What does a haemorrhoidectomy involve?

Haemorrhoidectomy involves surgical excision of the haemorrhoidal tissues. There are three major vascular pedicles from which haemorrhoids arise. The aim of the operation is to remove as much haemorrhoidal tissue as possible leaving enough anal lining (mucosa) between these tissues for adequate healing to occur. This leaves behind “raw” areas or ulcers where the haemorrhoidal tissues have been removed which heal from inside out over the next few weeks.

What are the risks of surgery?

A small amount of bleeding is expected after the surgery and may last for a couple of weeks. However, there is a small risk of a major bleed requiring readmission to hospital and the potential need to return to the operating theatre to control the bleeding. Thankfully this is not common.

This is uncommon but the risk increases if the anal lining is closed after a haemorrhoidectomy. Antibiotics are given at the start of the procedure and you are discharged on a course of oral antibiotics which has been shown to help with the post-operative pain.

This can occur if too much tissue is removed and not leaving behind adequate anal lining (mucosa) between the removed haemorrhoids.

It is rare to experience incontinence after a haemorrhoidectomy but there is a small risk of damage to the internal anal sphincter muscle which can result in variable degrees of incontinence.

Before surgery

Fast from midnight for a morning procedure OR from 7am for an afternoon procedure.

You will be contacted by the hospital the day before your procedure to let you know what time to come in. This is usually 1-2 hours before your procedure to allow for the hospital check-in procedures.

You will be given a fleet enema about an hour before your procedure. This is to empty the rectum before operating.

After surgery

Expect some bleeding especially after opening your bowels for the first time. You will also pass a dressing called Spongistan which is placed inside the anus at the end of the procedure. This helps stop the bleeding and can resemble a large clot when passed into the toilet bowl when you first open your bowels.

Pain is worst in the first three days after a haemorrhoidectomy but eases gradually over the first couple of weeks. Some degree of pain or stinging may last for up to four weeks after surgery (especially following defecation).

You should take regular Panadol (as long as there are no medical reasons for you not to take it such as an allergic reaction or liver disease).

Non-steroidal anti-inflammatory medication such as Neurofen and Voltaren can also help with pain and inflammation but should be taken on a full stomach. Take these for the first 3-5 days as required.

Stronger pain killers such as opioid anaelgesics (Endone, Codeine) may help in the first couple of days but should be taken sparingly as they can cause constipation which results in more pain when opening your bowels.

It is very important to maintain soft stools after haemorrhoid surgery. This is done by having an adequate intake of fluid and fibre (see Prevention of constipation) as well as taking regular Movicol (1 sachet 1-3 times a day).

Laxatives such as lactulose or coloxyl are not advisable as diarrhoea can worsen the pain post haemorrhoidectomy. The aim is to have soft stools NOT loose watery stools.

Most patients are worried about opening their bowels especially for the first time. You should not let fear of pain stop you from opening your bowels as this will only make things worse by hardening the stools and causing a spasm of the anal muscles. You should take a strong pain-killer before or after opening your bowels. Getting into the shower and washing the area with water is also very helpful.

If you are finding it difficult to pass soft stools, it may be due to a spasm of the anal sphincter. This can be treated with topical Rectogesic ointment 2-3 times a day. This is an over-the-counter ointment that should be applied into the first 1-2cm of the anus. The easiest way to do this is to wear a disposable non-sterile glove (plastic food-handling gloves are ok) then apply 1.5cm of the ointment using your index finger.

These are an excellent way of relieving the pain especially after opening your bowels. You should put a handful of salt into a shallow bath of warm water and sit in it for 15 minutes. This is both soothing and acts as an antiseptic.

There are no dressings apart from a pad that collects the post-operative blood. You may need to wear a pad for 2-3 days to prevent staining your underpants.

Ladies’ sanitary pads work well for this purpose and can be used by men and women.

You will be admitted overnight but may go home on the day of surgery if you wish and are comfortable enough.

Follow up with your surgeon is usually within 4 weeks of your operation. You will be given an appointment before leaving the hospital. If, however, your operation finishes after hours, you will need to contact the rooms for a follow up appointment.