Ask The Doctor: Do I Need Hemorrhoid Surgery
Q.I have bleeding hemorrhoids, and my doctor recommends surgery. How do I know if this is really necessary?
A. The symptoms of itching, rectal pain, and bleeding of hemorrhoids can be very uncomfortable. Yet surgery is rarely the first treatment. Most hemorrhoids can be managed with conservative measures. Try boosting the fiber and fluid in your diet and getting regular exercise to stimulate bowel function. If possible, move your bowels whenever you feel the urge. Use a wet cloth or wipe and pat dry after a bowel movement to avoid irritating inflamed skin. Sit in a warm-water sitz bath to ease discomfort. Over-the-counter hemorrhoid products, including witch-hazel wipes and analgesic creams, can provide temporary relief.
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How Do You Treat External Hemorrhoids Diagnosis
External hemorrhoids appear as bumps and/or dark areas surrounding the anus. If the lump is tender, it suggests that the hemorrhoid is thrombosed. Any lump needs to be carefully followed, however, and should not be assumed to be a hemorrhoid since there are rare cancers of the anal area that may masquerade as hemorrhoids.
Hemorrhoid Medication: When Why And Which Ones To Use
A number of OTC creams, ointments, and pads that contain hydrocortisone or witch hazel are available to help relieve pain, swelling, and itching caused by hemorrhoids. According to the National Institute of Diabetes and Digestive and Kidney Diseases, doctors recommend using over-the-counter products for a week. If symptoms persist beyond a week, follow up with your doctor.
Creams and suppositories containing hydrocortisone can cause the skin to weaken and thin, so they should not be used for more than a week. If any of these creams cause a rash or dry skin around the area, contact your healthcare provider.
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Less Time In The Bathroom
Johannsson et al6 reported that patients with hemorrhoids spent more time on the toilet and had to strain harder and more often than controls in the community and hospital.
Garg and Singh7 and Garg8 use the mnemonic TONE for appropriate defecation habits:
- Three minutes during defecation.
- No straining and no cell phone use during defecation.
- Enough fiber.
What Treatments Are Available For Thrombosed External Hemorrhoids
The treatments for external hemorrhoids are different from those for internal hemorrhoids. One treatment option is to allow clots in the external hemorrhoids to be slowly absorbed by the body over several weeks. You can try hot baths, ointments or creams for the discomfort. Most experts recommend that the blood clots be surgically removed.
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Hemorrhoid Home Remedies: Warm Sitz Bath
A sitz bath refers to sitting in a few inches of warm water three times a day for 15 to 20 minutes. A sitz bath may help decrease the inflammation of hemorrhoids. Drying off the anal area completely after each sitz bath is important for minimizing moisture that irritates the skin surrounding your rectal area.
How To Get Rid Of Hemorrhoids: Diagnosis And Treatments
Most individuals who have hemorrhoids discover them by either
- feeling the lump of an external hemorrhoid when they wipe themselves after a bowel movement,
- noting drops of blood in the toilet bowl or on the toilet paper, or
- feeling a prolapsing hemorrhoid after bowel movements.
With a history of symptoms, a physician can begin diagnosis on the basis of a careful examination of the anus and anal area. Although the physician should try his or her best to identify the hemorrhoids, it is perhaps more important to exclude other causes of hemorrhoid-like symptoms that require different treatment such as
- anal fissures,
This is true whether or not hemorrhoids are found during anoscopy.
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When To Consider Hemorrhoid Removal Surgery
Your doctor may decide that you are a good candidate for hemorrhoid removal surgery if:
You have combined internal and external hemorrhoids.
You have grade 3 or 4 prolapsed internal hemorrhoids. Prolapse means that the hemorrhoids are dropping, or slipping out of the anus. Grade 3 prolapse occurs with a bowel movement, but you can manually push the hemorrhoid back through your anus. A grade 4 prolapse cannot be put back.
You have additional anorectal conditions that require surgery.
Youve had minimally invasive procedures or other treatments that have not corrected the problem.
