What Is a Hemorrhoidectomy?

A hemorrhoidectomy is a surgical procedure used to remove hemorrhoids. Hemorrhoids are swollen veins outside or just inside the anus. They can cause pain, itching, bleeding, and other bothersome symptoms. While most hemorrhoids can be treated with at-home measures, some cases require a hemorrhoidectomy. 

During this surgery, a surgeon will remove the hemorrhoids using a scalpel or other device. Up to one out of every 10 people with symptom-causing hemorrhoids eventually needs hemorrhoid surgery.

Purpose

A hemorrhoidectomy will get rid of your hemorrhoids and relieve the symptoms, like pain, they had been causing.

Hemorrhoids usually go away on their own. Lifestyle changes like an increase in fiber and water can help in their treatment. There are non-surgical, in-office procedures that can treat hemorrhoids, too. But if lifestyle changes and non-surgical treatment options have not worked, you might need a hemorrhoidectomy.

You might also need the surgery if you are bleeding a lot, are in pain, or have hemorrhoids that have become swollen and hard.

External Hemorrhoids

Hemorrhoids that occur outside the anus (external hemorrhoids) can be painful. This can be especially true if they become thrombosed, meaning a blood clot has formed. A healthcare provider may recommend cutting off a thrombosed hemorrhoid through surgery if it is causing severe and consistent pain for more than a few days. An external hemorrhoid that is very large or causing other symptoms also may benefit from a hemorrhoidectomy.

Even when external hemorrhoids go away on their own, they may leave behind an empty sac of skin called a skin tag. If this skin is bothersome, a surgeon can cut it off with surgery.

Internal Hemorrhoids

Hemorrhoids that occur inside the anal canal (internal hemorrhoids) often do not cause pain or other symptoms. Sometimes, however, an internal hemorrhoid can prolapse, or protrude, from the anus. A prolapsed hemorrhoid can lead to symptoms such as pain, and a healthcare provider may perform a hemorrhoidectomy to treat it.

Internal hemorrhoids can also become trapped in anal tissue. These hemorrhoids can lead to ulcers or tissue death and are extremely painful. They need immediate medical attention, which often means a hemorrhoidectomy.

Types of Hemorrhoidectomy

There are several methods surgeons can use to perform a hemorrhoidectomy. The type of hemorrhoidectomy depends on whether the hemorrhoid is external or internal.

Hemorrhoidectomy for External Hemorrhoids

A hemorrhoidectomy for external hemorrhoids usually involves excising, or cutting off, the hemorrhoids. In this procedure, the surgeon makes a circular incision around the hemorrhoid with a scalpel, scissors, or electrosurgical device. They then remove the skin and either close up the resulting wound with sutures or leave it open to heal on its own.

Hemorrhoidectomy for Internal Hemorrhoids

A surgeon may use one of several techniques to perform a hemorrhoidectomy on an internal hemorrhoid. The most common and effective is making an incision around the hemorrhoid and cutting out the hemorrhoid with a scalpel or other instrument. The procedure is referred to as the conventional technique.

Another type of hemorrhoidectomy for internal hemorrhoids is the stapled technique. For this, the surgeon uses a special device that lifts up the excess tissue above the hemorrhoids into a ring and cuts it off. No incision is needed for this procedure, so people tend to have less immediate post-surgery pain than with conventional hemorrhoidectomy. However, there tend to be more long-term complications, like fecal incontinence (leakage of stool).

To remove an internal hemorrhoid, a surgeon might perform a hemorrhoidal artery ligation. In this surgery, they will use an ultrasound device to cut off the blood supply to the arteries involved in the hemorrhoids. Over time, the hemorrhoids shrink up and fall off.

How Does It Work?

A hemorrhoidectomy can be performed in a hospital or, if the appropriate equipment is available, in your healthcare provider's office. Depending on the type of surgery, you may be placed under conscious sedation or given local or general anesthesia. You may also be given a perianal block to numb the area. Also known as an anal block, a perianal block stops the nerves in the area from transmitting pain signals to the brain.

