Haemorrhoid Surgery

 

Haemorrhoids are enlarged and dilated veins in and around the anus or rectum. The swollen veins can be either internal or external. Internal haemorrhoids are located inside the lining of the rectum and are not noticeable unless they are substantially enlarged, at which point that can be physically felt. They usually do not cause any pain, but can become apparent as they can cause rectal bleeding when emptying the bowels. Internal haemorrhoids can sometimes protrude outside of the rectum and can be seen or felt as moist areas of skin that are slightly lighter in colour than the surrounding area. As the rectum has a number of pain sensitive nerves, haemorrhoids can become painful. They can sometimes be pushed back in with the help of your finger or suppositories which will also help soften them.

 

External haemorrhoids are positioned below the skin, surrounding the anus. They are lower than internal haemorrhoids and are noticeable when they itch or bleed when opening the bowels, causing pain. External haemorrhoids can be seen when examining the anus, and can be felt more easily than internal haemorrhoids.

 

Blood clots can sometimes form within haemorrhoids that have descended externally, causing complications. Blood clots can cause an extremely painful condition called a thrombosis, resulting in the haemorrhoid turning blue or purple. This will often result in bleeding. Although unsightly, thrombosed haemorrhoids are generally not serious and will often reduce in size or disappear on their own after a few weeks. However, if the pain continues or gets worse, you may require surgery to remove them.

 

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Causes of Haemorrhoids

Haemorrhoids are caused by the swelling of the anal or rectal veins which can cause mild or severe irritation. A number of reasons can cause them. These include:

 

• Standing or sitting for long periods of time
• Pregnancy
• Obesity
• Straining when opening the bowels
• Poor diet which is low in fibre
• Chronic constipation
• Coughing or sneezing

 

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Symptoms of Haemorrhoids

Symptoms of haemorrhoids can range from being fairly mild to extremely painful. The most common symptom is painless bleeding. Bright red blood on the outside of stools, dripping into the toilet or on the toilet paper is very common. However, any rectal bleeding with a bowel movement is abnormal and should be discussed with your doctor who may refer you for further tests to rule out more serious conditions. These can include:

 

• Anal fistulas and/or fissures (abnormal passages between a hollow organ and body surface)
• Infection
• Inflammatory bowel disease
• Certain cancers such as bowel cancer

 

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Diagnosing Haemorrhoids

In order to make an accurate diagnosis, your doctor will take a full medical history and a description of your symptoms. A physical examination will involve your doctor looking at your anus and rectum to check for any swelling, irritation and lumps. A digital rectal examination will involve the doctor using a set of gloves and applying lubrication so they can insert a finger into your rectum to check for any tenderness and lumps. Your muscle tone may also be examined.

 

Doctors sometimes use a grading system to categorise haemorrhoids. This gives them an indication as to the severity of your condition. The system works in 4 stages:

 

1st Degree

Haemorrhoids are slightly enlarged and bleed, but do not protrude outside the anus.

 

2nd Degree

Haemorrhoids protrude and retract, with or without bleeding. Certain activities can cause this, such as emptying the bowels or straining whilst undertaking tasks such as heavy lifting.

 

3rd Degree

Haemorrhoids protrude outside of the anus and have to be pushed back in by a finger.

 

4th Degree

Haemorrhoids protrude and cannot be pushed back into the anal canal. Thrombosed haemorrhoids (containing blood clots) are classed as 4th degree.

 

Your doctor may refer you for additional tests, including:

 

Colonoscopy

A colonoscopy is a diagnostic procedure to aid your doctor in working out the cause of a problem in your bowel (colon). The procedure involves inserting a flexible telescope into the bowel through the rectum. The procedure usually takes around 30-45 minutes to perform. If appropriate, your doctor may give you a sedative or painkiller before you undergo the procedure. The telescope will be inserted into your colon and air will be blown into the bowel to ensure your surgeon can see what they are looking for. 