You have significant amounts of bleeding from your hemorrhoids.
You have a strangulated internal . This occurs when the anal sphincter traps the hemorrhoid and cuts off blood supply to the tissue.
- You have a hemorrhoid with that recur after less invasive treatments.
Symptoms Of Prolapsed Internal Hemorrhoids
Hemorrhoids prolapse when their blood vessels swell and extend from their location in the rectum through the anus. In the anal canal, the hemorrhoid is exposed to the trauma of passing stool, particularly hard stools associated with constipation. The trauma can cause bleeding and sometimes pain when stool passes.
The presence of
- inflammation, and
- constant moisture
can lead to anal itchiness , and occasionally the constant feeling of needing to have a bowel movement. The prolapsing hemorrhoid usually returns into the anal canal or rectum on its own or can be pushed back inside with a finger, but falls out again with the next bowel movement.
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What Is A Hemorrhoidectomy
A hemorrhoidectomy is surgery to remove hemorrhoids, whether theyre internal or external.
Surgery is typically not the first line of treatment. But when all else fails, hemorrhoidectomy is a safe, effective treatment that doesnt just make hemorrhoids easier to live with it gets rid of them altogether.
When Is Surgery Necessary For Internal Hemorrhoids
Bright, red smears on the toilet paper after a bowel movement, or drops into the toilet bowl. Itching. Tissue prolapsing from the anus, sometimes so prominently that it cannot be pushed back in even with a finger. While external hemorrhoids are known as the more annoying of the two types of hemorrhoids, internal hemorrhoids are no walk in the park, either.
Your colon and rectal surgeon, also known as a proctologist, will be able to educate you about the different types of hemorrhoids.
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Why Is Hemorrhoid Surgery Done
Surgery is indicated when all other approaches fail and in specific conditions such as:
- Hemorrhoids with significant bleeding
- Larger external hemorrhoids
- Protruding internal hemorrhoids
Hemorrhoids can be managed either medically or with surgery, depending on the severity of the symptoms. For grade I and II hemorrhoids, dietary changes and medical treatment are indicated as the first-line treatments.
For grade I, II and III hemorrhoids unmanageable by medical treatment, the office-based procedure will be indicated. Office-based procedures include the following:
- Rubber band ligation: It involves placing rubber bands on the hemorrhoids.
- Infrared photocoagulation: Heat produced by the infrared light cuts of the blood supply to the hemorrhoids.
- Electrocoagulation: Electric currents cuts of the blood supply to the hemorrhoids.
- Sclerotherapy: Injecting a chemical solution into the area around the hemorrhoids.
- Cryotherapy: Involves freezing the hemorrhoids.
What If I Need A Hemorrhoidectomy
If rubber band ligation or another similar in-office procedure does not help or if you have large protruding hemorrhoids that make you a poor candidate for this type of treatment you may require a hemorrhoidectomy.
A traditional hemorrhoidectomy is an invasive surgery that takes a week or more of recovery before you can return to work and your regular activities. It also requires general anesthesia. Still, it is the most effective method of getting rid of problematic hemorrhoids.
The surgeon completes this procedure by making an incision around the inflamed tissue and removing the involved blood vessels. Hemorrhoidectomies are typically performed as day surgery, and patients return home the same day. Complications or reactions to anesthesia may call for overnight hospitalization.
While traditional hemorrhoidectomies are very effective and most patients are pleased despite the long recovery time, a newer alternative is being used by some doctors to treat prolapsed internal hemorrhoids. Known as a stapled hemorrhoidopexy or PPH, this procedure utilizes a special stapler to tack the inflamed tissue back into its natural position. Over the following days, the inflamed tissue returns to its original size, eliminating symptoms.
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When Hemorrhoid Surgery May Be Necessary
Very few people fewer than 10 percent of all adults who see a doctor because of symptomatic hemorrhoids will require a surgical operation.
Surgery to remove hemorrhoids is called a hemorrhoidectomy.
