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Hemorrhoids surgery or hemorrhoidectomy is recommended by a proctologist in case a patient has very large internal or external hemorrhoids. Grade 3 hemorrhoids that protrude through the anus during bowel movements and Grade 4 prolapsed hemorrhoids are the ones that mostly require hemorrhoidectomy. Sometimes, a hemorrhoidectomy is suggested after other treatments,  such as rubber band ligation, have failed. 

Studies show that in about 5% of patients, hemorrhoids come back even after surgery. This is because, while the surgery offers a long-term cure, some patients fail to follow the proctologist’s recommendations and lead a healthier lifestyle. 

So in this blog, we will understand more about hemorrhoidectomy and the dos and don’ts the patients must remember and follow after the surgery. 

Hemorrhoidectomy: What to expect?

During a hemorrhoidectomy, the doctor makes incisions in the tissue around the hemorrhoid under general or spinal anesthesia. The hemorrhoid doctor uses a scalpel, a cautery pencil, or a laser to remove the hemorrhoid. The hemorrhoid is removed after the swollen vein inside the hemorrhoid is tied off to prevent the bleeding. After the surgery, the area is sewn closed or left open and is covered with a medicated gauze. The procedure is mostly performed as an outpatient procedure and the patient is allowed to go home on the same day.

Sometimes, a less invasive stapling procedure called stapled hemorrhoidopexy is done to cut off the blood supply to the hemorrhoids and lift up the hemorrhoidal tissue.. The stapled surgery is less painful than hemorrhoidectomy but more expensive. Studies also show that people who undergo this surgery are at higher risk of recurring hemorrhoid than formal hemorrhoidectomy.

Lately, some proctologists depend on Doppler-guided hemorrhoid artery ligation which utilizes a special probe to locate the hemorrhoidal arteries. These are sequentially ligated with reduction of blood supply to the hemorrhoids that will ultimately shrink. No tissue is removed in this procedure. A plication of the rectal mucosa (mucopexy) is usually added to deal with the prolapse

Your road to recovery

After a hemorrhoid removal surgery, you may feel pain or ache in the anal area for 2 to 4 weeks. However, if you follow the guidelines recommended by your doctor, you will feel better each day. To help with the pain, a painkiller is prescribed to you. Post-surgery, it is common to experience some light bleeding and/ or clear/yellowish discharge from your anus. This mostly happens along with your bowel movement and may last for around one to two months after the surgery.

Generally, your doctor will give you the go-ahead to return to your normal routines within a few days once the discomfort is well tolerated. Even then, you will need to stay away from strenuous activities. Remember to not lift anything heavy or strain during bowel movements to help your wound heal faster.

Here are some additional tips to help you heal faster and better after a hemorrhoidectomy-

• Walking is a great way to stay active during your recovery period. However, remember to take a break and rest when you feel tired.
• Don’t move too quickly or lift heavy things until you are completely healed. Any strain on the surgical wound will delay your recovery and increase discomfort.
• After a shower, remember to pat your anal area dry. Follow the same routine after a bowel movement as well.
• Include high-fiber foods in your diet in the days following your surgery to make bowel movement easier. This lowers the chances of getting hemorrhoids again.
• If you notice that your bowel movements are irregular after the surgery, ensure that you intake plenty of liquids. If required, your doctor may prescribe a stool softener or mild laxative as well. 
• Using a sitz bath is highly recommended during your recovery period. Sit in 8 to 10 centimeters of warm water for 15 to 20 minutes three times a day after bowel movements. This will help you heal faster. Remember to pat the area dry.
• Don’t sit on the toilet for too long or strain during bowel movements. This may restart bleeding from the wound. Keep your anal area clean and dry.
• If required, support your feet on a small step stool while sitting on the toilet. This helps flex your hips and widens your pelvis into a squatting position, easing your bowel movements.
• Ask your doctor if you can use hydrocortisone cream on the skin around your anal area. This has been shown to reduce pain and itching around the wound during healing.
• You can use baby wipes or medicated pads like hazel witch pads instead of toilet paper to clean your anal area after a bowel movement. Applying refrigerated hazel witch pads or ice on the area also helps with the pain and irritation around the anus.
• To avoid putting strain on the wound and decrease swelling in the area, try lying on your stomach with a pillow under your hips.
• To facilitate your healing and to avoid infections, your doctor may prescribe antibiotics. Take them as directed and do not stop until you complete the course.
• In most cases, your doctor will prescribe pain medication. If not, consult with him and ensure that you can take an over-the-counter medication.
• If you are already on any medications, check with your doctor as to when you can restart them. You will also get instructions as to how you should take your new medicines alongside.
• If you take aspirin or other blood thinners, ask your doctor before taking it.
• Before taking any medicine read the label to ensure that it doesn’t hinder your healing process.
• You can also apply for topical numbing medicines before and after bowel movements for pain relief.
• Go for your follow-up appointment to ensure that the treatment is working. You can also use the opportunity to discuss what medicines/ remedies continue to keep hemorrhoids away.
• Take a break from work for at least a week, especially if your work involves sitting for long hours or includes heavy lifting or other strenuous activities. 

Emergency care and next steps

In rare cases, patients may experience side effects like loss of consciousness or shortness of breath after the surgery. If you experience something like that, seek medical help immediately.

Additionally, if you notice symptoms like increased pain, swelling, redness or red streaks coming from the area, pus draining from the wound, fever or warmth in the anal region, sickness in your stomach, signs of heavy bleeding, you must seek immediate medical attention to address the issue. Reach out to your proctologist in Dubai immediately to avoid complications and get the necessary treatment for the same.

Hemorrhoidectomy is a long-term, almost permanent solution for hemorrhoids as long as you follow the above-mentioned recommendations during the recovery period. Make sure to eat fibrous foods, intake a lot of liquids, exercise regularly, and get treatment for constipation if required to reduce the risk of recurring hemorrhoids. It is also very important that the procedure is carried out by an expert proctologist as complications, such as anal incontinence or anal stricture, may occur.  Talk to our hemorrhoids doctor and proctology specialist, Dr. Antonio Privetera today for more information.