Haemorrhoidectomy

A haemorrhoidectomy is an operation to remove haemorrhoids (piles) from the anus. It is often done as a day case, requiring no overnight stay. If you do stay, you will only need to be in hospital for one or two nights.

The operation is usually performed under a general anaesthetic. This means you will be asleep throughout the procedure.

Your specialist or hospital will talk to you about admission procedure, however before you come into hospital, you will also be asked to:

• have a bath or shower at home on the day of your admission
• remove any make-up, nail varnish and bulky or sharp jewellery. Rings and earrings that you would prefer not to remove can usually be covered with adhesive tape
• follow any fasting instructions given to you. Typically, you must not eat or drink for about six hours before a general anaesthetic. However, some anaesthetists allow occasional sips of water until two hours beforehand

You may be prescribed a laxative to take in the days leading up to your admission. This will ensure that your bowel is empty on the day of your operation, and will help make your first bowel movements afterwards easier. Please follow the instructions carefully.

When you arrive at the hospital, a nurse will explain how you will be cared for during your treatment and will perform some simple tests such as checking your pulse and blood pressure, and taking a urine sample.

Your consultant and anaesthetist will also visit you. This is a good time to ask any outstanding questions about your treatment.

Once the anaesthetic has taken effect, your specialist will tie a tight string (ligature) around the base of the haemorrhoid to control bleeding, and then cut off the outer part. The wound is closed with stitches. Most of the stitches will be inside the anal canal. These stitches will dissolve over about two to four weeks.

The surgeon may place an absorbent pack into your rectum to help stem bleeding. This usually stays in place until your first bowel movement. The operation usually takes 30-60 minutes.

Consent
You will be given a consent form to sign. By doing this, you confirm that you understand what the procedure involves, including the benefits and risks, and give your permission for it to go ahead.

Please refer to further information below regarding the possible side-effects and complications of this procedure. You need to know about these in order to give your informed consent.

After your operation
You will be taken from the operating theatre to the recovery room, where you will come round from the anaesthetic under close supervision. After this, you will return to your room.

Back on the ward
A nurse will assess the operation site and regularly monitor your blood pressure and pulse. If you are sore, you may require painkillers. Please discuss this with your nurse, consultant or anaesthetist.

When you feel ready, you can begin to drink and eat, starting with clear fluids such as water or apple juice.

Going home
If your operation has been planned as a day case, you will be able to go home once you have made a full recovery from the anaesthetic. However, you will need to arrange for someone to drive you home and then stay with you for the first 24 hours. If you stay overnight following your operation, you should be ready to leave the next morning.

Before you are discharged, the nurse will advise you about caring for your surgical wounds and bathing. The nurse will also give you a contact telephone number for the hospital, in case you need to ask for any further advice, and will make an outpatient appointment for you.

After you return home
A general anaesthetic can temporarily affect your co-ordination and reasoning skills, so you should avoid drinking alcohol, using power tools or signing legal documents for 24 hours afterwards.

You can expect to be off work for one or two weeks, depending on the nature of your job. You should not drive until you feel confident that you could perform an emergency stop without discomfort.

You may have some discomfort lasting for up to three weeks. To reduce pain, continue taking painkillers as advised by your specialist or the hospital.

Don't do any strenuous exercise, lifting or carrying or standing for long periods. But do stay as active comfortable, as this will help your bowel function to return to normal.

A small amount of bleeding or discharge from the anus is quite common. You may need to wear a pad (panty liner) for a few days. The blood loss may increase after each bowel movement. This will gradually reduce over the next few weeks. It is important to follow the nurses advice about hygiene. A soak in the bath after every bowel movement will help the area to heal.

Its important to avoid constipation. You may be given a laxative, but you can help by eating plenty of wholegrain cereals and at least five portions of fruit or vegetables a day. This results in soft, regular bowel movements that are easier to pass, and may help prevent further haemorrhoids. You should drink at least two litres of fluid a day, including plenty of water.

You should contact the hospital or your doctor if :

• blood loss suddenly increases or becomes bright red
• you do not have a bowel movement for several days
• you experience severe pain after a bowel movement

Haemorrhoidectomy is a commonly performed and generally safe surgical procedure. For most people, the benefits in terms of improved symptoms are greater than any disadvantages. However, all surgery does carry some element of risk. This can be divided into the risk of side-effects and the risk of complications.

Side-effects
These are the unwanted but mostly mild and temporary effects of a successful treatment. Examples of side-effects include feeling sick as a result of the general anaesthetic. After a haemorrhoidectomy, you will have some pain at the site of the operation for a few days and there may be a small amount of bleeding or discharge from the anus. It will be uncomfortable to sit down, and the pain may be worse when passing stools. These effects disappear as the surgical incision heals.

Complications
This is when problems occur during or after the operation. Most people do not experience problems. Possible complications of any surgery are excessive bleeding during or soon after the operation, infection, and an unexpected reaction to the anaesthetic.

Specific complications of a haemorrhoidectomy are unusual but can include:

• difficulty passing urine after the operation. A catheter may be required to empty the bladder
• constipation for a few days after the operation
• the stitches coming apart, leaving open wound. This usually heals very quickly
• any scar tissue causing the anus to become tighter (stenosis), which can make it difficult to pass stools. A treatment known as anal dilation can usually resolve this
• very occasionally, faecal incontinence, or a painful tear in the anus (fissure). These may require further surgery

The chance of complications depends on the exact type of procedure you are having and other factors such as your general health. You should ask your specialist to explain how these risks apply to you.

This information was published by Bupa Group's Health Content Team and has been reviewed by appropriate medical or clinical professionals. To the best of their knowledge the information is current and based on reputable sources of medical evidence, however Bupa (Asia) Limited makes no representation or warranty as to the completeness or accuracy of the Content.

The information on this page, and any information on third party websites referred to on this page, is provided as a guide only. It should not be relied upon as a substitute for professional medical advice, nor is it intended to be used for medical diagnosis or treatment. Bupa (Asia) Limited is not liable for any loss or damage you suffer arising out of the use of, or reliance on, the information.

Third party websites are not owned or controlled by Bupa and any individual may be able to access and post messages on them. Bupa is not responsible for the content or availability of these third party websites.

WebMDHealth
http://my.webmd.com/content/healthwise/78/19443