Hemorrhoidectomy:

This operation is the final step when all other avenues have been explored to relieve the symptoms, or the situation has arisen where you have thrombosed or strangulated grade 3-4 hemorrhoids which need treatment. You will have been to visit the doctor and have the operation explained to you and any tests that you need will have been organised and completed prior to going into hospital when you went for your pre assessment.

You will have been given instructions regarding not eating and drinking anything before the operation and also about your bowel preparation this can include bowel prep which empties your bowels prior to the operation. You may not want to do this but unless the surgeon has a good view they may not proceed.

You will have been advised by the anaesthetist which anaesthetic is appropriate for you this can be either

Regional block – spinal or epidural – numb from waist down

General anaesthetic – a state of unconsciousness whereby you feel no pain or distress

The Hemorrhoidectomy Operation

The doctor who is performing the procedure will explain what they are going to do, and will ask for your written permission to perform the procedure. This procedure is performed on grade 3-4 hemorrhoids

1. If you are happy that you understand both what procedure you are going to have done and have been told of the risks involved with the procedure then you can sign the relevant document.
2. You will be asked to take your clothes off and put on a gown
3. You will have discussed which anaesthetic is suitable for you and the anaesthetist will then either give you a general or spinal anaesthetic
4. You will be positioned either on the operating table with stirrups for your feet called the lithotomy position. Or on your front with your bottom raised it will depend on the location of the hemorrhoids. ( it will seem all a bit undignified but you will have either a sheet or blanket covering you until the procedure begins
5. You will have sterile drapes put over you to maintain a sterile field for the surgeon
6. An antiseptic/bacterial solution will be painted around the perineal area to eliminate germs from the skin surface
7. An instrument called a proctoscope will be gently placed in your anus so the doctor will be able to have a good view the hemorrhoid. This will have a light attached so the surgeon may see easily.
8. Local anaesthetic and a blood vessel constrictor will be injected around the hemorrhoids to be treated this will give pain relief tto the area as wll as reducing the blood flow.
9. The surgeon will then excise (cut away) from the base of the hemorrhoid carefully sealing bleeding vessels with cautery (burn) from the diathermy.
10. Sutures are used to tie of f larger blood vessels and the hemorrhoid is removed.
11. Once the operation is completed non adhesive dressing will be placed on the wound site with dressing gauze and a large sanitary pad this will be taped in position
12. You will be placed on your side after the procedure to cause your buttocks to press together helping with the pressure which reduces bleeding.
13. When you are in recovery the wound site will be inspected frequently to check on bleeding a small amount is expected but larger quantities may require surgical opinion.
14. 24 hours after the operation the dressings will be removed and you will be encouraged to take a bath.
15. Normal bowel habits should be resumed as soon as possible, and you will be encouraged to eat finer rich foods and drink plenty of fluids. The first bowel movement is often dreaded due to pain however it is important that you open your bowels regularly to prevent constipation.

Normal bowel habits should be resumed as soon as possible, and you will be encouraged to eat fibre rich foods and drink plenty of fluids. The first bowel movement is often dreaded due to pain however it is important that you open your bowels regularly to prevent constipation.

Post Operative Pain

This is a painful procedure, and it can continue to be painful for up to 2 weeks after the operation. You will be given regular pain relief medicines to alleviate the pain

Special Precautions

1. Ensure you have adequate pain relief available to you; if you are uncomfortable ask the nursing staff for additional pain relief.
2. Make sure you have someone available to help you when you are discharged form hospital
3. Make sure you are able to urinate easily after the procedure(go for a wee)
4. Maintain a good fluid intake
5. Take any stool softener or laxatives you have been prescribed
6. Try and do some gentle exercise, do not lie in bed or on the couch all the time
7. Eat plenty of fibre rich foods so you do not become constipated
8. Do not do any heavy lifting for at least two weeks
9. Maintain a good hygiene regime wash after each bowel movement

Healing / Recovery time after Hemorrhoidectomy

The initial healing takes approximately two weeks until you feel more comfortable but full health can take up to 6 weeks. Most people will takes two weeks off work for recovery but may not be able to return to work for a month depending on the type of work you do. You may be able to discuss reduced hours with your employer so you are able to resume work gradually.

Complications and risks

• Pain you may find that having your bowels open may continue to cause you pain
• Bleeding – a post operative bleed can sometimes take place unexpectedly days after the operation
• Infection – the internal bowel surface may become infected, you will experience a foul smelling discharge with pus if this occurs.
• Return of the hemorrhoids – the operation may not be effective
• Faecal (stool/ poo) incontinence – this can happen in the short term but usually sorts itself out if not you will need to see your doctor
• Inability to pass urine (wee) – this is something that might happen immediately post operatively and would be rectified at the hospital
• Anal Fistula / Fissure (a narrow track from inside the bowel to the skin surface)
• Narrowing of the lumen of the bowel (the internal scaring of the bowel has caused it to become smaller)