the procedure itself does not cause any pain.

2. What are the dos after haemorrhoidectomy?

Sit for 15 to 20 minutes in 8- 10 centimetres of warm water (sitz bath) three times a day before and after bowel movements. After that, pat the area dry. Do this as long as you have anal pain. Avoid long periods of sitting on the toilet or straining during bowel movements.

3. How should I sleep after piles surgery ?

Sleeping flat on the stomach, may relieve pressure on your anus and provide some relief. Lying on the back puts additional pressure on the anus, resulting in additional pain from haemorrhoids and sleeping. To avoid this, you should lie on the side with a pillow between their legs.

4. How do you pee after piles surgery?

Take the prescribed pain medication and take warm sitz baths in a bathtub or sitz basin. Try to relax the bladder and urinate into the water while soaking. If you are unable to urinate within the first eight hours of your surgery, notify your doctor right away.

5. How long does it take to recover from haemorrhoid surgery?

Complete recovery from haemorrhoid surgery typically takes about 4 weeks. Following your haemorrhoidectomy, you will experience pain or discomfort in your rectal area.

6. What foods to avoid after haemorrhoid surgery?

Avoid foods that cause constipation such as dairy, red meat, desserts and processed foods such as pizza, pasta and caffeine-containing drinks.

7. What are the possible complications of haemorrhoid surgery?

Potential complications include pain, delayed bleeding, urinary retention or urinary tract infection and faecal impaction. In rare cases, complications like infection, wound breakdown, faecal incontinence, and anal stricture may also occur.

8. What exercise can you do after a haemorrhoidectomy?

A Kegel exercise can be performed by slowly contracting the muscles of the anus, then holding for five seconds. Do this about five times and repeat as many times each day as you like.

9. What exercises should be avoided after a haemorrhoidectomy?

Any type of weightlifting is not recommended. Lifting with haemorrhoids will only prolong the healing process and can make those bothersome haemorrhoids worse.

10. Can a haemorrhoid come back after a surgery?

A haemorrhoid is usually cured by surgery. However, the long-term success of haemorrhoid surgery is dependent on your ability to change your daily bowel habits to avoid constipation and straining.

11. How do you keep the area clean after piles surgery?

The area can be kept clean with warm water and enough water pressure to rinse away any remaining debris. It is critical to avoid using harsh soaps. Allow the area to air dry or pat it dry with a soft towel.

Citations

https://colorectalsurgery.ucsf.edu/conditions--procedures/hemorrhoidectomy.aspx
https://www.bcm.edu/healthcare/specialties/surgery/general-surgery/hemorrhoidectomy
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2780175/pdf/ccrs20077.pdf
https://muschealth.org/medical-services/ddc/patients/gi-surgery/rectal-surgery/hemorrhoid
https://surgery.ucsf.edu/conditions--procedures/hemorrhoidectomy.aspx
https://emedicine.medscape.com/article/1582358-technique
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4755769/pdf/10-1055-s-0035-1568144.pdf