Hemorrhoidectomy: Preparation and Recovery

This is a very common condition and according to some researches, almost 50% of all Americans have developed this condition at least once in their lifetime. More then the half a million Americans per year are seeking medical help because of the hemorrhoids.
It is estimated that 10 million people in North America have hemorrhoids. Most patients with symptomatic hemorrhoids are between the ages of 45 and 65.
 
There are several possible treatment options. In many cases, especially more serious ones when all other methods failed, operation called hemorrhoidectomy is the only plausible solution.

Causes of hemorrhoids

There were many researches about possible causes of hemorrhoids and some of them showed that this is a poly-etiological disease. There are several possible causes, which can provoke this condition. They include:
 
1.    genetic predisposition
2.    straining during bowel movements
3.    too much pressure on the rectal veins due to poor posture
4.    Constipation
5.    chronic diarrhea
6.    poor bathroom habits
7.    pregnancy,
8.    postponing bowel movements,
9.    Low-fiber diet
10. Obesity
11. A sedentary lifestyle.

Symptoms and types of hemorrhoids

There are two main types of hemorrhoids and they both have some characteristic symptoms:

   1. External hemorrhoids are those that occur outside of the anal verge. Most common symptom is pain, which can be accompanied by swelling and irritation. Nevertheless the itching is often considered to be the main symptom and sign of external hemorrhoids. The fact is that it is more common due to skin irritation.
      When the blood vessel perforates, a fresh red blood will be found in the stool.
   2. Internal hemorrhoids are those that occur inside the rectum. Interesting thing about this type of hemorrhoids is that, because this area has no pain receptors, they are usually not painful and most people are not aware that they have them. They also may cause bleeding when irritated or perforated.

There are also two special forms of hemorrhoids that don’t belong either to the internal or external type. First of them are Prolapsed hemorrhoids.
 
The fact is that these simple internal hemorrhoids can become so distended that they get pushed outside of the anus.
 
Strangulated hemorrhoids are also a special type of hemorrhoids, which occur when anal sphincter spasms and traps a prolapsed hemorrhoid outside of the anal opening. This of course is causing the cut off in the blood supply.
 

Treatment of hemorrhoids

Prevention of hemorrhoids

Prevention includes several activities that can be performed easily. Some of those include:

    * drinking more fluids
    * eating more dietary fiber
    * exercising
    * practicing better posture
    * Reducing bowel movement strain
    * Laxatives should be avoided
 

Temporary relief

There are several possible treatments that are being developed in order to temporary relieve the symptoms of hemorrhoids or to cure the condition for good.
 
Temporary relief is offered to those patients with mild symptoms and temporary conditions that will probably heal spontaneously. Some of the measures are:

    * Warm sitz baths using a bidet,
    * extendable showerhead,
    * cold compress, or
    * topical analgesic medications

 
It is believed that these measures are sufficient to provide temporary relief and if a person uses them in the early stages of hemorrhoids, further development and irritation should be stopped.

Natural treatments

Many natural treatments have shown to be very effective in treating chronic hemorrhoids. Some of them include:

   1. Usage of herbs and dietary supplements that strengthen the vein walls. Some of those supplements are butcher's broom, horse chestnut, bromelain and Japanese pagoda tree extracts. It is also proven that pure aloe juice can relieve some symptoms of hemorrhoids.
   2. Eating diet rich in fibers can also relieve the symptoms. Food rich in plantain and Psyllium seed can help create soft stool that is easy to pass through the rectum, which will lessen the irritation of existing hemorrhoids.

