Haemorrhoidectomy (surgical removal of the haemorrhoids) is reserved for very large or complicated haemorrhoids. This procedure is performed under general anaesthesia in hospital. The operation involves removal of the haemorrhoids (usually three) and internal stitching of the wounds. The skin is usually not stitched and the wounds heal gradually. Although it remains the most effective treatment for large haemorrhoids, it is associated with pain after surgery and a recovery period of several weeks. The surgery is usually performed as a day only or overnight stay procedure under general anaesthetic. The operation takes around about forty minutes. You will be given a prescription for a strong painkiller such as oxycodone to use after the operation. It is advisable to use a stool softener after to avoid becoming constipated. You should bathe the haemorrhoidectomy wounds in a shallow salt bath 2-3 times a day. This reduces irritation to the surrounding skin and the heat is very soothing. Most patients will need 2-3 weeks off work after haemorrhoid surgery.
Local anaesthetic has been used to provide pain relief today but this will wear off over the next few hours. It is important to take some painkillers before the pain becomes intense, as it will then be harder to control. Unless otherwise directed you should use Panadol 1 gram every six hours and Ibupfrofen 400 milligrams every eight hours for the next 48 hours. You should check with your doctor that it is appropriate for you to take Ibupfrofen. If you require stronger pain relief Endone 5 milligram may be used but this will require a prescription. You must not drive or work while using this medication.
Wounds around the anus cannot be stitched closed because of the risk of infection. As a result you may have an open wound, which will have been dressed in the operating theatre. If a dressing has been used this can be easily removed in the bath or shower later that day. Unless otherwise instructed, the wound requires no dressing, and you should wear a pad inside your underwear to absorb any fluid leaking from the wound. These secretions can irritate the skin around the anus. This can be prevented by using a barrier cream like Bepanthen or Vaseline.
Your bowels will continue to work normally after your surgery. It is best to avoid becoming constipated, as hard motions will increase you level of discomfort. Normafibe, one teaspoon twice daily may be used for the first week after surgery. It is normal to experience pain with bowel movements for the first week or so after surgery. You may see blood on the toilet paper or in then bowl with the first few bowel motions.
Warm baths are very soothing when you are in pain. A handful of cooking salt may be added to the bathwater in order to help keep the wound clean. If you find it helpful you can bathe 2–3 times per day and after bowel movements.
Things to watch out for
If you experience high fevers, large volume bleeding, difficulty passing urine or increasing pain, you should notify your doctor as soon as practicable.
Resuming normal activities
Anal surgery is painful. Except after very minor procedures, you will need 5–14 days off work. Sport and vigorous physical activities should be avoided for 2–3 weeks.