Before the Surgery

Before you undergo a hemorrhoidectomy, your healthcare provider will perform a physical exam. If you have internal hemorrhoids, this may involve using a finger or scope to feel or look inside the anus. The exam will help your doctor know which type of anesthesia and surgical technique will work best.

Your provider will tell you when to stop eating or drinking before your procedure. They also may instruct you to stop taking certain medications, particularly blood-thinners. Make sure to tell them about all the drugs you take. If necessary, they will consult with other healthcare providers on your team to determine which medications you need to pause.

You will likely need to clean out your rectum with an enema before the surgery. If you are immunocompromised or have cellulitis (a bacterial skin infection), you may be prescribed an antibiotic drug to prevent infection. Follow all of your preoperative instructions closely.

During the Surgery

The surgical team will place you in a position to make your anus and rectum easily accessible to the surgeon. They may tape your buttocks apart to help with access as well.

So you don't feel the procedure, an anesthesiologist may give you some form of sedation or anesthesia.

The surgeon uses a surgical steel device to gently open your anal canal. Then, depending on which technique they are using, the surgeon will either remove the hemorrhoidal tissue with a scalpel, scissors, or laser or cut off the blood supply to the hemorrhoids with a stapling or ligation device. Finally, the surgeon will either close up the wound or leave it open to heal on its own.

After the Surgery

Having pain in the area of the surgery is normal after a hemorrhoidectomy. It may take several weeks to get back to all of your regular activities. To ease the pain, your healthcare provider may prescribe pain medication or recommend over-the-counter options. They also may recommend that you take sitz baths (warm, shallow baths) each day.

Trouble urinating or having a bowel movement is quite common after hemorrhoid surgery, as well. Taking sitz baths, eating fiber, taking a fiber supplement, and drinking plenty of water may help with these issues. Stool softeners or laxatives may also be appropriate in cases of constipation. 

If problems persist, call your healthcare provider. You may need to have another procedure to help remove the urine or stool from your body.

You also will likely need to continue with your postoperative lifestyle changes, such as increased fiber and water intake along with exercise, to prevent hemorrhoids from developing again.

Risks and Precautions

A hemorrhoidectomy can be much more effective for severe or recurring hemorrhoids than non-surgical options. However, it presents more risks. Each hemorrhoidectomy technique has unique risks for recurrence and possible complications. Common complications include pain, swelling, and a feeling of tightness in the anal area after the surgery. 

Other complications that may arise after the surgery include:

• Urinary retention and urinary tract infection
• Bleeding
• Fecal incontinence
• Anal stricture, or a narrowing of the anal canal that makes it hard to pass stool
• Recurring hemorrhoids

In rare cases, system-wide infections, abscesses, or inflammation of the abdominal lining can occur after hemorrhoid surgery. These complications require emergency medical care.

Hemorrhoidectomy is not right for everyone. For example, people with inflammatory bowel disease, existing fecal incontinence, or uncontrolled bleeding may not be able to undergo this surgery. Tell your healthcare provider if you are pregnant or breastfeeding. They can advise you about what is safe for you.

How to Prepare for a Hemorrhoidectomy

You can usually go home the same day of the surgery, so you should not have to stay overnight in the hospital. You will need to bring someone with you to the appointment to drive you home after the surgery. It is also a good idea to ask someone to help you perform daily tasks for a few weeks after the surgery while you heal.

You may need to stop eating, drinking, and taking certain medications before the surgery. Your surgical team will give you detailed preoperative instructions to follow.

On the day of the surgery, wear comfortable, loose-fitting clothing.

A Quick Review

A hemorrhoidectomy is a surgery performed to remove hemorrhoids. Hemorrhoids are a common condition, and they often go away on their own. If they don’t, lifestyle changes or non-surgical procedures often cure them. However, if lifestyle changes and non-surgical procedures don't get rid of the hemorrhoids, a hemorrhoidectomy may be needed to remove them. A hemorrhoidectomy may also be warranted in cases of extreme pain or when an internal hemorrhoid has prolapsed. Whether your hemorrhoids are internal or external can dictate what type of hemorrhoidectomy you have. The surgery is usually successful and has few serious or long-term side effects.