Patient Information
Surgeries: Rectal: Hemorrhoids
Some internal hemorrhoids protrude so far and become so large, that they cannot be removed with either rubber band ligation or infrared coagulation. This is especially true if the internal hemorrhoids are also associated with swollen or protruding skin. Surgery may be indicated since the skin cannot be removed with rubber bands. In addition, only a limited number of internal hemorrhoids can be removed with rubber bands one at a time. So, surgery may be indicated.
The important factor to consider is how much trouble the hemorrhoids are causing. If the hemorrhoids are not causing very much trouble in the way of pain or bleeding, and if the person does not mind waiting several months for treatment to be completed, then rubber band ligation or infrared coagulation are considered.
If the internal hemorrhoids are causing a great deal of pain, discomfort, protrusion, and bleeding, or the person does not wish to wait several months for treatment to be completed, then surgery is indicated. The advantage of surgery is that all of the hemorrhoids can be treated at one time. The disadvantage is that while some people have been able to return to work after one week, others will require two to three weeks of recuperation before they feel able to return to work.
This surgery can be completed using local anesthesia, spinal block, or general anesthesia. When local anesthesia is used, the surgeon gives medications by vein so that the patient sleeps through the procedure and does not feel or remember any of the procedure. This is the safest type of anesthesia.
After he gives the anesthesia, the surgeon places a metal scope into the anal canal to see the internal hemorrhoids. 
He lifts up the excess hemorrhoidal mucosa and removes the bulging internal and external hemorrhoids with scissors or a laser beam. The laser is more expensive than the scissors. There is no difference in the amount of pain afterwards or the outcome of the surgery.
After removing the internal and external hemorrhoids, the surgeon sews the anal and rectal mucosa to the underlying muscle so that it cannot protrude again. He carefully avoids injury to any of the sphincter muscles underneath the hemorrhoids.
The suture (surgical thread) will dissolve, and does not have to be removed later. This is outpatient surgery. The person has the surgery in the afternoon and goes home the next morning.
After hemorrhoid surgery, it is important to take three heaping tablespoons of natural vegetable powder daily so the bowels move easily with less pain. Warm baths help reduce the pain following surgery as do Sitz baths, which spray water on the anal area.
It is normal to have some bleeding after hemorrhoid surgery, but if it is more than one half cup, the patient should call the surgeon.
Content for this page adapted from
Dr. Christopher Lahr's book "Shining Light on Constipation."