 

Flexible Sigmoidoscopy

A flexible sigmoidoscopy is a diagnostic procedure used to check the inner lining of the rectum and lower part of the colon. It is often used for patients who are experiencing rectal bleeding. A sigmoidoscope is a long, flexible tube, about half an inch in diameter. It has a very small light and camera which allows the doctor to view the lining of the rectum and the lower third of the colon.

 

Anoscopy

An anoscopy is a straightforward procedure that helps your doctor detect any abnormalities in the gastrointestinal tract, particularly in the anus and rectum. Your doctor will insert a device called an anoscope into your anus. It is usually made of disposable plastic or stainless steel and enables your doctor to get a detailed look at the tissue with the anal-rectal area.

 

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Treatment for Haemorrhoids

Haemorrhoid symptoms will often disappear on their own, but if your symptoms are mild, your doctor may recommend over the counter suppositories or topical ointments to ease pain, itching and swelling. Suppositories help soften stools, making bowel movements less painful.

 

A healthy high fibre diet and drinking 8 glasses of water a day can help alleviate the condition for some people as this can promote softer more regular bowel movements. A low fibre diet can lead to constipation which often contributes to flare-ups of haemorrhoids. Constipation usually results in straining whilst trying to empty the bowels which can further irritate the swollen veins. Warm baths can also help ease any discomfort, along with ice packs to reduce pain and swelling.

 

If conservative treatments are not providing relief from your haemorrhoids, your doctor may recommend you for a surgical procedure.

 

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Removal of Haemorrhoids

There are various procedures for removing haemorrhoids, ranging from laser treatment that can be carried out by your GP, through to surgical removal for large and very painful haemorrhoids.

 

Surgical removal of haemorrhoids is generally a safe and effective procedure, but you will still be required to follow a healthy diet and lifestyle in order to avoid future constipation.

 

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Types of Surgery

Surgery for the removal of haemorrhoids falls into 2 categories – with or without anaesthetic.

 

Without Anaesthetic:

 

Sclerotherapy

Sclerotherapy is a common form of haemorrhoid removal surgery and is usually performed at your GP practice. A chemical (phenol or quinine urea) is injected into the haemorrhoid which causes it to shrink and stop bleeding. This procedure causes little pain, and any that is felt usually subsides by the following day. Sclerotherapy tends to be more successful in treating small, internal haemorrhoids, although you will be required to return for treatment after a few years.

 

Banding

Banding, formally known as Rubber Band Ligation can also be carried out at your GP practice and is used for treating internal haemorrhoids. The aim is to encircle the base of the haemorrhoid with a tight rubber band. Restricted blood flow to the banded tissue allows it to wither and die. It is then replaced by an ulcer that heals with a small amount of scarring. The procedure generally needs to be carried out 2-3 times, roughly 2 months apart to allow for healing. It is not painful, but you may experience pressure or mild discomfort. Complications are more common with banding compared to Sclerotherapy, particularly bleeding 1-2 weeks after the procedure, or a bacterial infection in the tissues surrounding the haemorrhoids (cellulitis) may develop. Symptoms usually return after several years, but can be treated again with further ligation.

Banding is not recommended for patients taking blood thinners due to the high risk of bleeding complications.

 

Coagulation Therapy

Coagulation Therapy, also known as infrared photocoagulation is a procedure which uses infrared light, heat or extreme cold to make the haemorrhoid retract and shrink. Again this procedure can be carried out at your GP practice, usually along with an anoscopy to diagnose your condition.

 

Haemorrhoid Artery Ligation

Haemorrhoid Artery Ligation is a fairly new procedure which uses an ultrasound to shut off the blood vessels that are causing the haemorrhoid. A Doppler sensor is inserted into the anus to detect the arteries after which the doctor can tie them off to cut the blood supply. Haemorrhoids are immediately reduced and within a matter of weeks are no longer visible. It is more effective than banding and is virtually painless.

