Between 80 and 90 percent of people with hemorrhoids find relief with non-invasive treatments. Changes in diet, paired with topical medications or other doctor recommended treatments are effective for most patients. For those who do not respond to this first line treatment, sometimes other options must be explored. While a surgical hemorrhoidectomy is often an option, there may be other procedures that can offer relief without the extended recovery time.
When Is Surgery Necessary?
While hemorrhoids can be dangerous for those with bleeding disorders, for most people they only affect quality of life. That said, symptomatic hemorrhoids can have a huge impact on a person’s daily life. It may be difficult to stay active with your family, sit through meetings at work, or even enjoy your favorite activities.
The pain, itching, burning and bleeding associated with hemorrhoids is bad enough, but for some with more severe cases, incontinence and soiling may occur. This can make hygiene a struggle, further interfering with quality of life.
While most minor cases of hemorrhoids clear up with little to no intervention at all, more serious cases may require more attention. These may include:
- Prolapsed hemorrhoids that have not responded to other treatments
- Prolapsed hemorrhoids that cannot be pushed back manually
- Large, symptomatic external hemorrhoids
- Hemorrhoids that are both internal and external
In addition, any patient with rectal bleeding who has hemophilia or a related bleeding disorder, or who is on anticoagulation or antiplatelet medication, should see a doctor as soon as possible. Symptomatic hemorrhoids can bleed heavily in these patients, and lead to major medical problems. Surgery may be the best choice for many of these patients.
What Are The Nonsurgical Treatments?
Many people try to put off seeing a doctor about their hemorrhoids. Because very effective treatments are available, though, opting for treatment often brings fast relief. And the good news is that it often consists solely of lifestyle changes.
For almost all patients, treatment begins with simple diet changes, including increasing fiber and fluid intake. Doctors may prescribe laxatives or stool softeners to minimize constipation, and recommend increasing activity to help keep the bowels moving properly. In the great majority of people, this is effective in reducing or eliminating hemorrhoidal symptoms. Reducing the time spent sitting, especially on the toilet, may also help. Bathing in a warm, shallow bath — known as a sitz bath — can help reduce pain and swelling until the treatment begins to work.
In the rare occurrence that these lifestyle changes do not offer relief from a patient’s hemorrhoid symptoms, the doctor will most likely offer a slightly more invasive treatment such as steroidal creams, painless hemorrhoid injections (“sclerotherapy”) or an in-office banding procedure. Only once these less invasive treatments have failed to reduce symptoms or have been ruled out as a possibility is surgery considered.
What Type Of More Invasive Treatments Are Used?
Before a doctor will resort to performing surgery for hemorrhoids, there is one last procedure that can be used. Rubber band ligation is a common, highly effective procedure that can be performed in just a few minutes. By placing bands at the base of the swollen hemorrhoidal tissue, the blood supply to the tissue can be cut off. This is most commonly used on prolapsed hemorrhoids that return to their natural position on their own or can be pushed back into place manually, although it may be effective in more serious cases.
A procedure, known as a stapled hemorrhoidectomy (PPH), is sometimes used in hemorrhoids that have prolapsed and are difficult to push back into place. It may also be utilized in the case that rubber band ligation fails. A special stapling device is used to staple the hemorrhoidal tissue in place, effectively preventing further prolapse while also disrupting blood supply to the tissue.
A similar procedure, called a THD is also used. It involves ligating the blood supply to the hemorrhoids and repositioning them back up into the anal canal. Your proctologist, also known as a colon and rectal surgeon, will be able to advise you on a suitable operation for you.
When these procedures cannot be used, or when they have failed, most doctors will recommend a surgical hemorrhoidectomy. The hemorrhoidectomy is the most effective treatment available for symptomatic hemorrhoids, and has a low rate of recurrence.
A hemorrhoidectomy in an invasive procedure where the offending tissue is surgically excised. The recovery can be extended, lasting for a month or more. The pain may be significant enough to warrant a prescription for an opioid painkiller during the first three to seven days. Most return to work within a week to ten days.
Why Is A Hemorrhoidectomy Often Preferred?
A hemorrhoidectomy is the gold standard as far as surgical treatments for internal hemorrhoids are concerned.
A closed hemorrhoidectomy can be differentiated from its counterpart, the open hemorrhoidectomy, by the way the surgical incision in handled after the tissue has been excised. During a closed procedure, the wound is stitched closed. This is typically done with absorbable sutures that do not require manual removal.
During the open procedure, the wound is left open to heal on its own. This may be necessary if too much tissue has to be removed in order to properly eliminate the hemorrhoidal bundles. The location of the hemorrhoids may also call for an open incision in some cases. Lastly, those with a high risk of infection may undergo an open hemorrhoidectomy, because it makes the wound easier to clean later if an infection does occur.
While the possibility of complications is similar for both open and closed hemorrhoidectomies, the closed procedure is highly preferred by most surgeons. Postoperative pain is also similar, with both causing significant discomfort for several days, then gradually lessening. The advantage of a closed hemorrhoidectomy, though, is in the speed of wound healing. The surgical site is often completely healed in three to four weeks for patients whose wound is closed with stitches, while full healing may take four to six weeks after an open hemorrhoidectomy.