Hemorrhoids are dilated, often bulging veins in the anus and lower rectum which can result in itching, pain and bleeding. According to the American Society of Colon and Rectal Surgeons, millions of Americans have hemorrhoids, with more than half of the population having at least one episode of hemorrhoids after the age of 30. Often, conservative therapy with sitz baths, stool softeners and a high-fiber diet suffices to treat symptoms of hemorrhoids; however, surgery is occasionally required. A hemorrhoidectomy, in which the hemorrhoidal tissue is surgically excised, is the most complete form of hemorrhoid surgery, but also carries the highest complication rate.
Inability To Urinate
Sayfan and colleagues reported in a July 2001 article in "Annals of Surgery" that up to 12.5 percent of patients undergoing hemorrhoidectomy are unable to urinate after surgery due to tissue swelling. This complication is alleviated via insertion of a catheter into the bladder until the swelling resolves. Occasionally, hemorrhoidectomy-associated urinary retention leads to a urinary tract infection requiring antibiotics.
Bleeding
A hemorrhoidectomy involves removal of engorged blood vessels, which may result in bleeding during or after the procedure. When performing a hemorrhoidectomy, often a local anesthetic with epinephrine is utilized, which constricts the blood vessels. Occasionally, when the anesthetic wears off, so does the vessel constriction, resulting in bleeding in some cases, according to Dr. Zuber in the April 2002 issue of "American Family Physician." Such bleeding often resolves spontaneously, but may require electrical heat, called cautery, or sutures.
Stricture
According to the "Annals of Surgery" article, significant narrowing of the anus or rectum from scar tissue, called a stricture, is a complication in up to 5 percent of hemorrhoidectomy cases. The incidence of strictures is reduced by limiting the amount of cautery used during a hemorrhoidectomy as well as minimizing the use of sutures.
Pain
Postoperative pain is a common complication of hemorrhoidectomy, reports MayoClinic.com, and usually persists for several days. Pain medications, warm baths and stool softeners are used to relieve some of the discomfort. A certain type of hemorrhoidectomy, called a stapled hemorrhoidectomy, in which staples are used to block blood flow to hemorrhoids, has less associated discomfort.
Hemorrhoid Recurrence
The Encyclopedia of Surgery says that, although hemorrhoidectomy is the most complete way of treating hemorrhoids, hemorrhoids do recur after a hemorrhoidectomy in 5 percent of patients. Recurrence is higher with a stapled hemorrhoidectomy compared to the traditional type of hemorrhoidectomy. Treatment of hemorrhoid recurrence may require repeat surgery, although conservative measures often help.
References
- American Society of Colon and Rectal Surgeons: Hemorrhoids
- "Annals of Surgery": Sutureless Closed Hemorrhoidectomy: A New Technique; J. Sayfan, A. Becker and L. Koltun; July 2001
- "American Family Physician": Hemorrhoidectomy for Thrombosed External Hemorrhoids; T. Zuber; April 2002
- MayoClinic.com: Hemorrhoids
- Encyclopedia of Surgery: Hemorrhoidectomy
