Surgical Care Group

Hemorrhoidectomy

Hemorrhoids are very common in both men and women. About half of the population have hemorrhoids by age 50. Hemorrhoids are also common during and immediately after pregnancy. The pressure of the fetus in the abdomen, as well as hormonal changes, cause the hemorrhoidal veins to enlarge. These veins are also under severe pressure during childbirth. For most women, however, hemorrhoids that develop during pregnancy are a temporary problem. Hemorrhoids usually are not dangerous or life threatening, and in many cases, hemorrhoidal symptoms will go away within a few days.

Hemorrhoids are swollen or dilated veins around the anus or lower rectum, similar to varicose veins in the legs.
Internal hemorrhoids are inside the anus; external hemorrhoids are under the skin around the anal edge.

Hemorrhoids develop when pressure on the rectal veins cause the veins to stretch and swell. Contributing factors include straining to move your bowels, pregnancy, aging, chronic constipation or diarrhea, and sitting too long on the toilet.

The most common symptom of internal hemorrhoids is bright red blood on the toilet paper or in the toilet.
Sometimes an internal hemorrhoid may protrude through the anus outside the body and become irritated and painful. This is known as a protruding hemorrhoid.
Symptoms of external hemorrhoids may include painful swelling or a hard lump around the anus that results when a blood clot forms. This condition is known as a thrombosed external hemorrhoid.
There may also be irritation and/or itching caused by excessive straining, rubbing, or cleaning around the anus.
Draining mucus may also cause itching.

Any time bleeding from the rectum or blood in the stool occurs, proper diagnosis by a physician is important to rule out colorectal cancer or other digestive diseases.
The doctor will examine the anus and rectum to look for swollen blood vessels that indicate hemorrhoids. An anoscope or proctoscope (short, hollow, lighted tubes) may be used to view internal hemorrhoids and to more completely evaluate the rectum.
Sigmoidoscopy or colonoscopy is sometimes recommended to rule out other causes of gastrointestinal bleeding. Sigmoidoscopy and colonoscopy are diagnostic procedures that allow examination of the lower colon or the entire colon using lighted flexible tubes inserted through the rectum.

Symptoms can sometimes be relieved by the following:

A Sitz baths–sitting in plain, warm water several times a day for about 10 minutes.
Application of a hemorrhoidal cream to the affected area or use of hemorrhoidal suppositories.
Eliminating pressure and straining when passing stool by increasing fiber in your diet and drinking 6 to 8 glasses of fluid per day. Good sources of fiber include fruits, vegetables, and whole grains. Fiber supplements such as Metamucil or Citracil can also be used. Often these measures will decrease symptoms of pain and swelling within a few days. A firm lump may take 4 to 6 weeks to resolve.
If pain is severe or persistent, your physician may remove a hemorrhoid containing a clot through a small incision to provide relief. This procedure is done under local anesthesia as an outpatient.

When symptoms are severe and/or persistent, hemorrhoids may need to be treated endoscopically or surgically.

Rubber Band Ligation:
A rubber band is placed around the base of the hemorrhoid inside the rectum. The band cuts off circulation, and the hemorrhoid withers away and falls off within a few days. The wound usually heals within a week or so after that. Ligation is generally not painful and can often be done in the office without anesthesia.
Hemorrhoidectomy:
A surgical procedure removes the hemorrhoids and any excessive tissue that causes bleeding and protrusion. A hemorrhoidectomy is necessary when clots repeatedly form in external hemorrhoids, when a protruding hemorrhoid cannot be reduced, if rubber band ligation fails, or if there is persistent bleeding. Although there is usually more pain associated with hemorrhoidectomy, in some cases, it is the best method for the permanent removal of hemorrhoids. Hemorrhoidectomy is generally done on an outpatient basis under anesthesia. A period of inactivity is required following surgery.

Your physician can discuss your options with you and recommend the best method of treatment for you.