Haemorrhoidectomy

Background

A haemorrhoidectomy involves cutting off (excising) the haemorrhoids and skin tags. Often there are up to three haemorrhoids that need to be excised.

Pre-operative preparation

In the week leading up to the surgery it is important to try and keep your stools soft. This will help with post operative bowel function and pain management. Drink plenty of water and maintain a high fibre diet. You may benefit from using fibre supplements such as Metamucil.

The operation

The operation can either be performed as a day case or an overnight stay in hospital. You may be given an enema by the nursing staff in hospital prior to your procedure. The operation itself will usually take anywhere from 15 minutes to an hour depending on the number and size of the haemorrhoids.

The haemorrhoids are usually removed with diathermy (cautery) and tied off. The wounds are only partially closed on the inside with the wound on the skin left open. This tends to help the healing process.

Post-operative care

Hospital stay

A haemorrhoidectomy can be either performed as a day case or an overnight stay. This will depend on the extent of the surgery, other medical problems and your preference. Most people who stay overnight following a haemorrhoidectomy can go home the next morning.

Pain relief and medications

Haemorrhoid operations have a reputation for being painful in the post operative period. For most people this pain starts to develop a few days after the operation once bowel actions happen. Many will report that the pain is worst for the first 2 weeks and then slowly subsides after this. By about 6 weeks most people are back to normal.

You will be given ample pain relief to go home with to help with your recovery.

You will also be prescribed laxatives to use as required. Take them for as long as you require. Many of the strong pain killers can result in constipation which in turn can worsen the pain. The laxatives will help counteract this effect.

You may be prescribed antibiotics to go home with.

Wound care

Wound care following a haemorrhoidectomy is quite easy. Try to keep the area as clean as possible. Many find it easier to have a shower after a bowel action as cleaning can be painful. Salt baths have been used in the past but can be painful initially as the salt can sting open wounds.

Return to work

Most people following a haemorrhoidectomy do not want to return to work for at least one week and often two or more. Once you feel comfortable it is safe to return to work. Sitting for prolonged periods will not delay the healing process.

Complications

Any surgery carries risks of complications. The following are some of the more common and serious complications:

Bleeding

You will get small amounts of bleeding in the first few weeks. This is normal and should settle over time. Serious bleeding is very uncommon.

Infection

Surprisingly significant wound infection is relatively uncommon. The wounds will often ooze a clear or yellow liquid but this not necessarily indicat an infection that requires antibiotics.

Sphincter damage

Underneath the haemorrhoids are the sphincter muscles. These are the muscles that help to maintain continence. Rarely these muscles can be damaged during a haemorrhoidectomy resulting in leakage.

Anal stenosis

If too much haemorrhoid tissue is removed it can cause problems with excess scarring and narrowing of the anal canal. For this reason it is sometimes not possible to remove all haemorrhoids and may require a second operation.

Recurrence

Haenorrhoids can recur. However, a haemorrhoidectomy has the least risk of this happening. Take steps to avoid constipation and straining with increased water and fibre in the diet.