When do hemorrhoids need surgery

Hemorrhoid surgery is usually performed in a hospital, surgical center, or surgeon's office by a general surgeon or colon and rectal surgeon. In select cases of suddenly occurring thrombosed external hemorrhoids that cause severe pain, surgery may be performed in an emergency room.

On the day before surgery, you will likely be asked to eat a light, non-greasy breakfast and lunch. After lunch, you will be asked to only drink clear liquids up until four hours prior to your surgery at which point you cannot drink anything.

You may be advised to stop taking certain medications several days prior to surgery. At the top of the list are those that increase your risk for bleeding, such as nonsteroidal anti-inflammatory drugs NSAIDs. You will also be instructed to undergo a cleansing bowel regimen prior to the procedure. Typically, your colon cleansing products can be purchased over the counter. An example regimen may include the following:.

Follow the specific instructions outlined by your healthcare provider. On the day of your surgery, wear comfortable, loose-fitting clothes and avoid wearing makeup or nail polish. Leave all valuables, including jewelry, at home. Make sure you bring your driver's license, insurance card, and a list of your medications. If you are staying overnight in the hospital, pack a bag the night before your surgery. In addition to personal care items like a toothbrush and hairbrush and comfort items like a magazine or hand cream , be sure to pack:.

Someone will need to drive you home when you are discharged, so either plan for the person to accompany you to your surgery or to be on stand-by for your discharge.

You should stop smoking at least two weeks and ideally six to eight weeks before surgery, as smoking can impair wound healing. On the day of your hemorrhoid surgery, you will arrive at the hospital, surgical center, or office and check-in.

After checking in, you will be taken to a holding area where you will change into a hospital gown. A surgical nurse will review your medication list, record your vitals heart rate, blood pressure, etc. You may receive an antibiotic through your IV at this time to help prevent post-operative infection.

The IV will also be used for administering fluids and medications during and after surgery. Your surgeon will then come to greet you and review the operation with you. They might perform an anoscopy while they are there to double-check the status of your hemorrhoids e. From there, you will be wheeled into the operating room on a gurney where the anesthesia process and surgery will start.

If general anesthesia is needed, the anesthesiologist will give you inhaled or intravenous medication to put you to sleep.

Once asleep, a breathing tube called an endotracheal tube will be inserted down your throat to allow for mechanically-assisted breathing during the operation. With regional anesthesia , the surgeon injects a numbing medication into your spine. You may feel a stinging sensation as the medication is being injected. Local anesthesia also involves a numbing medication, but it is injected into the area around your anus.

You will also probably be given a sedative to help you relax or fall asleep during the surgery. Compared to spinal regional anesthesia, research suggests that local anesthesia for hemorrhoid surgery is associated with less pain and urinary retention after surgery. Just as what's involved in delivering anesthesia differs depending on the technique being used, so do the steps that come next. Here's one example. For a conventional internal hemorrhoidectomy, you can generally expect the following:.

A nurse will monitor your vital signs in the recovery room as you slowly wake up from general anesthesia or the sedative. Since urinary retention is a potential complication of hemorrhoid surgery, you may be asked to urinate before being approved to go home if a same-day surgery. If you are staying in the hospital, you will be wheeled on a gurney to your hospital room.

Recovery can take anywhere from one to six weeks, depending on the type and extent of your surgery. As you recover at home or in the hospital, expect to experience pain and a sensation of anal fullness or tightness for the first week or so.

To ease your pain, your surgeon will advise the following:. You can expect to have a bowel movement by the third day after your surgery. It's important to follow up with your surgeon as advised. During these appointments, your surgeon will check your wound site, monitor for complications, access your pain, and remove any sutures if applicable.

Mild bleeding and a yellow-red discharge from the anal area are common after surgery. Both may increase with bowel movements and activity. Your surgeon will advise you to wear pads to monitor the drainage and to avoid soiling your underwear and pants. You may also have a gauze dressing over your anal wound or some sort of packing in your anal area. Talk to your surgeon about when to remove this and how to change or replace it if applicable and necessary.

Check with your surgeon, but you can probably shower the day after surgery. That said, you will want to avoid submerging your wound in a soapy bath for one week sitz baths are OK. If you have any stitches, they will dissolve around 10 to 14 days after surgery or be removed at one of your follow-up appointments.

