When Do Hemorrhoids Require Surgery?

Hemorrhoid surgery may be indicated when other treatments do not control symptoms.

Intense or frequent flare-ups may also lead to the evaluation of surgical treatment. The decision considers symptoms and the impact of hemorrhoidal disease on quality of life. Many patients begin treatment with dietary changes, bowel habit modifications, and, when necessary, medications.

What Symptoms Indicate the Need for Surgery?

Recurrent bleeding, significant prolapse, and persistent symptoms may lead to a surgical evaluation. Prolapse is the exteriorization of hemorrhoidal tissue through the anus.

In grade III internal hemorrhoids, the exteriorized tissue needs to be manually repositioned. In grade IV, the tissue remains exteriorized and cannot be repositioned. Hemorrhoids with advanced prolapse may require surgical treatment, especially when symptoms persist despite other forms of treatment.

External hemorrhoidal thrombosis occurs when a blood clot forms within an external hemorrhoid. This condition can cause a hardened, very painful lump near the anus. Some patients with external hemorrhoidal thrombosis may benefit from early surgical removal.

Persistent bleeding also requires investigation. Anal bleeding should not be automatically attributed to hemorrhoids, as other bowel and rectal conditions can present with the same symptom.

How is the Evaluation for Surgery Performed?

The evaluation begins with an analysis of the patient’s symptoms and medical history. A proctological examination allows for the assessment of the anal region and the identification of the type of hemorrhoid, the degree of prolapse, and the presence of complications.

Anoscopy is an examination that allows visualization of the inside of the anal canal. This examination aids in the evaluation of internal hemorrhoids and in defining the degree of prolapse.

The type of hemorrhoid, the degree of prolapse, and the intensity of symptoms help define the treatment. The response to previously administered treatments is also part of this decision.

What Surgical Techniques Are Available?

Different techniques exist for the surgical treatment of hemorrhoidal disease. The choice depends on the type of hemorrhoid, the symptoms, and the characteristics of each patient.

Hemorrhoidectomy involves the surgical removal of symptomatic hemorrhoidal tissue. The American Society of Colon and Rectal Surgeons primarily recommends this technique for selected patients with external hemorrhoids or combined symptomatic internal and external disease.

Stapled hemorrhoidopexy is a technique used to treat prolapsed internal hemorrhoids. The procedure does not address the external component of hemorrhoidal disease. This technique is not routinely recommended as a first-line surgical option by the American Society of Colon and Rectal Surgeons.

Transanal hemorrhoidal dearterialization identifies and ligates the vessels supplying blood to internal hemorrhoids. This technique may be used in selected patients as one of the surgical treatment options.

The indication for hemorrhoid surgery is individualized. The type of hemorrhoid, symptoms, degree of prolapse, and response to previous treatments help define the strategy for each patient.