Haemorrhoids, also known as piles, are soft fleshy lumps just inside the back passage (anus). They bleed easily, usually causing fresh bright-red bleeding when a motion is passed. They do not usually cause pain but can cause itching. When large, they can pass through the anus (prolapsed pile), feeling like a lump when you clean yourself (see figure 1).
Haemorrhoids develop gradually, often over a long period of time. They are associated with constipation, often run in families and can be made worse by pregnancy.
Q. What is it ?
Piles (haemorrhoids) are the loose lining of skin that bulges out through the ring muscle which holds the back passage shut. They contain big blood vessels which can bleed or clot up and cause pain. The loose skin can produce irritating tags. Haemorrhoidectomy simply means removal of the haemorrhoids.
The operation
You will probably have a general anaesthetic and be completely asleep. Sometimes you may be given an injection in the back to numb the area. The ring muscle is stretched and the piles are trimmed off. Usually after two or three days, when your bowels have opened, you will feel fit enough to leave hospital provided there is someone to look after you.
The wound(s) are not closed with stitches. The area of the back passage is full of bugs and if the wound is closed, bugs may get 'trapped' and cause an infection and an abscess (a pool of pus). Instead, the wound is left open to heal slowly. The wound healing is completed within a week or two.
Q. Any alternatives ?
If you do nothing the piles will stay about as troublesome as they are now or get worse. They will not get better. Instead of cutting off the piles, they can be frozen or nipped off with rubber bands. Overall the best option is to have the piles cut out.
Before the operation
Stop smoking and get your weight down if you are overweight. (See Healthy Living). If you know that you have problems with your blood pressure, your heart, or your lungs, ask your family doctor to check that these are under control. Check the hospital's advice about taking the Pill or hormone replacement therapy (HRT). Check you have a relative or friend who can come with you to the hospital, take you home, and look after you for the first week after the operation. Bring all your tablets and medicines with you to hospital.
On the ward, you will be checked for past illnesses and will have special tests to make sure that you are ready and that you can have the operation as safely as possible. You will have the operation explained to you and will be asked to fill in an operation consent form.
Before you sign the consent form, make sure that you fully understand all the information that was given to you regarding your health problems, the possible and proposed treatments and any potential risks. Feel free to ask more questions if things are not entirely clear. Many hospitals now run special preadmission clinics, where you visit a week or so before the operation, where these checks will be made.
After - in hospital
There is some discomfort on moving rather than severe pain. You will be given injections or tablets to control this as required. Ask for more if the pain is not controlled or if it gets worse. Many hospitals are now using what is called PCA (patient controlled analgesia). By pressing a button on a device you can inject painkillers into your bloodstream through a very fine plastic tube that goes into one of the small blood vessels (veins) in your hand.
A small computer controls the amount of painkiller that is released and prevents any accidental overdose. Alternatively, you may have a fine tube in your back through which pain relief can be given to help control the pain. The second day after the operation you should be able to spend most of your time out of bed and in reasonable comfort. You should be able to walk slowly along the corridor. By the end of the first week the wound should be virtually pain-free.
A general anaesthetic will make you slow, clumsy and forgetful for about 24 hours. The nurses will help you with everything you need until you are able to do things for yourself. Do not make important decisions during this time.
It is quite normal for the bowels not to open for a day or so after the operation. The first time you open your bowels it may be a bit painful but this should improve quickly. You may also see a small amount of blood mixed with your stool for a few days after the operation. This eventually stops. Once your bowels have opened you can make plans to go home. The discomfort of the operation can make it difficult to pass urine and empty the bladder.
It is important that your bladder does not seize up completely. If you cannot get the urine flowing properly after six hours, contact the nurses or your doctor. This can sometimes happen sometimes soon after an operation and you might need to have a catheter (draining plastic tube) put in your bladder for a few days.
The wound may have a dressing held on with elasticated net pants. There may be some staining with old blood during the first 12 hours. The dressing will be removed the day after operation and will be replaced with a lighter one. There may be black threads tied round the stumps of the piles. These will drop off by themselves in two or three days. Do not pull them.
There are many different types of dressings for piles. Ask the nurses for details. You can wash the wound area as soon as the dressing has been removed. Soap and tap water are entirely adequate. Salted water is not necessary. Avoid using toilet paper after you open your bowels. This can scratch the healing wound(s) and cause pain and bleeding. Is better to wash the area with soap and water. You can bath or shower as often as you wish. Some hospitals arrange a check up about one month after you leave hospital. Others leave check-ups to the general practitioner. The nurses will advise about sick notes, certificates etc.
After - at home
You are likely to feel very tired and need to rest two to three times a day for a week or more. You will gradually improve so that by the time a month has passed you will be able to return completely to your usual level of activity. It will take a month before your back passage feels normal again.
You can drive as soon as you can make an emergency stop without discomfort in the wound, i.e. after about 10 days. You can restart sexual activities within a week or two, when the wound is comfortable enough. You should be able to return to a light job after about one week and any heavy job within two weeks.
Possible complications
If you have this operation under general anaesthetic, there is a very small risk of complications related to your heart and lungs. The tests that you will have before the operation will make sure that you can have the operation in the safest possible way and will bring the risk for such complications very close to zero.
Complications are rare and seldom serious. If you think that all is not well, let the doctors or the nurses know. The wound is always a bit moist for a week or two. There is likely to be a discharge of yellow matter and even some dark blood on the dressings during this time. Opening your bowels becomes gradually easier particularly if you take a laxative.
DO NOT however take bran or a high-fibre diet until the back passage is pain-free in case you end up with a blockage. Occasionally after 7 to 10 days there is more bleeding. Contact your doctor straight away. Rarely, you can have an infection in the wound area which is settled by taking antibiotics for a few days. Occasionally you may notice difficulty controlling the wind or your stool through your back passage. This improves after a day or two.
If it doesn't or if it gets worse it is potentially an indication of the very rare complication of a sphincter (the muscle that keeps the back passage shut) injury that took may have taken place during the operation. The sphincters are the muscles that help you control your back passage and obviously if they have been damaged you will partially or completely lose control of you back passage. This might require an operation to fix it.
The chance of the piles coming back again is less than 1 in 20. Maintaining good bowel habits by using fibre and water in the diet and avoiding straining can help a lot in preventing the recurrence of piles.
Q. What are the benefits of surgery ?
Surgery will remove the haemorrhoids. You should no longer have any of the symptoms that haemorrhoids can cause.
Q. Are there any alternatives to surgery ?
Haemorrhoids can often be successfully treated by simple measures such as eating more fibre and drinking more fluid.
If these simple measures are unsuccessful, the haemorrhoids can usually be treated successfully in a clinic. Local treatments include 'banding' or 'injecting' the haemorrhoids.
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