Haemorrhoid Surgery
There are several options for haemorrhoid treatment.
If lifestyle modifications do not provide adequate symptom improvement, several surgical options are available.
Which operation is appropriate for you depends on the size and location of your haemorrhoids, as well as what symptoms you are experiencing.
The most common procedures for haemorrhoids are:
Rubber band ligation (RBL)
Haemorrhoid artery ligation & recto-anal repair (HAL-RAR)
Haemorrhoidectomy
What is rubber band ligation?
Rubber band ligation (RBL) is a treatment for small to medium-sized internal haemorrhoids. The rubber band is placed using a specialized device to the base of the haemorrhoid. This stops blood from flowing into the haemorrhoid and results in the haemorrhoid shrinking away over the following 1-2 weeks.
RBL is performed as a day procedure. It is usually performed under a light sedation for patient comfort.
RBL is generally painless as the rubber bands are placed in a location where there are no pain nerves. However, the presence of the rubber bands in the anus may produce a sensation of fullness or a sensation of the need to pass a bowel motion. This sensation is most noticeable in the first few days after the procedure. This will get better over 24-48 hours. It is important not to strain if you feel this sensation, as this may dislodge the rubber bands and prevent them from working.
What is haemorrhoid artery ligation & recto-anal repair (HAL-RAR)?
HAL-RAR is an operation for medium to large-sized internal haemorrhoids. It may also improve symptoms from external haemorrhoids. HAL-RAR is a relatively new operation designed to treat haemorrhoids without the need to cut them out.
A specialized ultrasound device is used to find the exact location of the blood vessels going to the haemorrhoids. A stitch is tied around this blood vessel, which stops blood from entering the haemorrhoid.
If your haemorrhoids prolapse (meaning they protrude out of your anus), the stitch is also run from the top of the haemorrhoid to the bottom of the haemorrhoid. The top and bottom ends of the stitch are then tied together, pulling the haemorrhoid up and preventing future prolapse.
Over the next few days to weeks, the haemorrhoids will get smaller and symptoms improve.
The stitches used in a HAL-RAR are self-dissolving. There is no need to have them removed.
HAL-RAR is performed under general anaesthesia. HAL-RAR can be performed as a day procedure.
HAL-RAR is generally associated with minimal pain. Most patients can return to work in 24-48 hours. Some people experience a throbbing sensation in the anus or a sensation to open their bowels during the recovery period. This sensation is not harmful and will improve on its own.
HAL-RAR has fewer potential risks than haemorrhoidectomy.
What is haemorrhoidectomy?
A haemorrhoidectomy involves cutting away the haemorrhoid. It is most appropriate for large external haemorrhoids. Any associated internal haemorrhoids can also be cut away at the same time.
The haemorrhoid is usually cut away with electrocautery. The main blood vessel going to the haemorrhoid is either tied off with a stitch or sealed with electrocautery.
If you have many large haemorrhoids around the entire circumference of the anus, it may not be possible to cut all the haemorrhoids away. This is because if too much is cut away at one time, excessive scarring may occur which can cause difficulty with passage of bowel motions in the future.
Haemorrhoidectomy is performed under general anaesthesia. Patients usually go home the next day after haemorrhoidectomy.
Before the procedure
No specific preparation is required before haemorrhoid surgery.
It is recommended that lifestyle modifications (that will prevent haemorrhoids returning) be started before surgery and continued after surgery. These include maintaining a soft stool, avoidance of straining at stool and limiting the time you spend on the toilet to less than 2 minutes.
After the procedure
After HAL-RAR or haemorrhoidectomy, you will be provided with pain killers, antibiotics and stool softeners to go home with.
It is important to continue to maintain the lifestyle modifications described in the ‘Before the procedure’ section. This will not only make your post-surgery recovery more comfortable, but also prevent haemorrhoids from returning in the future.
Good skin hygiene after bowel motions is recommended. Make sure to dry the area well using soft toilet paper or wipes. Avoid rough, scratchy toilet paper. Dry the area with a dabbing motion (not a wiping motion). Also avoid wearing underwear made from synthetic materials, as this traps unwanted moisture.
Risks
Haemorrhoid surgery is generally very safe. However, any operation has possible risks or complications.
Possible risks associated with any surgery include:
Bleeding
Infection
Blood clots. These may develop because you are under anaesthesia and do not move during the surgery time. Preventative anti-clotting medication may be administered during your hospital stay.
Possible risks associated with haemorrhoid surgery include:
Anal stenosis. This is a permanent narrowing of the anus, which causes difficulty with passage of bowel motions. This is a potential risk of haemorrhoidectomy only.
Anal sphincter injury. This is a potential risk of haemorrhoidectomy only.
Inability to pass urine after surgery. This is common after haemorrhoid surgery and usually improves on its own within 24 hours. In some instances, a thin tube (known as a catheter) may need to be placed into the bladder to allow passage of urine. This is a temporary measure and usually removed in 24 hours.