Medical treatments

There are several surgical and non-surgical procedures, which will relieve the symptoms of chronic hemorrhoids. Some of those are:

   1. Hemorrhoidolysis: desiccation of the hemorrhoid using some electrical instruments. It is painless and highly effective.
   2. Dilation: Relieving the hemorrhoids could be also done by stretching the anal sphincter muscle, but this method has several side effects, which made it very unpopular. 
   3. Rubber band ligation
   4. Sclerotherapy: This treatment is done by injecting some hardening agent into hemorrhoids. 
   5. Cryosurgery:  injection of medications which causes them to fall away
   6. Laser, infrared or BICAP coagulation
   7. Hemorrhoidectomy
 

Hemorrhoidectomy

A hemorrhoidectomy is the surgical removal of a hemorrhoid. It is the best and the most effective method of hemorrhoids treatment. This is the last defense treatment. The primary purpose of a hemorrhoidectomy is to relieve the symptoms associated with hemorrhoids that have not responded to more conservative treatments. Surgery is very helpful because it completely relieves hemorrhoid symptoms that could not be relieved using non-surgical treatment or control prolonged bleeding that could lead to anemia.

Preparation for the operation

Patients who are scheduled for a surgical hemorrhoidectomy should be given a sedative intravenously before the procedure. The small-volume Saline enemas are also given to cleanse the rectal area and lower part of the large intestine. This preparation provides the surgeon with a clean operating field. A few days prior to surgery, blood and urine tests may be performed. You should not eat or drink 12 hours before the procedure. It is proven that the operation can be extremely risky for the people who are suffering from some blood diseases or bleeding disorders, cancer of the stomach and intestines, inflammatory bowel disease or women who are in the first trimester of pregnancy.

The operation details

The operation can be done using local or general anesthesia. Local anesthesia causes a loss of feeling in the area where the surgery is to be done but patient remains awake during the operation. General anesthesia causes the patient to become unconscious during the operation.
 
During the surgery, the patient is positioned so that the anal-rectal area is fully exposed. The hemorrhoids are simply clamped, tied off, and then cut away. Special care must be taken because there is a risk of damaging the muscles that control the anal opening. Hemorrhoidectomy has a high rate of success and the good news is that most patients have an easy recovery with no recurrence of the hemorrhoids.
 

Postoperative care

During the first hour or hemorrhoidectomy, patients should lie on their back in order to decrease the risk of an anesthesia-induced headache, which can be painful and prolonged. Intrahospital stay is reduced to the minimum and patients may be able to go home the same day or may spend 1 or 2 days in the hospital. The pain medication is prescribed and should be taken as directed. Generally, the complete recovery can last from 6 weeks up to 2 months.

Precautions to take

Every individual should do some particular activities at the first three to four weeks after the surgery. Some of those activities are:

    * Avoid lifting anything heavy
    * Keep the incision clean and dry
    * Eat a high-fiber diet
    * Drink plenty of fluids
    * Take some stool softener or a laxative to prevent constipation.

Possible postoperative complications

Some possible complications that are common after this type of operation are:

    * Infection
    * Excessive bleeding
    * Narrowing of the rectum
    * Allergic reaction to the anesthetic.
    * Anal fistula or fissure
    * Constipation
    * Excessive discharge of fluid from the rectum
    * Fever
    * Inability to urinate or have a bowel movement
    * Severe pain, especially when having a bowel movement
    * Severe redness and swelling in the rectal area

You should suspect that you have developed some kind of post-operative complication if you experience severe pain, especially with bowel movements, excessive drainage of fluid or pus, fever, severe redness and swelling in the rectal area, inability to have a bowel movement or inability to urinate.

Laser hemorrhoidectomy

In the last couple of years, laser operation is also being used to treat the hemorrhoids.  During the laser hemorrhoidectomy, laser light source is being used to remove tissue that is diseased or to treat blood vessels that are bleeding.
 
Advantages of laser surgery

   1. These types of operations are called bloodless surgeries because the laser procedures usually involve less bleeding than conventional surgery.
   2. The risk of infection is also largely reduced since the heat generated by the laser keeps the surgical site free of bacteria.
   3. The incision is also much smaller.
   4. Laser procedures often take less time and cost less.

Disadvantages of laser surgery

Hospital must be equipped with oxygen and other drugs and equipment required for cardiopulmonary resuscitation and physicians performing laser procedures should be properly trained, licensed, and insured. Emergency transportation to a hospital should be available whenever laser surgery is performed in a non-hospital setting.