 

With Anaesthetic:

 

Haemorrhoidectomy

A haemorrhoidectomy is a surgical procedure for the removal of large external haemorrhoids and prolapsed internal haemorrhoids, causing problems which cannot be managed through non-surgical treatments. This procedure is carried out either under a general, local or regional (numbing the body from the waist down) anaesthetic so you will not feel any pain. If you are having a local or regional anaesthetic, you may be given a sedative to help you relax during the procedure.

 

The surgeon will cut out any external large haemorrhoids or internal haemorrhoids (excisional haemorrhoidectomy). Once they have all been cut out, the area will be closed with sutures (stitches) or left open (open technique). The results with both methods are similar. You will then be taken to the recovery room for a brief period for observation to ensure your vital signs are stable, after which you can go home.

 

Haemorrhoidopexy (Stapled Haemorrhoidectomy)

Haemorrhoidopexy is also referred to as stapling and is usually carried out as a day-case procedure. As with a haemorrhoidectomy, you will be required to have either a general, local or regional anaesthetic to ensure you do not feel any pain. This type of surgery is used to treat prolapsed haemorrhoids. The staple fixes the haemorrhoid back into place inside the rectum which results in the blood supply being cut off and the tissue shrinking and be reabsorbed. The procedure is quicker than a haemorrhoidectomy and is less painful with a faster recovery time.

 

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Post-Operative Recovery

Post-operative pain is a significant issue resulting from a haemorrhoidectomy. Rectal and anal pain is common, and your doctor will usually prescribe a painkiller to ease discomfort. If pain is severe, narcotics are often required. Pain can last for up to 4 weeks’ post-surgery. Recovery usually takes between 2-6 weeks, depending on the type of surgery performed and the severity of your condition. Most patients will begin to feel better after the first week, particularly if they are able to keep their bowel movements soft and slightly loose.

 

If you do not experience any complications with your recovery, you should be able to return to non-strenuous activities a week after treatment, and resume normal activities within 2-3 weeks.

 

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Risks and Complications

Complications are rare, but should be conveyed to your doctor if you have any concerns.

 

Bleeding

A small amount of bleeding is common following surgery; however, significant amounts, particularly with clots, should be reported to your doctor.

 

Infection

Infection after a haemorrhoidectomy is a risk due to the location of the treatment. Stools can come into contact with the surgical site and contribute to infection. Signs of infection can include:

 

• Fever and chills
• Pain with urination
• Inability to urinate
• Presence of pus
• Dizziness

 

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Aftercare

The below steps can often prevent a recurrence of haemorrhoids or help to avoid further treatment.

 

• Staying hydrated by drinking at least 8 glasses of water per day
• Eating a high fibre diet
• Using a stool softener to avoid straining when emptying the bowels
• Avoiding heavy lifting or pulling
• Light exercise for 15 minutes a day
• Taking a warm bath with warm salt water several times a day to soak the anal area (sitz bath)

 

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Need Help?

At One Healthcare we can book you in to see a specialist Colorectal surgeon, usually within 48 hours, for an initial consultation.  Haemorrhoid surgery is available at One Ashford Hospital in Kent and One Hatfield Hospital in Hertfordshire.

 

 

You can use your private medical insurance or pay for your Haemorrhoid Surgery treatment. We offer competitive, fixed price packages. If you are using your health insurance, please contact your insurer first for approval and let them know you’d like to be treated at either the One Ashford Hospital or One Hatfield Hospital.

Why One Healthcare

• Modern purpose-built hospital opened in March 2016 (Ashford) December 2017 (Hatfield)
• Fast access to diagnostics including MRI, X-ray and Ultrasound
• 0% and low finance options**
• Private, spacious, en-suite rooms
• Specialist Physiotherapy and nursing teams
• Little or no waiting time
• ‘Ultra clean air’ theatres
• Freshly prepared food
• Calm, dignified experience

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