External Hemorrhoids: When to Consider Surgery

External hemorrhoids issues?

Hello, Doctor.
I previously consulted you about the issue of external hemorrhoid thrombosis, which has now resolved.
However, due to work-related stress, I often feel like it's a ticking time bomb.
If I want to undergo surgery, should it be done when a thrombosis occurs or when it is not present? Each time it flares up, I experience persistent discomfort and a sensation of a foreign body in the anal area.
My job involves heavy lifting and climbing, and when it flares up, it becomes very uncomfortable and can even lead to increased swelling.
Although these episodes are infrequent, they are quite bothersome when they occur during work.
Is surgery an option?
1.
You mentioned before that a simple external hemorrhoid thrombosis can allow for same-day discharge; does this also include the removal of the external hemorrhoid?
2.
Should surgery be performed only when a thrombosis occurs, or is it better to wait until the swelling subsides?
3.
Is the thrombosis caused by congestion in the external hemorrhoid? If it is removed, will there be no further formation of thrombosis? I noticed I developed hemorrhoids during high school due to irregular habits, but now I maintain a regular daily bowel routine.
I also clean myself with water after using the toilet, yet I still occasionally develop thrombosis after bowel movements.
Thank you for your assistance.

zhì chuāng wèn tí, 20~29 year old female. Ask Date: 2019/11/29

Dr. Ke Fangxu reply Surgery

1.
The outpatient procedure on the same day only includes thrombectomy and does not include external hemorrhoidectomy.

2.
If a thrombectomy is performed, it can only be done when the thrombosis occurs; once the swelling subsides, there is no longer a thrombus present, and only a standard hemorrhoidectomy can be performed.

3.
Congestion can lead to thrombosis, and external hemorrhoids are the residual skin tags and tissue left after thrombosis.
If poor lifestyle habits and bowel habits persist after hemorrhoidectomy, there is a likelihood of recurrence within two to three years.

Reply Date: 2019/11/29

More Info

When it comes to external hemorrhoids, particularly those that have become thrombosed, the decision to consider surgery can be nuanced and depends on several factors, including the severity of symptoms, frequency of episodes, and the impact on your daily life.
1. Timing of Surgery: Generally, surgery for external hemorrhoids, especially when thrombosed, is most effective when performed soon after the onset of symptoms. If you are experiencing significant discomfort due to a thrombosed hemorrhoid, surgical intervention can provide immediate relief. However, if the thrombosis has resolved and you are left with persistent symptoms such as a feeling of pressure or discomfort, you may still consider surgery. The key is to assess the overall impact of these symptoms on your quality of life.
2. Surgical Options: The procedure to remove a thrombosed external hemorrhoid is typically a simple outpatient surgery. Patients can often go home the same day. This procedure involves making a small incision to remove the clot and relieve pressure. If you are considering surgery, it is advisable to discuss with your surgeon whether they recommend performing the procedure during an active episode of thrombosis or after the swelling has subsided. Some surgeons prefer to wait until the area is less inflamed to minimize complications and ensure a smoother recovery.

3. Causes and Recurrence: External hemorrhoids can become thrombosed due to increased pressure in the anal region, often exacerbated by straining during bowel movements, prolonged sitting, or heavy lifting. While surgical removal of the hemorrhoid can alleviate current symptoms, it does not guarantee that new hemorrhoids will not form in the future. Lifestyle changes, such as maintaining a high-fiber diet, staying hydrated, and avoiding prolonged sitting, can help reduce the risk of recurrence.

4. Postoperative Care: After surgery, it is essential to follow your surgeon's postoperative care instructions to promote healing and minimize discomfort. This may include recommendations for pain management, dietary adjustments, and hygiene practices.
5. Consultation with a Specialist: Given your ongoing symptoms and the impact they have on your work and daily activities, it would be beneficial to consult with a colorectal surgeon. They can provide a thorough evaluation and discuss the potential benefits and risks of surgery based on your specific situation.

In summary, if your external hemorrhoids are causing significant discomfort and affecting your quality of life, surgical intervention may be warranted. The timing of the surgery can vary based on your symptoms, and it is crucial to have an open discussion with your healthcare provider about the best approach for your case. Remember, while surgery can provide relief, adopting preventive measures is vital to minimize the risk of future episodes.

Similar Q&A

When to Consider Surgery for External Hemorrhoids: A Guide

Hello, doctor. I read that you mentioned external hemorrhoids without pain can be left untreated. However, my external hemorrhoid swells every morning when I wake up and only reduces in size by the next morning, repeating this cycle. I have tried conservative treatments, includin...

Dr. Ke Fangxu reply Surgery
The three main indications for hemorrhoid surgery are bleeding, pain, and discomfort. If conservative treatments have been tried without improvement and are affecting your daily life, then it may be better to opt for surgery sooner rather than later to achieve relief. Of course, ...

Post-Surgery External Hemorrhoids: When to Consider Another Procedure?

Hello Doctor: I underwent a hemorrhoidectomy on November 5th, and it has been a month since the surgery. There are still four to five external hemorrhoids at the anal opening. Generally, I don't feel discomfort unless I apply pressure, but after a bowel movement, the hemorrh...

Dr. Ke Fangxu reply Surgery
The disadvantage of circumferential excision is that it is not very effective in removing external hemorrhoids. If the swelling of the hemorrhoids is severe enough to affect daily activities, a repeat excision surgery may be necessary; otherwise, observation may be an option.

Understanding External Hemorrhoids: Symptoms, Treatments, and Surgery Options

The doctor mentioned that there is a small white area on top of my external hemorrhoid. If the medication does not help, I may need to have it surgically removed. What could this small white area indicate? If surgery is necessary, what type of procedure would be best? Thank you.

Dr. Zhang Shuhao reply Surgery
Surgical intervention for external hemorrhoids is recommended in two situations: one is when there are severe local symptoms, including pain, ischemic necrosis, incarceration, or purulent infection; the other is when there is a suspicion of malignancy. Surgery can involve local e...

Do You Need Surgery for External Hemorrhoids? Alternatives Explored

Is surgery the only option for external hemorrhoids? Are there no other methods? Mine is between grade three and four.

Dr. Ke Fangxu reply Surgery
If external hemorrhoids are not accompanied by bleeding or pain, surgery is not necessarily required. What are the alternative treatment outcomes we hope to achieve? If the goal is for the external hemorrhoids to disappear, then surgery may be the only option. However, if the foc...