Hemorrhoidectomy for Thrombosed External Hemorrhoids?

Hemorrhoid treatments

People suffering from hemorrhoids can go to extreme lengths to avoid painful symptoms. Pain and irritation in the rectum can be terrifying for anyone. This is worse for people suffering from thrombosed external hemorrhoids.

Hemorrhoids are caused by increased pressure on the vessels inside the anus. It causes the veins to become inflamed and bulge. While there are other causes, hemorrhoids mainly result from strenuous bowel movements and prolonged sitting. Both acts increase intra-abdominal pressure and put stress on the anus.

Hemorrhoids are divided into three types. They can be internal, external, or thrombosed. Doctors believe thrombosed hemorrhoids to be the most painful and complicated type. When chronic hemorrhoids remain swollen, blood can pool inside the vessels. Clots can form inside the vessels and obstruct the flow of blood. They cause an increase in swelling and the buildup of pressure, making thrombosed hemorrhoids extremely painful.

Furthermore, thrombosed hemorrhoids also tend to develop complications like abscesses and fistulas. There are several treatment options available to counter the posed health risks. They range from simple home remedies to complicated surgical procedures. Doctors don’t usually suggest a surgical treatment unless necessary. Let’s learn about the different ways hemorrhoidal pain is managed.

Common Treatments

All hemorrhoid treatments aim to relieve hemorrhoidal pain and irritation. The easiest and most widespread treatment is taking a Sitz bath. Taking one ensures proper cleaning of the anal region. Soaking the rectal area in a tub filled with warm water can help reduce pain, improve blood flow, and help clean the anus. It is a simple and popular method to manage pain.

Other non-invasive hemorrhoid treatments include the following:

Dietary and Lifestyle Changes

Dietary changes include the incorporation of more fiber into your food. Fiber and roughage help avoid constipation. Constipation puts strain on the abdomen and leads to forced bowel movements and prolonged sitting on the toilet. Lifestyle changes, like exercising, help reduce physical inactivity and relieve stress on the anus.

Over-the-Counter Drugs

OTC drugs like painkillers and topical ointments help reduce the inflammation caused by hemorrhoids. They are very effective in managing painful symptoms of severe hemorrhoids.

Stool Softeners

Stool softeners help retain moisture in the stool. Hard and dry stool can cause trauma to the rectal walls and irritate hemorrhoids which aggravate the condition. Consult your doctor and take stool softeners if you have a history of chronic constipation. Stool softeners also help avoid painful bowel movements.

Rubber Band Ligation

It is a minimally invasive treatment recommended to patients with prolapsed hemorrhoids. Rubber-band ligation involves tying a band around hemorrhoids to restrict blood flow. It is an effective non-surgical treatment for reducing pain, inflammation, and swelling associated with hemorrhoids.

When Is Surgery Needed?

Invasive surgical treatment is used as the last resort for hemorrhoidal disease. Doctors may recommend it for the following reasons:

Unmanageable Pain

External and thrombosed hemorrhoids can cause severe pain and discomfort. In cases of unmanageable pain, surgery might be the only way to alleviate symptoms.

Failure of Alternative Treatment

Non-surgical methods can fail in severe cases of hemorrhoidal disease. If attempts at relieving pain through simple remedies fail, doctors recommend surgical options to treat hemorrhoids.

Medical Emergency

Medical emergencies include severe and uncontrollable rectal bleeding, Grade III and IV hemorrhoids, and ruptured hemorrhoids. In these cases, immediate medical attention becomes vital.

The most effective surgical option is an external hemorrhoidectomy for thrombosed external hemorrhoids.

Hemorrhoidectomy for Thrombosed External Hemorrhoids

Hemorrhoidectomy is a surgical procedure that completely removes a hemorrhoid and mitigates the risk of recurrence. It has a high success rate and can quickly manage large external hemorrhoids and acutely swollen thrombosed hemorrhoids.

The procedure involves performing an incision over the site of thrombosis to cut out the hemorrhoidal tissues and swollen veins. The incision can be made using a scalpel, laser, or electrocautery. Great care is taken to avoid cutting into nearby muscle sphincter and rectal tissue. Anesthesia is administered to the patient before the surgery.

Since the surgery involves making single or multiple incisions, sutures are required to prevent bleeding. A new procedure, called hemorrhoidopexy, uses a circular stapling device to remove the hemorrhoid and simultaneously seal the wound. Although more costly, no sutures or incisions are required, and the procedure is less painful.

Hemorrhoidectomy is usually an outpatient surgery, meaning the patient can go home on the same day. Different hemorrhoidectomy techniques can be used depending on the severity of hemorrhoidal disease and the surgeon’s preference. Some common methods include:

  • Open hemorrhoidectomy
  • Stapled hemorrhoidectomy or procedure for prolapse and hemorrhoids (PPH)
  • Lateral internal sphincterotomy
  • Hemorrhoidal artery ligation and recto-anal repair (HAL-RAR)

HAL-RAR is a new procedure and is especially effective for thrombosed external hemorrhoids. It involves the use of a sensor that is inserted into the anus. The sensor can detect arteries that are supplying blood to the thrombosed hemorrhoids. With the device's help, the surgeon will tie off the arteries and cut-off blood supply to the hemorrhoids. This reduces complications related to bleeding during the surgery and significantly reduces inflammation and swelling. HAL-RAR is an effective surgical treatment and is relatively painless.

Risks and Postoperative Care

Although rare, there are risks to surgery. Patients can sometimes suffer from excessive bleeding, fecal inconsistency, and infections. The stitches can become infected and cause a fever to develop. People can have trouble peeing or excessive bleeding from the anal area. Surgery is recommended during the first 72 hours of the appearance of the thrombosed hemorrhoid.

Attempting to excise it after the prescribed period can result in severe pain. Fortunately, most of these risks are relatively rare and can be managed by postoperative care.

Postoperative care mainly involves pain management. The patient can suffer from mild to severe pain for 2-4 weeks before resuming daily activities. Pain medication is prescribed in this regard and includes over-the-counter painkillers.

Soaking the surgical site in warm water is recommended to keep the area clean and pain-free. It is also essential to avoid constipation as bowel movements are a primary postoperative concern. Doctors recommend taking a high fiber diet, using stool softeners, and increasing liquid intake to keep the stool soft. These tips help reduce strained bowel movements and make it easier to pass the stool.

We hope this article helped you understand hemorrhoidectomy for thrombosed external hemorrhoids. Although not necessary, this procedure can prevent the recurrence of hemorrhoids and help you live a pain-free life. Consult your doctor for a more effective treatment plan.