Surgery
Most hemorrhoids do not require surgery. It is usually considered only for severe hemorrhoids.
Surgery may be done if other treatments (including home treatment) have failed. Surgery is also considered when symptoms become so bothersome that your lifestyle is affected or when hemorrhoids create a medical emergency, such as uncontrolled bleeding or blood and pus at the anus along with severe rectal pain.
External hemorrhoids
External hemorrhoids usually are not removed with surgery (hemorrhoidectomy) except if they are very large and uncomfortable or if you are having surgery on the anal area for another reason, such as internal hemorrhoids or a tear (anal fissure).
Internal hemorrhoids
Surgical removal of hemorrhoids (hemorrhoidectomy) is a last resort for treating small internal hemorrhoids.
Hemorrhoidectomy is considered the most successful way to treat large internal hemorrhoids, especially those that are still a problem after treatments that cut off blood flow to hemorrhoids (fixative procedures) have been tried.
Surgery Choices
The surgical option for hemorrhoids is a hemorrhoidectomy, used mostly for large internal hemorrhoids.
What To Think About
Occasionally, increased pressure on external hemorrhoids causes them to break and bleed. This causes a lump (thrombosed, or clotted, hemorrhoid) to form. You may suffer from severe pain at the site of the clotted hemorrhoid.
A procedure to relieve the pain can be performed in a health professional's office or outpatient clinic. The health professional applies local anesthesia and then makes a small incision where the lump has occurred to remove the clot and reduce pressure and pain. The procedure works best if it is done less than 4 or 5 days after the clot has formed.
If the pain is tolerable, you may choose to wait to see a health professional. The pain usually goes away in a few days. After 4 or 5 days, the pain from cutting and draining the hemorrhoid is usually worse than the pain from the clot.
Brent Shoji, MD - General Surgery
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