Your doctor may recommend a hemorrhoidectomy if:
- You have large external hemorrhoids
- You have both internal and external hemorrhoids
- An internal hemorrhoid has prolapsed
In a hemorrhoidectomy, the doctor makes a small incision to remove the hemorrhoid and surrounding tissue before closing the wound with stitches.
A hemorrhoidectomy is performed in an operating room and can be done under general anesthesia, in which you are unconscious and unable to feel pain.
It can also be done with a spinal anesthetic block while you are awake , or with a combination of relaxing and sedating drugs given intravenously and a local anesthetic injected around the anus.
Hemorrhoidectomy is associated with postoperative pain, but the procedure is successful for 95 percent of cases.
More recently, another option aimed at avoiding the postoperative pain of a hemorrhoidectomy has become available, called a stapled hemorrhoidopexy. A circular stapling device pulls the hemorrhoidal tissue upward and to its normal position, stapling it in place. The staples eventually fall out over time.
There are many options for the treatment of hemorrhoids. Its best to discuss the benefits and risks of each of these with your doctor in order to come up with the treatment plan that is best for your particular case.
How Long Is It Going To Take To Recover From A Hemorrhoid Procedure
It depends on the procedure you opt for, but you can generally expect to be recovering for 2-3 weeks. The goal of postoperative care is to minimize side effects and reduce the risk of complications. Doctors vary in their recommendations, so its important to follow your treating physicians suggestions.
Lets look at the three most popular treatments for hemorrhoid and their aftercare protocols:
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How Do Doctors Treat Hemorrhoids
Doctors treat hemorrhoids with procedures during an office visit or in an outpatient center or a hospital.
Office treatments include the following:
- Rubber band ligation. Rubber band ligation is a procedure that doctors use to treat bleeding or prolapsing internal hemorrhoids. A doctor places a special rubber band around the base of the hemorrhoid. The band cuts off the blood supply. The banded part of the hemorrhoid shrivels and falls off, most often within a week. Scar tissue forms in the remaining part of the hemorrhoid, often shrinking the hemorrhoid. Only a doctor should perform this procedureyou should never try this treatment yourself.
- Sclerotherapy. A doctor injects a solution into an internal hemorrhoid, which causes scar tissue to form. The scar tissue cuts off the blood supply, often shrinking the hemorrhoid.
- Infrared photocoagulation. A doctor uses a tool that directs infrared light at an internal hemorrhoid. Heat created by the infrared light causes scar tissue to form, which cuts off the blood supply, often shrinking the hemorrhoid.
- Electrocoagulation. A doctor uses a tool that sends an electric current into an internal hemorrhoid. The electric current causes scar tissue to form, which cuts off the blood supply, often shrinking the hemorrhoid.
Outpatient center or hospital treatments include the following:
Sometimes complications of hemorrhoids also require treatment.
Are You A Good Candidate For Hemorrhoid Removal
The goal of hemorrhoid surgery is to remove the enlarged hemorrhoid tissue and relieve rectal , itching and bleeding. But surgery is not your only option. Hemorrhoid treatments include lifestyle changes, minimally invasive procedures, and surgery. Use the following information as a guide in making the decision to have hemorrhoid removal surgery.
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Enlarged Hemorrhoids: What Surgical Procedures Are Used To Treat Hemorrhoids
Sometimes the symptoms of enlarged hemorrhoids are so bad that treating the symptoms alone is no longer enough. Then there are various procedures that can be done to remove the tissue that is causing problems.
Hemorrhoids are normal cushions of tissue filled with blood vessels, found at the end of the rectum, just inside the anus. If they become enlarged, they can cause unpleasant symptoms. The most suitable type of treatment will mainly depend on the size of the hemorrhoids and the severity of symptoms. Each approach has its own advantages and disadvantages. Depending on the procedure, side effects can occur some more severe than others.
Sclerotherapy and rubber band ligation are generally carried out as day procedures, without an anesthetic. If someone has grade 3 or grade 4 hemorrhoids, doctors often recommend surgery. A general or local anesthetic is usually needed for this. You then have to stay in the hospital for a few days, and stay off work for some time too.
