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Hemorrhoid Treatment Options
Most hemorrhoids do not require surgery. It is usually considered only for severe hemorrhoids. Surgery may be done if other treatments (including home treatment) have failed. Surgery is also considered when symptoms become so bothersome that ones lifestyle is affected or when hemorrhoids create a medical emergency, such as uncontrolled bleeding or blood and pus at the anus along with severe rectal pain. External hemorrhoids usually are not removed by surgery, except if they are very large and uncomfortable or if the person is having surgery on the anal area for another reason, such as internal hemorrhoids or an anal fissure. Surgical removal of hemorrhoids (hemorrhoidectomy) is a last resort for treating small internal hemorrhoids.
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Hemorrhoidectomy is considered as the most successful way to treat large internal hemorrhoids, especially those that are still a problem after treatments that cut off blood flow to hemorrhoids (fixative procedures) have been tried. Hemorrhoid surgery is carried out either with general anesthesia or with spinal anesthesia. Incisions are made in the tissue around the hemorrhoid. The swollen vein inside the hemorrhoid is tied off to prevent bleeding, and the hemorrhoid is removed. The surgical area may be sewn closed or left open. Medicated gauze covers the wound. The operation is usually done in a surgery center on an outpatient basis. Stapled hemorrhoidopexy uses a circular stapling device to remove hemorrhoidal tissue and close the wound. No incision is made. The hemorrhoid is lifted and then stapled back into place in the anal canal.
Most hemorrhoids can be treated with simple changes to diet and bowel habits. Most do not require surgery or other treatment unless the hemorrhoids are very large and painful. The goal of non-surgical procedures used to treat hemorrhoids, called fixative procedures, is to reduce the blood supply to the hemorrhoid so it shrinks or goes away. The scar tissue left in place helps support the anal tissue and helps prevent more hemorrhoids from developing. Fixative procedures include tying off the hemorrhoids with a rubber band (rubber band ligation) or using heat, lasers, or electric current to create scar tissue (coagulation therapy). Fixative procedures are usually tried before surgery if hemorrhoids are small and stick out of the anus during a bowel movement but return to their normal position afterward (second degree hemorrhoid). Hemorrhoidectomy may provide better long-term results than fixative procedures. However, surgery is more expensive, requires longer recovery times, is usually more painful, and has a greater risk of complications. Fixative procedures are the preferred hemorrhoid treatment for people older than age 70 and for those who are in poor health. Click here for more information.
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