Internal Hemorrhoids: When to Consider Surgery?

Questions about surgery for hemorrhoidal swelling?

Hello, doctor.
I would like to ask about my condition.
Initially, when I was experiencing severe pain from hemorrhoids, a digital examination diagnosed me with grade I internal hemorrhoids.
I have since found some relief with medication and topical treatments, but every time I sit down, I feel a sense of swelling in the anal area.
As a student, I have to sit for at least an hour during classes, and exams can last over two hours.
While the pain is not as severe as it was initially, I still experience discomfort and swelling.
Additionally, when I ride my motorcycle, I also feel uncomfortable after the trip.
I have returned to my doctor for follow-ups, and they have prescribed medication multiple times, both oral and topical, but I still find the hemorrhoid issue quite bothersome.
The discomfort affects my sitting posture, causing me to sit sideways or lie down, and I also have a slight hunchback, which adds to my discomfort.
I feel that this is impacting my daily life.
I would like to ask if it is possible to undergo surgery for grade I hemorrhoids.
If so, what types of surgeries are suitable for internal hemorrhoids that are less likely to recur in the absence of bad habits? I am considering surgery because I feel it is affecting my current quality of life.
Thank you, doctor.

Jim, 20~29 year old female. Ask Date: 2024/02/23

Dr. Ke Fangxu reply Surgery

First-degree internal hemorrhoids are not typically recommended for surgical intervention because the postoperative pain may exceed the original discomfort.
Additionally, if the hemorrhoids are not severe, surgery may not result in significant improvement.
If medication treatment does not yield satisfactory results, you might consider trying rubber band ligation for internal hemorrhoids.
Personally, I do not recommend surgical treatment.
It is essential to prioritize improving dietary and bowel habits, as well as maintaining a healthy lifestyle.

Reply Date: 2024/02/23

More Info

When it comes to understanding internal hemorrhoids and the considerations for surgery, it's important to first recognize the nature of the condition and the various treatment options available. Internal hemorrhoids are swollen veins located inside the rectum, and they can cause discomfort, pain, and other symptoms such as bleeding during bowel movements. In your case, it seems that you have been diagnosed with grade I internal hemorrhoids, which typically do not protrude outside the anal canal and may not cause significant pain, but can still lead to discomfort, especially during prolonged sitting or activities like riding a motorcycle.

The management of internal hemorrhoids often begins with conservative measures, including dietary changes to increase fiber intake, hydration, and the use of topical treatments or oral medications to alleviate symptoms. However, if these measures do not provide sufficient relief and the hemorrhoids continue to affect your quality of life, it may be time to consider surgical options.

Surgery for hemorrhoids is generally recommended when conservative treatments fail, and the symptoms significantly impact daily activities. For grade I internal hemorrhoids, surgery is not typically the first line of treatment, but it is not out of the question, especially if you are experiencing persistent discomfort that affects your daily life. Surgical options for internal hemorrhoids include:
1. Rubber Band Ligation: This is a minimally invasive procedure where a small rubber band is placed around the base of the hemorrhoid to cut off its blood supply. The hemorrhoid eventually shrinks and falls off. This method is effective and has a low recurrence rate.

2. Sclerotherapy: In this procedure, a chemical solution is injected into the hemorrhoid, causing it to shrink. This is also a minimally invasive option and can be performed in an outpatient setting.

3. Infrared Coagulation: This technique uses infrared light to coagulate the blood vessels supplying the hemorrhoid, leading to its shrinkage.

4. Hemorrhoidectomy: This is a more invasive surgical procedure where the hemorrhoids are surgically removed. It is usually reserved for more severe cases, such as grade III or IV hemorrhoids, but can be considered if other treatments have failed.

5. Stapled Hemorrhoidopexy: This technique involves using a stapling device to reposition the hemorrhoids and cut off their blood supply. It is less painful than traditional hemorrhoidectomy and has a quicker recovery time.

Regarding your concern about recurrence, while no procedure can guarantee that hemorrhoids will not return, adopting a healthy lifestyle that includes a high-fiber diet, regular exercise, and avoiding prolonged sitting can significantly reduce the risk of recurrence.
In conclusion, if your symptoms are significantly affecting your daily life and conservative treatments have not provided adequate relief, it may be worth discussing surgical options with your healthcare provider. They can assess your specific situation, including the severity of your symptoms and any underlying factors, to determine the most appropriate treatment plan for you. Remember, it's essential to communicate openly with your doctor about your symptoms and how they impact your life, as this will help guide the decision-making process regarding surgery.

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