Hemorrhoidectomy is appropriate when you have the following:

• very large internal hemorrhoids, internal hemorrhoids that still cause problems after fixative procedures
• large external hemorrhoids that cause significant discomfort and pain
• both internal and external hemorrhoids
• had other treatments for hemorrhoids that have failed

Like any other surgical procedure, hemorrhoidectomy has its own risks. Pain, bleeding, and urinary retention are the most common side effects. The least common risks are divided into early problems or abnormalities that occur a few days after the surgery and late problems – those that occur months after the surgery.

Early problems are as follows:

• bleeding from the anal area
• hematoma or collection of blood in the surgical area
• incontinence or inability to control bladder or bowel
• infection of the surgical area
• fecal impaction or stool trapped in the anal canal

Late problems include:

• narrowing or stenosis of the anal canal
• recurrence of hemorrhoids
• fistula – which is the abnormal passage that forms between the anal or rectal canal
• rectal prolapsed – which happens when the rectal lining protrudes out of the anal opening like a protruding hemorrhoid.

There is a special preparation done before hemorrhoidectomy is performed. A day before the surgery, the nurse will give you an enema to cleanse your colon. Special preparations are mainly done to prevent the occurrence of infections after your surgery.

Keep in mind that the gastrointestinal tract consisting of the large intestine to the anus is inhabited by many bacteria. In this area, they are the harmless non-visible organisms that merely feed on food scraps to survive, but once they gain access to the other parts of your body, they turn into the most aggressive infection-causing machines overnight.

Before the hemorrhoid operation, you will either be given a general or spinal anesthesia so that you will not feel any pain. In a general anesthesia, you are asleep during the entire procedure, while in spinal anesthesia, you are numb form waist down to your toes. You are conscious and able to talk the whole time during the procedure.

The procedure involves making an incision on the tissue surrounding the hemorrhoid. Before hemorrhoid removal can take place, the swollen veins inside it are tied up to prevent bleeding. The incised area may be sewn or left open. Medicated gauze is used then placed over the incised wound. The incision can be done using either a knife, cautery pencil, or a laser. Lasersare often advertised as they are less painful and encourage faster healing, but these claims have not been proven. What is known is that lasers are more expensive than the traditional technique, takes longer to perform and can cause deep tissue injury.

After the surgery, you can expect some pain. Some bleeding is normal, especially on the first defecation. Straining is still avoided up to this point to prevent hemorrhoids from coming back.

For this, conservative management is applied at home. Follow up exams with your surgeon are done 2 to 3 weeks after surgery to check for your progress and complications.

Hemorrhoidectomy may provide better long-term results than fixative procedures that basically use the principle of cutting off blood flow to the hemorrhoid. However, surgery is more expensive, has greater risk of complications, and usually is more painful.