Haemorrhoidectomy is an operation whereby the haemorrhoids are excised surgically. It is performed under a general anaesthetic (fully asleep) and can be done as a day case or an overnight stay in hospital. Once asleep, an examination is performed to assess the number and severity of the haemorrhoids. Most commonly, there are three haemorrhoids that are removed. The wounds are deliberately left open in order to minimise the risk of infection and to decrease the amount of pain post-operatively. Occasionally not all the haemorrhoids can be removed in one operation as this can lead to scarring that decreases the size of the anus.
What to expect post-operatively
The perianal wounds will heal up over a period of 4 – 8 weeks.
Pain is the biggest problem after a haemorrhoidectomy. The severity varies between people but one should expect an unpleasant first week after which things usually improve. By the end of the second week, most people are very comfortable although in a small group of people the discomfort may last up to 4 weeks.
Local anaesthetic will be injected into the wound at the end of the operation and therefore you should be comfortable when you wake up. You should take regular analgesia in the first 48 hours including paracetamol (Panadol) 1g (2 tabs) every 4-6 hours (max 8 tabs per day) and an anti-inflammatory such as ibuprofen (nurofen) 400mg every 4 – 6 hours. You will be given a prescription for a stronger pain killer such as oxycodone (endone) 5 – 10 mg every 4 hours or tramal (tramadol) 50 – 100mg every 6 hours. These can be used in addition to the other 2 painkillers if needed. After 48 hours, use the painkillers only if needed. Wean off the strong painkillers first of all and then the simple ones.
Other measures to help with the pain include ice packs and/or warm salt baths. An antibiotic called metronidazole (flagyl) 400mg three times per day is sometimes used for it’s analgesic properties.
You will wake up with a gauze dressing and a combine gauze pad (like a sanitary pad). There are no special dressings needed for the wounds. They will heal very well (in most circumstances) with time. The wounds will ooze fluid, often blood stained or yellowy-green like pus which can be foul smelling. This is normal and does not usually mean an infection which is very rare. The discharge will slowly decrease over days to weeks. You can clean the wounds by taking a shower and running soap and water over the area or by taking a warm bath (with table salt). Do this after each bowel motion. Pat the area dry and simply replace the combine pad (sanitary pad) which is there to protect your clothing and underwear. These can be purchased at any pharmacy.
It is important to keep the bowel moving without constipation or straining. Use either movicol 1-2 sachets daily or Metamucil 1-2 sachets daily if needed for a few weeks (especially if using endone). Maintain a diet rich in fluids and fibre. Laxatives are important to use during the weeks of healing. They also have a role to play for prevention of future problems especially if diet and lifestyle measures are not enough to maintain a healthy bowel habit.
Most people require 1 – 2 weeks off work and exercise. This might be longer depending on the work that you do. You can return to work and exercise when you feel comfortable.
Complications of haemorrhoidectomy are not common. Despite the post-operative discomfort that most experience, the vast majority of patients are very happy with the operation when asked after 6 weeks.
Small amounts of bleeding are common post-operatively. A significant bleed (more than a small cupful) occurs in 1 in 100 cases. This usually occurs 1 – 2 weeks after the procedure. Please call the rooms if this occurs or if it is after hours, present to the nearest emergency department. A balloon catheter can be inserted to control this bleeding and in the majority, no return to theatre is needed.
This is very rare, despite the area being operated on.
This is when a narrowing develops in the anal canal after healing. The risk is very small with good surgical technique. It is treated by anal dilatation and laxatives and very rarely, further surgery.
In a minority of cases, the wounds don’t completely heal after 6 weeks and an anal fissure develops. This can usually be healed with creams but sometimes another procedure is needed.
This can occur with any haemorrhoidal operation. This one has the lowest recurrence.