Haemorrhoidectomy (surgery for piles)

About haemorrhoidectomy

Haemorrhoidectomy is an operation to remove piles, which are swollen and inflamed blood vessels in the anal canal. Surgical treatment may be an option if other treatments haven’t worked or you have severe piles that cause pain, itching or bleeding.

What are the alternatives to haemorrhoidectomy?

Piles can usually be treated with self-help measures, such as eating a high fibre diet, or using soothing creams, ointments and suppositories to relieve the symptoms. Alternatively, non-surgical treatments may help, such as banding (where a small elastic band is placed just above the pile to cut off its blood supply), or less commonly sclerotherapy (where the pile is injected with an oily solution to make it fall off). Haemorrhoidectomy is only used if non-surgical treatments haven't worked. Your surgeon will be able to advise you which treatment is most suitable.

Preparing for a haemorrhoidectomy

Your surgeon will explain how to prepare for your procedure. For example, if you smoke you will be asked to stop, as smoking increases your risk of getting a chest and wound infection, which can slow your recovery.

Haemorrhoidectomy is routinely performed as a day case and is usually done under general anaesthesia. This means you will be asleep during the operation. You will be asked to follow fasting instructions, which involves not eating or drinking, typically for about six hours beforehand.

However, it’s important to follow your surgeon’s advice.

You may be prescribed a laxative to take in the days leading up to your admission to hospital. This will ensure that your bowel is empty on the day of your operation and will help make your first bowel movements afterwards easier. At the hospital, you may also have a bowel washout (an enema) before your operation.

Your surgeon will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to understand what will happen, and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead, which you may be asked to do by signing a consent form.

You may be asked to wear compression stockings to help prevent blood clots forming in the veins in your legs.

What happens during a haemorrhoidectomy?

The operation can take up to an hour depending on the size and number of piles to be treated, and the technique used.

Conventional open and conventional closed haemorrhoidectomy

These are the most common surgical techniques for removing piles.

Your surgeon will cut the pile away from the anal sphincter muscle using an electric current (known as diathermy). Rarely, laser or ultrasound can be used to remove the pile. If you have a closed haemorrhoidectomy, your surgeon may use dissolvable stitches to close the wound. In open haemorrhoidectomy the wound may be left open to heal naturally. An absorbent dressing may then be placed into your rectum to help stop any minor bleeding. This usually stays in place until your first bowel movement.

Doppler-guided haemorrhoidal artery ligation

This technique involves your surgeon using a thin, tube-like viewing device called a proctoscope to locate arteries higher up in your bowel that are supplying blood to the piles. Once your surgeon has found these arteries, he or she will tie them off using dissolvable stitches. When the blood supply is cut off, the piles gradually shrink in size over several weeks. Although your symptoms won’t improve immediately, you should expect to feel better after around four to six weeks.

Doppler-guided haemorrhoidal artery ligation has the advantage of causing very little pain after the operation compared to conventional haemorrhoidectomy.

Stapled haemorrhoidopexy

In this technique your surgeon uses a specially-designed circular stapler. He or she will put the stapler into your rectum and remove a doughnut-shaped piece of tissue above the pile. The staples lift and fix the pile back up into the anal canal and also reduce the blood supply to them, so that they shrink.

What to expect afterwards

You will need to rest until the effects of the anaesthetic have passed. You may need pain relief to help with any discomfort as the anaesthetic wears off.

You will usually be able to go home when you feel ready, but will need to arrange for someone to drive you home. Try to have a friend or relative stay with you for the first 24 hours.

Your nurse will give you some advice about caring for your healing wounds before you go home and you may be given a date for a follow-up appointment.

Recovering from a haemorrhoidectomy

It usually takes about eight to 12 weeks to make a full recovery from a haemorrhoidectomy, but this varies between individuals, so it's important to follow your surgeon's advice.

If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Don't take painkillers containing codeine (or similar) as these can cause constipation. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.

General anaesthesia temporarily affects your co-ordination and reasoning skills, so you must not drive, drink alcohol, operate machinery or sign legal documents for 24 hours afterwards. If you're in any doubt about driving, contact your motor insurer so that you're aware of their recommendations, and always follow your surgeon’s advice.

What are the risks?

As with every procedure, there are some risks associated with haemorrhoidectomy. We have not included the chance of these happening as they are specific to you and differ for every person. Ask your surgeon to explain how these risks apply to you.

Side-effects

Side-effects are the unwanted but mostly temporary effects you may get after having the procedure.