Symptoms Of Thrombosed External Hemorrhoids
External hemorrhoids can be felt as bulges at the anus, but they usually cause few of the symptoms that are typical of internal hemorrhoids.
External hemorrhoids can cause problems, however, when blood clots inside them. This is referred to as thrombosis. Thrombosis of such a hemorrhoid causes an anal lump that is
- very painful,
- tender, and
- often requires medical attention.
The thrombosed hemorrhoid may heal with scarring, and leave a tag of skin protruding in the anus. Occasionally, the tag is large, which can make anal hygiene difficult or irritate the anus. Even after such a hemorrhoid goes away, a residual skin tag may remain, and this may need to be surgically removed.
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Whom Do Hemorrhoids Affect
Although most people think hemorrhoids are abnormal, almost everyone has them. Hemorrhoids help control bowel movements. Hemorrhoids cause problems and can be considered abnormal or a disease only when the hemorrhoidal clumps of vessels enlarge.
Hemorrhoids occur in almost everyone, and an estimated 75% of people will experience enlarged hemorrhoids at some point. However only about 4% will go to a doctor because of hemorrhoid problems. Hemorrhoids that cause problems are found equally in men and women, and their prevalence peaks between 45 and 65 years of age.
Why You Probably Dont Need Hemorrhoid Surgery
Hemorrhoids are cushions of swollen tissue and blood vessels in your lower rectal region. They manifest in two ways, each with different symptoms: internal hemorrhoids form inside your rectum where there arent any pain-sensing nerve endings, so unless you experience rectal bleeding, you may not even be aware of them. External hemorrhoids present as bulges or bumps around the anus and are often the cause of the discomfort people associate with hemorrhoids. Its possible to have both internal and external hemorrhoids at the same time.
While nearly 75% of all Americans will have hemorrhoids at some point in their lives 50% will have experience them before they turn 50 only the most severe cases require surgery to have them removed.
Severe Hemorrhoids Vs Mild Hemorrhoids: Stages
Many physicians use a grading system to categorize hemorrhoids along four stages:
- First-degree hemorrhoids: Hemorrhoids that bleed, but do not prolapse. These are slightly enlarged hemorrhoids, but they do not protrude outside the anus.
- Second-degree hemorrhoids: Hemorrhoids that prolapse and retract on their own . These may come out of the anus during certain activities like passing stool, and then return back inside the body.
- Third-degree hemorrhoids: Hemorrhoids that prolapse and must be pushed back in by a finger.
- Fourth-degree hemorrhoids: Hemorrhoids that prolapse and cannot be pushed back in the anal canal. Fourth-degree hemorrhoids also include hemorrhoids that are thrombosed or that pull much of the lining of the rectum through the anus.
When Should You Get Hemorrhoid Surgery
Your healthcare provider may suggest surgery if you have large hemorrhoids, both internal and external hemorrhoids, or bleeding and pain that isn’t managed with other non-surgical treatments. With small hemorrhoids, your healthcare provider will usually suggest lifestyle changes first, such as eating a high-fiber diet and drinking lots of water.
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Why Is A Hemorrhoidectomy Performed
Hemorrhoids are fairly common, affecting nearly three out of four adults at some point in their lives. Most people are able to use noninvasive methods to manage symptoms. When those dont work, hemorrhoidectomy can be an effective treatment.
How Long Do Hemorrhoids Take To Heal
For many people, hemorrhoids last and last. Ongoing pain is especially common for people over age 50. For many people, hemorrhoidal pain returns years after treatment, and for many others the condition comes and goes, becoming more common over time.
Do Hemorrhoids Ever Go Away on Their Own?
Sometimes they do. Smaller hemorrhoids are apt to go away in just a few days. It’s a good idea during this time to avoid further irritating your rectal area by keeping the area as clean as you can.
How Can You Make Hemorrhoids Go Away?
Tougher cases of hemorrhoids may not go away on their own. After trying home remedies and over-the-counter options without success, you will need to talk to your doctor about other treatment options.
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