You will have specific activity guidelines to follow after surgery, such as:. Besides keeping in touch with your surgeon as instructed, you will also want to adopt lifelong habits that will prevent hemorrhoids from forming again.

These habits include:. If you are struggling with constipation, talk with your healthcare provider about taking an occasional laxative or using an enema. Such complications might include anal stenosis or fecal incontinence. Most patients with symptomatic hemorrhoids notice that their discomfort and irritation eases within about a week or so of implementing conservative strategies—making surgery moot.

That said, if surgery is needed, know that it's often very effective. It will also require a commitment to your post-operative care. If you are considering surgery for your hemorrhoids, please take your time talking with your healthcare provider about what the best surgical technique is for you.

Also, remember to review potential risks, what type of anesthesia is being used, and any concerns or questions you have. You want and deserve to be as informed and as comfortable as possible going into surgery. Compared with hemorrhoidectomy, however, stapling has been associated with a greater risk of recurrence and rectal prolapse, in which part of the rectum protrudes from the anus.

Complications can also include bleeding, urinary retention and pain, as well as, rarely, a life-threatening blood infection sepsis. Talk with your doctor about the best option for you. There is a problem with information submitted for this request.

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You will also receive emails from Mayo Clinic on the latest health news, research, and care. If you have signs and symptoms of hemorrhoids, make an appointment with your regular doctor. If needed, your doctor might refer you to one or more specialists — including a doctor with expertise in the digestive system gastroenterologist or a colon and rectal surgeon — for evaluation and treatment.

Be aware of any pre-appointment restrictions. When you make the appointment, ask if there's anything you need to do in advance. Before your appointment, take steps to soften your stools.

Eat more high-fiber foods, such as fruits, vegetables and whole grains, and consider an over-the-counter fiber supplement, such as Metamucil or Citrucel. Drinking six to eight glasses of water a day also might help relieve your symptoms. Hemorrhoids care at Mayo Clinic. Mayo Clinic does not endorse companies or products.

Advertising revenue supports our not-for-profit mission. This content does not have an English version. This content does not have an Arabic version. Diagnosis Your doctor might be able to see external hemorrhoids. Digital examination. Your doctor inserts a gloved, lubricated finger into your rectum. He or she feels for anything unusual, such as growths.

Visual inspection. One option for a minimally invasive treatment of internal hemorrhoids is laser coagulation. It is often recommended for medium-grade hemorrhoids — specifically, those rated level two or level three. In this procedure, a specialty laser is inserted right into the affected tissue.

The energy that it emits causes the tissue to coagulate and scar. Therefore, the hemorrhoid can no longer get the blood that it needs, so it withers and falls off. Another option is hemorrhoid banding. This treatment is usually best for patients with level one or level two hemorrhoids, but more severe cases may also benefit from the procedure. A tool called a ligator is used to place a tiny rubber band around the base of the hemorrhoid. This is another method of cutting off blood flow to the tissue so that it shrinks and then separates from the rectal wall.

Learn more about this procedure in the video below:. Sometimes an internal hemorrhoid sticks out of the anal opening. This condition is called prolapsing, and you can tell how far a hemorrhoid has progressed based on its level of prolapse. The most serious hemorrhoids are permanently prolapsed and do not go back into place even when you try to push them into the rectum. Prolapse is a sign that it is time for more than home remedies.

Once again, however, hemorrhoidectomy does not have to be the first course of treatment. Laser coagulation and rubber band ligation can be very effective procedures for resolving prolapsed hemorrhoids. If you've experienced hemorrhoids before, you should maintain a lifestyle aimed at hemorrhoid prevention. This includes eating lots of fiber, drinking plenty of water, avoiding constipation, and reducing how much sitting and straining you do.

Despite these changes, some people may experience repeated flare-ups. If you get hemorrhoids often, your doctor will probably recommend treating them instead of continuing to rely on home remedies.

Hemorrhoidectomy may eventually be required if initial procedures don't keep the problem at bay. However, it's usually best to try other treatments before resorting to major surgery. Minimally invasive procedures boast easier recovery times, and they are sufficient for treating the majority of cases.