Haemorrhoid Surgery

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Haemorrhoids

Haemorrhoids (piles) are enlarged blood vessels which occur around the anus. They can cause symptoms such as bleeding and itching, mucus discharge and pain if thrombosed. There are two types of haemorrhoids: internal and external.

Internal haemorrhoids are within the anus and are aggravated by constipation or straining. When they enlarge, internal haemorrhoids may come down through the anus (usually whilst passing stool). This is known as prolapse, with prolapsed haemorrhoids occasionally remaining outside the entire time. Prolapsed internal haemorrhoids may cause mucus discharge, which creates a ‘wet’ sensation in the underwear. Unless the haemorrhoids are complicated by clotting (thrombosis) or swelling/squeezing (strangulation), they are rarely painful.

External haemorrhoids are located on the outside of the anus and are covered by skin. They are usually enlarged due to stretching of the skin surrounding the anus, as in events such as childbirth or straining. These haemorrhoids are often itchy and uncomfortable, and can even be painful when blood clots form in the vessels under the skin.

Treatment

Mr Haddawi may discuss varying treatment options with you regarding your haemorrhoids. Treatment type usually depends on the severity and frequency of signs/symptoms, haemorrhoid size, and whether the haemorrhoids are internal or external.

Prevention is the most effective treatment course, and Mr Haddawi may be able to advise you on simple lifestyle changes that can prevent any pre-existing haemorrhoids from getting worse. This includes:

Controlling constipation and keeping weight within a healthy range
Eating plenty of high-fibre (including fruits, vegetables, breads, and cereals.

Maintaining an adequate level of fluid intake (usually at least 1.5L of water daily)
Using a bulk stool softening or fibre supplement.

Medical treatment for unproblematic, or smaller haemorrhoids is often effective.

This includes measures such as taking a salt bath 2-3 times per day for 10 minutes (best after a bowel motion), ice packs to reduce swelling, and soothing haemorrhoid creams, wipes, or suppositories.

Causes of Haemorrhoids

Many factors may contribute to the occurrence of haemorrhoids, including (but not limited to):

a Western diet (high in processed food, low in fibre), which causes constipation
Pregnancy and childbirth
Chronic coughing
Obesity

Rubber Band Ligation

This procedure is best done for internal haemorrhoids. This involves grasping and holding the haemorrhoid with a special suction tool, whilst simultaneously placing a small rubber band around the base of the haemorrhoid. This is usually performed on-site at Mana Clinic.

Surgical Excision (Haemorrhoidectomy)

This procedure is best done for large, prolapsing internal or for external haemorrhoids. Haemorrhoidectomy is performed in theatre under a general anaesthetic. This operation may cause pain for the two-to-three weeks following the procedure, which can be managed with painkillers and local anaesthesia.

Stapled haemorrhoidoplasty

This procedure is reserved for patients with circumferential prolapsing haemorroids, a disk of tissue is removed from the lower rectum and the defect is closed with a special stapling device, this will pull the haemorrhoids up into the anal canal.

Recovery after Haemorrhoid Treatment

Rubber band ligation may cause a mild ache. It is best to rest with your feet elevated and to use a stool softener immediately after your procedure. Mild bleeding may occur for the first few days after treatment, as well as when the haemorrhoid falls off (roughly 5-10 days after treatment). You may need to wear a pad or panty liner to protect your underwear during this period. As long as you do not have pain, you may return to normal activity in the first day or two after your procedure. Mr Haddawi will see you in the clinic approximately a few weeks after your initial treatment for a follow-up.

After surgical excision, you may be required to stay in the hospital overnight. This is to manage any post-operative pain. Pain may last for up to three weeks, requiring pain relief (such as paracetamol or ibuprofen). Minor anal bleeding and discharge are common for a few days. It may be best to wear a pad for a few days until the wounds heal. Mr Haddawi uses dissolvable stitches, so you do not need these removed.

Continue to use a laxative for three-to-four days after your surgery to ensure your bowels can open. You may find relief from a warm bath with Epsom salts after bowel motion or when you are in pain. Most patients return to normal daily activity within two weeks of the procedure, and Mr Haddawi will see you in the clinic for a follow-up 2-3 weeks after surgery.

After any surgical procedure, arrange for someone to drive you home. Do not drive, drink alcohol, make important decisions, or operate heavy machinery in the first 24 hours following general anaesthetic. Pain usually settles quickly when a pain reliever containing paracetamol or codeine is taken. Successful treatment does not guarantee haemorrhoids will not recur. If you adopt a healthy low-fat, high-fibre diet, exercise regularly, and drink plenty of water, you are minimising your risk of haemorrhoids returning.

Surgical Risks

As with any surgical procedure, there is a small chance of experiencing complications after haemorrhoid treatment. Mr Haddawi works with you closely to ensure any risks are mitigated as much as possible.

General risks as with any surgery are uncommon, these include:

A chest infection, which may develop after general anaesthesia.
Sore throat, caused by the breathing tube used for general anaesthesia. This may last for a few days.

Rubber band ligation and haemorrhoidectomy present their own unique set of risks. Rubber band treatment may provoke:

Mild pain
Mild bleeding
Pelvic infection. This is extremely rare but can be life-threatening and require immediate treatment with antibiotics.

Haemorrhoidectomy complications include:

Retention of urine (uncommon).
Bleeding, also not common.
Anal fissure (anal ulcer) rarely may result from failure of one of the haemorrhoidectomy wounds to heal. This can be minimised by keeping the stools soft.
Rarely, sepsis (blood infection). This may lead into bleeding into the rectum approximately 10 days after surgery. Sepsis can be life-threatening, and requires immediate treatment.

Call Mr Haddawi immediately on 027 557 9797 if you experience any of the following after your surgery:

Severe pain
Difficulty urinating
Severe, unexpected rectal bleeding, or passing of blood clots.
A fever greater than 38º C or chills
A general feeling of being unwell
Weakness or dizziness