Hemorrhoids: When to Consider Surgery for Relief

Hemorrhoid issues

Hello, Dr.
Ke.
About six months ago, I visited a doctor and was diagnosed with external hemorrhoids.
I would like to address the issue of hemorrhoids.
I can see a small lump the size of a soybean when I spread my buttocks.
Although I wash with water after using the restroom and most of my bowel movements are soft, I still experience increasing swelling in my rectal area after a normal bowel movement in the morning.
Given this situation, do you recommend surgery? Previously, when I inquired about postoperative issues, you mentioned that the risks of complications are relatively low with modern surgery compared to the past.
Should I consider addressing this issue before it worsens? Does delaying treatment increase the likelihood of complications? I noticed in your previous articles that patients who waited until their hemorrhoids reached grade 3 or 4 seemed to have more postoperative issues.
I would appreciate your clarification on these questions.

Zhìchuāng wèntí, 20~29 year old female. Ask Date: 2019/12/05

Dr. Ke Fangxu reply Surgery

1.
Surgical intervention is not necessary if there is no persistent bleeding or severe pain.

2.
The likelihood of developing complications is relatively low, and there is no correlation between early intervention and the occurrence of such complications.
Common postoperative issues typically include wound pain and bleeding, which are situations that all patients encounter after surgery and are not related to the severity of hemorrhoids.
For younger patients, I generally do not recommend surgery due to a higher recurrence rate.
It is advisable to prioritize improving dietary and bowel habits instead of assuming that surgery will resolve all issues.
If one's lifestyle does not improve, it is expected that recurrence may occur shortly after surgery.

Reply Date: 2019/12/05

More Info

When considering the management of hemorrhoids, particularly when symptoms are present, it is essential to evaluate the severity of the condition and the impact it has on the patient's quality of life. Hemorrhoids can be classified into two main types: external and internal. External hemorrhoids are located under the skin around the anus, while internal hemorrhoids are found inside the rectum. The symptoms can include pain, itching, swelling, and bleeding during bowel movements.

In your case, you mentioned experiencing a yellow bean-sized lump, which suggests the presence of an external hemorrhoid. The fact that you experience increasing swelling after bowel movements indicates that the hemorrhoid may be inflamed or thrombosed (clotted), which can cause significant discomfort. While maintaining a diet that promotes soft stools is beneficial, it may not be sufficient to alleviate the symptoms entirely.

Surgery for hemorrhoids is generally considered when conservative treatments fail to provide relief. These conservative measures can include dietary modifications, increased fiber intake, topical treatments, and sitz baths. If these methods do not alleviate your symptoms, or if the hemorrhoids are causing significant pain or bleeding, surgical intervention may be warranted.

There are several surgical options available, ranging from minimally invasive procedures to more traditional surgical techniques. These include:
1. Rubber Band Ligation: This is a common procedure for internal hemorrhoids where a rubber band is placed around the base of the hemorrhoid to cut off its blood supply, causing it to shrink and fall off.

2. Sclerotherapy: This involves injecting a solution into the hemorrhoid to shrink it.

3. Infrared Coagulation: This technique uses infrared light to coagulate the tissue and reduce the hemorrhoid.

4. Hemorrhoidectomy: This is a more invasive procedure where the hemorrhoids are surgically removed. This is typically reserved for severe cases or when other treatments have failed.

You raised an important point about the timing of surgery. Generally, the earlier you address the issue, the better the outcomes tend to be. Delaying treatment can lead to the progression of hemorrhoids to more severe grades (such as Grade III or IV), which may complicate the surgical procedure and increase the risk of postoperative complications. Patients with advanced hemorrhoids often report more significant pain and a longer recovery period.

In terms of postoperative complications, modern surgical techniques have improved significantly, and the risks associated with hemorrhoid surgery have decreased. However, potential complications can still include pain, bleeding, infection, and, in rare cases, anal stenosis or incontinence. The likelihood of these complications can increase with the severity of the hemorrhoids and the complexity of the surgical procedure.

In conclusion, if your symptoms are persistent and affecting your daily life, it may be wise to consult with a colorectal surgeon to discuss your options. They can provide a thorough evaluation and recommend the most appropriate treatment based on the severity of your condition. Early intervention can lead to better outcomes and a quicker return to normal activities.

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