For example, you may have some mild pain in your anal area and bleeding or discharge from your anus. The pain and blood loss may be more noticeable during and after each bowel movement. You may find it helpful to wear a sanitary pad to prevent any leakage from the wound staining your clothes.

Most people don’t have any other problems after a haemorrhoidectomy, but you should contact your doctor if you have:

  • excessive bleeding
  • increasing pain
  • a high temperature
  • no bowel movement for several days
  • severe pain after a bowel movement

Complications

Complications are when problems occur during or after an operation. The possible complications of any operation include an unexpected reaction to the anaesthetic, excessive bleeding or developing a blood clot, usually in a vein in the leg (deep vein thrombosis, DVT).

Complications of haemorrhoidectomy are uncommon but can include:

  • infection
  • bleeding seven to 10 days after surgery
  • scar tissue causing your anus to become tighter (known as anal stenosis or stricture)
  • the loss of regular control of your bowels (faecal incontinence)
  • difficulty in passing urine (urinary retention)
  • a painful tear in your anus (anal fissure)
  • a tear in your rectum (rectal perforation)
  • a tear from your anus into your vagina if you are a women (known as an anovaginal fistula)

Speak to your surgeon for more information.
 

Which surgical method is best for removing piles?

Answer

Your surgeon will be able to recommend the best surgical method for you. There are benefits and risks associated with all haemorrhoidectomy procedures.

Explanation

Surgical treatment for piles is usually carried out by a specialist colorectal surgeon. Your surgeon will examine your piles and then decide the best method of treatment – it will usually depend on the size and location of them.

Although piles develop from inside your rectum, they can hang out of your anus. Conventional haemorrhoidectomy and stapled haemorrhoidopexy are more suitable for piles that are hanging out. Doppler-guided haemorrhoidal artery ligation may be a better option for piles inside your rectum.

Doppler-guided haemorrhoidal artery ligation may result in less pain after surgery than the conventional technique as the treatment is done higher up in your bowel, in an area which is less sensitive to pain, and the piles aren’t surgically removed.

Stapled haemorrhoidopexy may also results in less pain after surgery but there is a higher chance of the piles coming back.

Speak to your surgeon for more information about the options available to you.

What are the risks and benefits of having stapled haemorrhoidopexy?

Answer

Compared with conventional haemorrhoidectomy, stapled haemorrhoidopexy causes less pain afterwards and the recovery time is shorter. But, there is a greater risk of the piles coming back.

Explanation

Research suggests that stapled haemorrhoidopexy is a less painful alternative to conventional haemorrhoidectomy. The procedure also has a shorter recovery time compared to the conventional approach, but there is a slightly greater risk of the piles returning.

There is no difference in the number and type of complications between the two methods.

For more information about stapled haemorrhoidopexy, ask your surgeon.

What can I do to speed up my recovery after a haemorrhoidectomy?

Answer

Eating a healthy balanced diet, drinking enough fluids and gentle walking can help to speed up your recovery.

Explanation

Straining on the toilet won't help with your recovery because it increases your risk of having complications such as bleeding and tears in your anus.

To ease your bowel movements, it's important that you eat plenty of vegetables, fruit and high fibre foods, and drink enough fluids as this can help prevent constipation. Your doctor may suggest taking a bulk-forming laxative until your wounds are fully healed.

Increasing the amount of exercise you do will also probably help to ease constipation. Don't do anything too strenuous, but gentle exercises such as walking will help.

Speak to your doctor or surgeon before making any changes to your diet or the amounts that you eat and drink.

What happens if I develop complications after a haemorrhoidectomy?

Answer

If you develop a complication, then depending on the type and seriousness of it, you may need further hospital treatment.

Explanation

As with every procedure, there are some risks associated with haemorrhoidectomy. The possible complications of any operation include an unexpected reaction to the anaesthetic, infection, excessive bleeding or developing a blood clot, usually in a vein in the leg (deep vein thrombosis, DVT).

Specific complications of haemorrhoidectomy are uncommon but there is a risk of damage to the tissues in your rectum and anus. Depending on how severe the damage is, you may need further treatment such as having another operation to stop the bleeding or repair the tissue.

There is an increased risk of infection after a haemorrhoidectomy procedure because of the nature of the location. Wound infections can be treated successfully if they are diagnosed early. Symptoms to look out for include excessive bleeding, increasing pain and a high temperature. If you notice any of these symptoms, contact your doctor as soon as possible, as you may have developed an infection and will need antibiotics.