Common Concerns About External Hemorrhoid Surgery: Pain, Recovery, and Anesthesia

Questions about external hemorrhoid surgery?

Hello Dr.
Ke,
I have a few questions that I hope you can take the time to answer.
Thank you.
1.
For external hemorrhoid surgery, is general anesthesia, spinal anesthesia, or local anesthesia required? (I understand that anesthesia carries risks.) Will the surgery be "very painful" during the procedure? How long does the surgery typically take?
2.
Is it necessary to stay in the hospital after the surgery? Can I recover at home? (Will the patient be able to walk on their own after the surgery?) How many days after the surgery can I return to work?
3.
My symptoms include a growth outside the anus, and sometimes I notice a little blood on the toilet paper when wiping (does this indicate that I may also have internal hemorrhoids?).
If I have both internal and external hemorrhoids, can they be addressed in one surgery?
4.
I have read online that many people say the surgery is very painful afterward.
Will bowel movements affect the surgical site? Will it be unbearable pain?
5.
About three years ago, I had a similar surgery, and it was so painful that I nearly fainted.
The doctor administered local anesthesia, but I received two injections, and I still felt significant pain.
Why is that? Did the anesthesia not work? Because of this experience, I am hesitant to undergo surgery again and would like to understand if patients typically experience a lot of pain during your procedures.
I appreciate your time in addressing these questions.
Thank you.
Michael

michael, 30~39 year old female. Ask Date: 2007/10/04

Dr. Ke Fangxu reply Surgery

1.
The anesthesia methods used for hemorrhoid surgery that you listed are all practiced by various physicians, depending on their preferences.
Each method has its advantages and disadvantages.
General anesthesia has the benefit of keeping the patient relaxed, but it carries a relatively higher risk.
Local anesthesia has a lower risk, but patients may feel more discomfort.
Spinal anesthesia falls in between the two, but patients must lie flat for eight hours post-surgery.
After anesthesia, patients typically do not feel anything during the surgery, which lasts about an hour.
2.
Except for patients who receive spinal anesthesia, they can walk after the surgery.
However, since the wound tends to be most painful on the night after the procedure, it is advisable to stay in the hospital.
Generally, a hospital stay of 2-3 days is required.
If the nature of one's work does not involve heavy lifting, returning to work immediately after discharge is also possible.
3.
Surgical treatment usually addresses all issues at once, including internal and external hemorrhoids, anal fissures, and polyps.
Your condition may be more akin to an anal fissure.
4.
The wound will be more painful during the first three days post-surgery (which is another reason for recommending hospitalization).
Having a bowel movement is likely to cause pain at the wound site, but this discomfort will gradually lessen.
5.
The so-called local anesthesia is actually a pelvic nerve block.
Physicians within the Veterans Affairs system often prefer this anesthesia method.
Personally, I have never encountered a patient who experienced ineffective results.
If the physician is not a colorectal surgeon, they may have only superficial knowledge and may not perform the nerve block effectively.
I personally prefer a combination of sedation and nerve block, as patients will be asleep and will not immediately feel pain post-surgery.
Of course, the choice of anesthesia varies by physician, and it is difficult to determine which method is superior; however, the primary goal should be to avoid causing pain to the patient.

Reply Date: 2007/10/04

More Info

Dear Michael,
Thank you for your questions regarding external hemorrhoid surgery. I understand that you have several concerns about the procedure, anesthesia, recovery, and pain management. Let’s address each of your questions in detail.

1. Anesthesia Options and Pain During Surgery: External hemorrhoid surgery can be performed under various types of anesthesia, including general anesthesia, spinal (epidural) anesthesia, or local anesthesia. The choice of anesthesia depends on the complexity of the procedure and the patient's health status. While all forms of anesthesia carry some risks, they are generally considered safe when administered by qualified professionals. During the surgery, patients typically do not feel pain due to the effects of anesthesia. The duration of the surgery can vary but usually lasts between 30 minutes to an hour, depending on the specific circumstances of the case.

2. Hospital Stay and Recovery: Most patients do not require an overnight hospital stay after external hemorrhoid surgery and can go home the same day. However, this can depend on individual circumstances and the extent of the surgery. After the procedure, patients are usually able to walk, although they may experience some discomfort. Recovery at home is common, and many patients can return to light activities within a few days. However, it is advisable to avoid strenuous activities or heavy lifting for at least a week or as directed by your surgeon.

3. Symptoms and Diagnosis: The presence of a "flesh-like" growth around the anus, along with occasional bleeding when wiping, may indicate external hemorrhoids and possibly internal hemorrhoids as well. It is not uncommon for patients to have both types of hemorrhoids simultaneously. Surgical intervention can address both external and internal hemorrhoids in one procedure, but this should be confirmed with your surgeon based on a thorough examination.

4. Postoperative Pain and Bowel Movements: It is common for patients to experience some pain after hemorrhoid surgery, especially during bowel movements. However, effective pain management strategies, including prescribed medications, can help alleviate discomfort. It is crucial to maintain soft stools to minimize strain during bowel movements, which can be achieved through dietary adjustments and possibly stool softeners. While some patients report significant pain post-surgery, many find that it is manageable with proper care.

5. Previous Pain Experience: Your past experience with pain during a similar procedure may have been influenced by several factors, including the effectiveness of the anesthesia, the extent of the procedure, and individual pain tolerance. It is important to communicate your concerns about pain management with your surgeon before the procedure. They can adjust the anesthesia plan or provide additional pain relief options to ensure a more comfortable experience.

In summary, while external hemorrhoid surgery can involve some discomfort, many patients find relief from their symptoms and can return to normal activities relatively quickly. It is essential to have open communication with your healthcare provider regarding your concerns and to follow their postoperative care instructions closely.

If you have further questions or need clarification on any points, please do not hesitate to reach out.

Best regards,
Doctor Q&A Teams

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