Jackson Surgical Associates

Thrombosed External Hemorrhoids

External hemorrhoids are located at the anal opening, just beneath the skin. These tissues rarely cause problems unless they thrombose, or form a blood clot. When this occurs, a hard, bluish lump may appear.

External hemorrhoids are often very painful because the swollen hemorrhoid stretches the sensitive skin around it.

To remove the blot clot and hemorrhoid, you will be asked to lie or kneel on a table. The hemorrhoid is then injected with a local anesthetic. This may cause some discomfort for a moment.

A small incision is made to remove the blood clot. The hemorrhoid may also be removed. The skin is then either closed with sutures or left open to heal on its own. The area around the incision will likely be sore for a few days. But your pain should improve soon after the procedure.

Internal Hemorrhoids

During this type of procedure, you will be asked to lie or kneel on a table. Your doctor then inserts an anoscope to view the anal canal.

There are three methods to treat the hemorrhoid—your doctor will use one of them. Because internal hemorrhoids do not have nerves that sense pain, you will not have too much discomfort. You can often return to your normal routine the same day. If you have many hemorrhoids, you may need repeated treatments.

Banding

The banding method is done by placing tight elastic bands around the base of the hemorrhoid. This cuts off blood supply to the hemorrhoid, causing it to fall off. This usually takes about a week. The area then heals within a few days.

Infrared Coagulation

This procedure is done using a small probe that exposes the hemorrhoid to short bursts of infrared light. This seals off the blood vessel, causing it to shrink. Slight bleeding may occur for a few days, and the area usually heals within a week or two.

Sclerotherapy

This procedure is done by injecting a chemical into the tissue around the hemorrhoid. The chemical causes the hemorrhoid to shrink within a few days. Bleeding usually stops in about 24 hours.

After any of these types of procedures, call your doctor if you have:

• Fever or chills
• Increasing pain
• Persistent bleeding
• Trouble urinating

Severe Hemorrhoids

For hemorrhoids that cause severe symptoms, your doctor may recommend hemorrhoid surgery to remove the hemorrhoid.

Your doctor can explain the procedure that will be used. You will also be told how to get ready for surgery and what to expect while you recover.

At the hospital or surgery center, on the day of surgery, you will be given an IV (intravenous line), which supplies fluids and medication. You may also be given a laxative or enema to clean stool from your rectum. An anesthesiologist will explain the type of anesthesia that will be used to prevent pain during your surgery.

During hemorrhoid surgery, your doctor will insert an anoscope to view the anal canal. Using surgical tools, the swollen hemorrhoids are then removed. In some cases, the incision is closed with sutures. In other cases, you may have a procedure that closes the incision with staples.

Hemorrhoidectomy With Sutures

The hemorrhoids are removed using surgical tools such as a scalpel or cautery (sealing) device. The incision is then closed with sutures.

In some cases, the incision may be left partially open. This allows fluid to drain and helps the healing process.

Stapled Hemorrhoidopexy

This procedure uses a special device to remove a ring of tissue from the anal canal. Removing the tissue cuts off blood supply to the hemorrhoids, causing them to shrink. The tissue ring is then secured with staples. This helps hold the tissue in place.

Recovering After Hemorrhoid Surgery

After resting in a recovery room, you usually can usually go home the same day. But in some cases, you may need to remain in the hospital overnight.

For a short time after surgery, you may have nausea, minor bleeding, and discharge. You will also likely have some pain. To help you feel better, your doctor will prescribe pain medication. You may also be prescribed medications to help make bowel movements easier.

After surgery, call your doctor if you have any of the following:

• Fever or chills
• Inability to move your bowels
• Increasing pain
• Persistent bleeding
• Trouble urinating

Once you are back at home, you will need to take it easy for a few days. To help speed your recovery, take care of the surgery site and maintain good bowel habits.

As you feel better, you can begin returning to your normal routine. Just keep in mind it may take a month or two for complete healing.

It is normal to have some pain after surgery. To help you feel better, your doctor will likely prescribe pain medication.

Do not wait for your pain to get bad. Take the medication on time as directed. Be aware that some pain medications can cause constipation. So your doctor may also prescribe a laxative or stool softener. If you have pain or burning after bowel movements, sitz baths can help provide relief.

Proper care for your wound will help speed healing. Your bandage can be removed the day after treatment. From then on, use soft gauze pads or sanitary napkins to control any fluid drainage. For best results, change the pads and your underwear frequently. Wash the area with warm water and mild soap to help the wound stay clean.

You may be nervous about having a bowel movement after surgery. But do not ignore the urge to go. This can lead to constipation and straining on the toilet.

For the first few days, you may have minor bleeding or muscle spasms during bowel movements. You can also have swelling that feels like unpassed stool or a hemorrhoid. Call your doctor if you are unable to have a bowel movement within the first few days after surgery.