Is Surgery the Only Option for Severe Hemorrhoids?

Q: Is Surgery the Only Option for Severe Hemorrhoids?

Hello： In response to your question, I would also recommend surgery in this situation. <br>Although this condition is not life-threatening, it significantly affects quality of life and can be quite troublesome when going out or traveling. <br>Since you are still very young, under

Should surgery be performed?

Hello Doctor: Thank you for your response.
I forgot to mention that I have both internal and external hemorrhoids.
My internal hemorrhoids can no longer be completely pushed back manually; every time I try, a small portion remains outside the anal canal.
The external hemorrhoids increase in size with the prolapse of the internal hemorrhoids.
Additionally, regardless of whether my stool is soft or hard, or if I am urinating or squatting, the hemorrhoids always prolapse, and they become significantly swollen each time.
After two weeks of medication and topical ointment treatment with no improvement, I have recently experienced some bleeding, though not much, and the external hemorrhoids cause a stinging pain.
The doctor diagnosed my internal hemorrhoids as grade IV.
I would like to ask if my condition truly requires surgery.
Thank you.

Xiao Feng, 20~29 year old female. Ask Date: 2009/12/29

Dr. Ke Fangxu reply Surgery

Hello: In response to your question, I would also recommend surgery in this situation.
Although this condition is not life-threatening, it significantly affects quality of life and can be quite troublesome when going out or traveling.
Since you are still very young, undergoing surgery sooner rather than later is the best course of action.
If you are a woman, this condition may worsen during future pregnancies, so surgical treatment is the fundamental solution.
With proper care afterward, you should not experience this issue again.

Reply Date: 2009/12/29

More Info

When it comes to severe hemorrhoids, particularly in your case where you have both internal and external hemorrhoids that are significantly protruding and causing discomfort, surgery is often considered the most effective treatment option. Given that your internal hemorrhoids are classified as fourth-degree, which means they cannot be manually reduced and are likely causing persistent symptoms, surgical intervention is typically recommended.

Understanding Hemorrhoids
Hemorrhoids are swollen veins in the lower rectum and anus, and they can be classified into two types: internal and external. Internal hemorrhoids are located inside the rectum and are usually not visible, while external hemorrhoids are located under the skin around the anus and can be seen and felt. The severity of hemorrhoids is classified into four degrees:
1. First Degree: Small, no prolapse.

2. Second Degree: Prolapse during bowel movements but can be pushed back manually.

3. Third Degree: Prolapse during bowel movements and must be pushed back manually.

4. Fourth Degree: Prolapse that cannot be pushed back in and may be associated with significant pain and bleeding.

Treatment Options
1. Conservative Treatments: These include dietary changes (increasing fiber intake), stool softeners, topical treatments, and sitz baths. However, as you mentioned, these methods have not provided relief in your case.

2. Minimally Invasive Procedures: For less severe cases, procedures such as rubber band ligation or sclerotherapy may be effective. However, these are generally not suitable for fourth-degree hemorrhoids.

3. Surgical Options: Given your diagnosis, surgical options become necessary. The most common surgical procedures for severe hemorrhoids include:
- Hemorrhoidectomy: This is the surgical removal of hemorrhoids and is considered the most effective treatment for severe cases. It involves excising the hemorrhoids and is usually performed under anesthesia.

- Stapled Hemorrhoidopexy: This procedure involves using a stapling device to reposition the hemorrhoids and cut off their blood supply, which can help reduce their size.

Risks and Considerations
While surgery is effective, it does come with risks, including pain, bleeding, and infection. Recovery time can vary, but many patients are able to return to normal activities within a few weeks. It’s also important to follow post-operative care instructions to minimize complications.

Conclusion
In summary, given the severity of your hemorrhoids and the ineffectiveness of conservative treatments, surgery is likely the best option for you. It is essential to discuss this with your healthcare provider, who can provide personalized advice based on your specific condition and overall health. They can also explain the surgical procedure in detail, including what to expect before, during, and after the surgery. Your comfort and quality of life are paramount, and addressing this issue surgically may provide significant relief from your symptoms.

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