When do external hemorrhoids need surgery

While hemorrhoids are a pain, the good news is most do not require surgery and can be managed through other treatments, changes in diet, or at home remedies. There are several options to treat hemorrhoids that cause very little pain, if any, and have a quick recovery time. In most cases, patients can go back to work within a day. Rubber Band Ligation , or banding, is a common procedure to treat internal hemorrhoids. A small elastic band is placed around the base of the hemorrhoid cutting off its blood supply, which causes the hemorrhoid to shrink.

Most cases require two to four procedures done about two months apart. Sclerotherapy involves injecting the hemorrhoid with a solution that causes the hemorrhoid to shrink. Coagulation therapy is a treatment where infrared light, heat, or extreme cold are used to retract and shrink the hemorrhoid.

This article was published on March 1, , and was last updated on May 1st, in Hemorrhoid Banding. Hemorrhoids are cushions of swollen tissue and blood vessels in your lower rectal region. External hemorrhoids present as bulges or bumps around the anus and are often the cause of the discomfort people associate with hemorrhoids.

Hemorrhoid surgery may be necessary for internal hemorrhoids that have prolapsed an internal hemorrhoid protruding outside of the anal canal if this prolapse is significant, such as when the protruding tissue cannot be pushed back in. Surgery is not the preferred option to treat most hemorrhoids, as patients may experience postoperative pain, bleeding, or incontinence.

There are other hemorrhoid treatments , such as rubber band ligation, that offer relief through less-invasive measures. The treatment technology involves placing a band around the base of the affected area to cut off the blood supply to the hemorrhoid, causing it to shrink and fall off within a few days. Find a Doctor Find a physician near you. Provide only temporary relief.

Treats the underlying cause. Treats the symptoms. Proven to be effective. Efficacy is unproven. Learn more about Hemorrhoid Creams and Home Remedies ». The inspection of the anal tissues should not be deferred, and anoscopy can be performed after administration of the anesthetic to make it more tolerable for the patient.

Suture placement is difficult in the anus because of the narrow surgical field and because sutures do not hold well in the tissues below the anoderm. Taking adequate bites of tissue with each pass of the suture needle and placing multiple, interrupted, buried sutures can ensure proper closure of the wound.

The suture should be subcuticular and not protrude through the anoderm. Passage of hard stool can easily tear the suture line. The need for soft stools must be emphasized to the patient. Multiple modalities can be used to soften the stools, such as stool softeners, stool-bulking agents and increased daily consumption of fluids.

Even with soft stools, however, it is not unusual for some tearing to occur at the suture line. Physicians with proper surgical skills can master this procedure.

Extensive training and experience in general and skin surgery may be needed before attempting this procedure unsupervised. The bleeding that occurs during the procedure may frighten novice surgeons. The complications of the procedure should be respected, and patients can be referred to more experienced physicians if a comfort level and adequate experience are lacking; however, the basic skills needed to perform this procedure are not unlike those for the fusiform excisional biopsy commonly performed for removal of skin lesions.

Already a member or subscriber? Log in. Interested in AAFP membership? Learn more. Bassford T. Treatment of common anorectal disorders. Am Fam Physician. Buls JG. Excision of thrombosed external hemorrhoids. Hosp Med. Ferguson EF. Alternatives in the treatment of hemorrhoidal disease. South Med J. Anorectal disorders. Clin Symposia. Office management of hemorrhoids. Female Patient. Grosz CR. A surgical treatment of thrombosed external hemorrhoids.

Dis Colon Rectum. Hemorrhoids: modern treatment methods. Muldoon JP. The completely closed hemorrhoidectomy: a reliable and trusted friend for 25 years. Outpatient management of hemorrhoids. Prim Care. Zuber TJ. Anorectal disease and hemorrhoids. In: Taylor RB, ed. Manual of family practice.

Boston: Little, Brown, —4. Adapted with permission from Zuber TJ. Office procedures. Office Procedures forms on hemorrhoidectomy for thrombosed external hemorrhoids are provided on pages , , and This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference.