Patient education: Hemorrhoid removal (The Basics)

What are hemorrhoids? — 

Hemorrhoids are swollen veins in the rectum. They can cause itching, bleeding, and pain. They are very common.

Hemorrhoids can be:

●Internal – You cannot see the hemorrhoid because it is hidden inside the rectum.

●External – You can see or feel the hemorrhoid around the outside of the rectum (figure 1).

There are many procedures to treat hemorrhoids. Some can be used for internal or external hemorrhoids. Others can only be used for internal hemorrhoids.

Surgery to remove hemorrhoids is called "hemorrhoidectomy."

How do I prepare for hemorrhoid removal? — 

The doctor or nurse will tell you if you need to do anything special to prepare. Before your procedure, your doctor will look at your anus and do a "digital rectal exam." For the exam, they will put a gloved finger into your anus and rectum to feel for lumps or anything abnormal. In some cases, the doctor will want you to do an "enema." This is a way to clean out your rectum before the procedure.

Your doctor will also ask you about your "health history." This involves asking you questions about any health problems you have or had in the past, past surgeries, and any medicines you take. Tell them about:

●Any medicines you are taking – This includes any prescription or "over-the-counter" medicines you use, plus any herbal supplements you take. It helps to write down and bring a list of any medicines you take, or bring a bag with all of your medicines with you.

●Any allergies you have

●Any bleeding problems you have – Certain medicines, including some herbs and supplements, can increase the risk of bleeding. Some health conditions also increase this risk.

You will also get information about:

●If you need to stop any medicines before your procedure. In some cases, the doctor will have you stop taking certain medicines for a time before the procedure. Follow your doctor's instructions carefully to know which are safe and which to avoid. Examples of medicines you might need to stop include:

•Aspirin or aspirin-containing medicines

•Other nonsteroidal antiinflammatory drugs ("NSAIDs") such as ibuprofen (sample brand names: Motrin, Advil) or naproxen (sample brand name: Aleve). Many non-prescription medicines contain NSAIDs, so check the labels or ask your pharmacist for help.

•Medicines used to prevent blood clots, such as warfarin (brand name: Jantoven)

•Certain medicines for heart conditions, such as dipyridamole (brand name: Persantine) or clopidogrel (brand name: Plavix)

•Certain herbs, such as fish oil or ginkgo biloba

●Eating and drinking before your procedure – In some cases, you might need to "fast" before surgery. This means not eating or drinking anything for a period of time. In other cases, you might be allowed to have liquids until a short time before the procedure. Whether you need to fast, and for how long, depends on the procedure you are having.

●What help you will need when you go home – For example, you might need to have someone else bring you home or stay with you for some time while you recover.

Ask the doctor or nurse if you have questions or if there is anything you do not understand.

What happens during hemorrhoid removal? — 

When it is time for the procedure:

●You might get an "IV," which is a thin tube that goes into a vein. This can be used to give you fluids and medicines.

●You will get anesthesia medicines. This is to make sure that you do not feel pain during the procedure. Types of anesthesia include:

•Local – This type of anesthesia uses medicine to numb a small part of your body so you don't feel pain.

•Regional – This type of anesthesia blocks pain in 1 area of your body, such as an arm, a leg, or the lower half of your body. If you get regional anesthesia, you might be awake. Or you might get medicines to make you relax and feel sleepy, called "sedatives."

•General – This type of anesthesia makes you unconscious so you can't feel, see, or hear anything during the procedure. If you have general anesthesia, you might get a breathing tube to help you breathe.

●You might get medicines to help control pain after the procedure.

●The doctors and nurses will monitor your breathing, blood pressure, and heart rate during the procedure.

Hemorrhoid removal can be done:

●In a doctor's office – Some internal hemorrhoids can be treated in a doctor's office if they are not causing a lot of pain.

The doctor can use:

•Rubber band ligation – The doctor places a tight rubber band or ring around the hemorrhoid to block blood flow. This cuts off the blood supply to the hemorrhoid. In a few days, the hemorrhoid will shrink and stop bleeding. Scar tissue will form in its place.

•Sclerotherapy – The doctor injects a liquid that causes the tissue to break down and form a scar.

•Infrared coagulation – The doctor uses infrared light waves to destroy the hemorrhoid tissue.

●In an operating room – Larger internal hemorrhoids and external hemorrhoids need to be removed in the operating room.

During surgery, the doctor can:

•Make a cut (incision) in the skin, and remove the hemorrhoid. The doctor might close the incision with a stitch or leave it open to heal.

•Use an ultrasound device to locate the hemorrhoid. Then, they use a stitch to "tie off" the blood supply to the hemorrhoid.

•Use a special stapler to remove the hemorrhoid and any extra skin or tissue

After surgery, the doctor might place gauze or a foam dressing in the anus to stop the bleeding. This will come out with a bowel movement.

What happens after hemorrhoid removal? — 

If you were treated in the doctor's office, you can go home shortly after the procedure.

If you had surgery, you will be taken to a recovery room. The staff will watch you closely as your anesthesia wears off. You might feel groggy or confused for a short time. You might also feel nauseous or vomit. The doctor or nurse can give you medicine to help with this.

After hemorrhoid removal:

●You will get medicine to help with pain, if needed. You might need other medicines, too.

●The doctor will want you to eat a high-fiber diet and drink plenty of water to help prevent constipation.

What are the risks of hemorrhoid removal? — 

Your doctor will talk to you about all of the possible risks and answer your questions. Possible risks include:

●Bleeding

●Infection

●Severe constipation

●Trouble urinating

●Narrowing of the anus

●Gas or fecal incontinence, which can be temporary or permanent

●More hemorrhoids

What else should I know? — 

Before you go home, make sure that you know what problems to look out for and when you should call the doctor. Make sure that you understand your doctor's or nurse's instructions. Ask questions about anything you do not understand.

More on this topic

Patient education: Hemorrhoid removal – Discharge instructions (The Basics)
Patient education: Hemorrhoids (The Basics)
Patient education: How to give an enema (The Basics)

Patient education: Hemorrhoids (Beyond the Basics)