Hemorrhoid Surgery

Everyone has haemorrhoids: cushions of blood vessels, connective tissue and muscle that line the anal canal and help with continence. They become a problem when they swell, slide down or bleed, usually because of straining, constipation, pregnancy, heavy lifting or the ageing of the supporting tissue. Internal haemorrhoids arise inside the anal canal and are graded from first degree, which only bleed, to fourth degree, which stay outside. External haemorrhoids lie under the skin around the anus and can form painful clots. Haemorrhoid surgery is the group of operations that remove, reposition or shrink these cushions. Conventional haemorrhoidectomy cuts out the enlarged tissue. Stapled haemorrhoidopexy lifts prolapsing tissue back into place. Haemorrhoidal artery ligation with recto-anal repair, known as HAL-RAR, ties off the feeding arteries with ultrasound guidance and stitches the prolapse up. Laser haemorrhoidoplasty shrinks the haemorrhoids from within.

Most haemorrhoids are treated without an operation. More fibre and fluid, avoiding straining, short courses of creams or suppositories, and clinic procedures such as rubber band ligation settle first- and second-degree haemorrhoids in most people. Surgery is recommended when symptoms continue despite these measures, or when the haemorrhoids are larger from the outset. Typical reasons are third-degree haemorrhoids that come out on straining and must be pushed back, fourth-degree haemorrhoids that stay outside, combined internal and external haemorrhoids, repeated bleeding causing anaemia, and haemorrhoids that return after several banding sessions. A large, clotted external haemorrhoid seen early may be removed under local anaesthetic. Because bleeding from the back passage can also come from polyps, fissures, inflammatory bowel disease or bowel cancer, a careful examination and, depending on age and symptoms, often a colonoscopy come before any haemorrhoid operation.

Haemorrhoid surgery is usually done under general or spinal anaesthesia, sometimes with local anaesthetic and sedation, and the choice of technique depends on the type and size of the haemorrhoids and on your priorities. In conventional haemorrhoidectomy, the surgeon removes each enlarged haemorrhoid with scissors or an energy device, leaving small wounds that are either left open or stitched closed. Stapled haemorrhoidopexy uses a circular stapler inside the rectum to remove a ring of tissue above the haemorrhoids and pull them back up, without wounds on the outer skin. In HAL-RAR, a small Doppler probe locates the arteries feeding the haemorrhoids, which are tied, and a running stitch lifts the prolapse. In laser haemorrhoidoplasty, a thin fibre delivers controlled energy into each haemorrhoid to shrink it from inside. Most procedures take about 20 to 45 minutes, and a small dressing is placed at the end.

Good candidates have troublesome haemorrhoids confirmed by examination, are fit for anaesthesia and have had other causes of bleeding excluded. Your surgeon examines the anal canal, often with a short viewing tube called a proctoscope, and asks about bowel habit, continence and previous anal surgery, because existing weakness of the sphincter muscles or conditions such as Crohn's disease change the plan. People with large external haemorrhoids often do better with excision, while those mainly troubled by prolapse or bleeding may suit stapled, artery-ligation or laser methods. Before surgery, blood tests check for anaemia and clotting, and blood thinners are adjusted on medical advice. You may be given an enema or a mild laxative to empty the lower bowel on the day. International patients can begin with a remote consultation describing symptoms and previous treatments, and the final choice of technique is made after examination on arrival.

Most people go home the same day or the next morning. Discomfort is greatest when opening the bowels in the first one to two weeks, so stool softeners, fibre, plenty of fluid and regular painkillers are prescribed, and warm shallow baths several times a day ease spasm and keep the area clean. Some bleeding and discharge are expected for a few weeks while wounds heal. After conventional haemorrhoidectomy, healing usually takes about three to four weeks, while stapled, artery-ligation and laser procedures generally allow a quicker return to normal activity. For travel, staying about five to seven days lets the first bowel movements settle and the surgeon check healing; sitting for long periods is uncomfortable early on, so a cushion and breaks to walk help on the flight. Heavy lifting is avoided for a few weeks, and keeping stools soft in the long term reduces the chance of recurrence.

Haemorrhoid surgery is common and generally safe, and the main burden is discomfort rather than danger. Early risks include bleeding, which occasionally needs a return to the operating theatre, difficulty passing urine after spinal anaesthesia, infection and anal spasm. Later, a small number of patients develop narrowing of the anal canal, small skin tags, a fissure or a slow-healing wound. Minor leakage of wind or soiling can occur for a while and rarely persists, which is why sphincter health is checked beforehand. Techniques differ: conventional haemorrhoidectomy gives a lasting result for large haemorrhoids with a lower recurrence rate but is more painful, whereas stapled, HAL-RAR and laser procedures cause less pain and allow a faster return to work but carry a higher chance of the haemorrhoids returning over the years. Discussing these trade-offs openly with your surgeon is the key to the right choice.