Also referred to as piles, hemorrhoids are fairly common. Sometimes they simply go away with little or no treatment. If lingering pain is experienced, over-the-counter steroid cream may help. Although this option shouldn’t be used for more than a week because of the possibility of skin thinning.
With an external hemorrhoid that has a blood clot inside of it, a small incision may be made to remove the clot and drain the excess fluid. Patients often experience immediate relief with this simple procedure. This option tends to be more effective if performed with 72 hours of a clot forming inside of a hemorrhoid.
For painful hemorrhoids that aren’t excessively large, minimally invasive surgery is often recommended. Procedures of this nature are usually in-office treatments that do not require anesthesia. The area being treated may still be numbed with medication to ease discomfort.
With rubber band ligation, two small bands are placed around the lower part of an internal hemorrhoid. Doing so cuts off circulation to the swollen veins. The tied-off hemorrhoid will then naturally fall off within a week or so after the procedure.
Also performed to treat varicose and spider veins, sclerotherapy involves the injection of a special solution (usually a salt solution) into the tissue of the hemorrhoid. The solution gradually shrinks the swollen vein. It’s not as effective as rubber band ligation. However, it may work well for smaller internal hemorrhoids.
Coagulation is done with infrared light or heat or a laser. This procedure is often recommended for smaller internal hemorrhoids that are bleeding. The application of heat causes the swollen veins to harden and then shrivel. Coagulation has few side effects. Patients are more likely to experience recurrence with this option.
More involved surgical procedures may be suggested if minimally invasive treatments aren’t effective. The most common type of hemorrhoid surgery that’s a step up from minimally invasive procedures is complete removal of the affected hemorrhoid, referred to as a hemorrhoidectomy.
During the procedure, excess tissue that’s causing the bleeding is removed. If this surgery is performed as an outpatient procedure, a local anesthetic may be used. In some cases, a spinal or general anesthetic is used. Small incisions are made in the affected area to slice away the hemorrhoids. Because of the sensitivity of the area where such irritations are usually located, stitches are sometimes needed after removal.
After surgery, there is usually some discomfort in the anal area for about 2-4 weeks. Warm baths and topical medication may improve comfort as the affected area heals. A hemorrhoidectomy is considered the most effective treatment for swollen veins in the anal area, especially internal ones. Possible complications associated with hemorrhoid removal are generally considered minor. However, some patients may develop a urinary tract infection or similar temporary bladder issues. If this is the case, medication usually corrects the problem.
Another surgical option is a stapled hemorrhoidectomy, also referred to as a procedure for prolapse and hemorrhoids (PPH). Normally recommended for internal hemorrhoids, this surgical option involves the use of staple-like device. Instead of removing the swollen veins, the hemorrhoids are repositioned. Doing so cuts off the blood supply, which causes the hemorrhoid tissues to shrivel and die.
Urinary retention and bleeding among the potential complications associated with hemorrhoid stapling, although such post-surgery issues are considered rare. The stapling option is typically used to treat hemorrhoids that have not fallen out of the anal area (prolapsed). Since the swollen veins are usually moved to an area where there are fewer nerve endings, stapling may be less painful for patients than hemorrhoidectomy during the recovery period.
Even after hemorrhoid surgery, it’s possible to develop hemorrhoids again. If you experience new flare-ups after minimally invasive surgery, removal, or hemorrhoid stapling, you may benefit from warm baths with a mixture of aloe vera and Epsom salts, applying cold packs to reduce the swelling, or the use of topical medications. If you have newly formed hemorrhoids that are painful or bleeding, you may be referred back to a hemorrhoid doctor. You may be able to reduce your odds of having problems with piles again post-surgery by not sitting for long periods of time, using support cushions, and eating more high-fiber foods to reduce the constipation that sometimes contributes to hemorrhoid formation.