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To remove internal or external hemorrhoids, it may be necessary to have surgery, which is indicated for patients who, even after undergoing treatment with medication and an adequate diet, maintain pain, discomfort, itching and bleeding, especially when evacuating.
There are several techniques to remove hemorrhoids, the most common being hemorrhoidectomy, which is the traditional technique that is done through a cut. The recovery takes between 1 week to 1 month, being necessary to stay in the hospital for about 2 days and maintain good hygiene of the intimate region during the recovery time.
Surgical techniques to remove hemorrhoids
Some techniques for removing internal or external hemorrhoids can be:
1. Hemorrhoidectomy
Hemorrhoidectomy is the most common surgery and involves removing hemorrhoids through a cut. For this reason, it is widely used in external hemorrhoids or in internal grade 3 and 4.
2. Technique by THD
This is a surgery done without cuts, where the doctor uses an ultrasound device to identify the vessels that carry blood to hemorrhoids. After these vessels are identified, the doctor will stop the blood circulation by sewing the artery, which causes the hemorrhoid to wilt and dry over time. This technique can be used for grade 2, 3 or 4 hemorrhoids.
3. PPH technique
The PPH technique allows the hemorrhoids to be fixed in their original position, using special titanium clamps. This procedure does not require sutures, has a fast recovery time and is done on internal hemorrhoids of grades 2 and 3.
4. Lacquering with elastic
This is a treatment where a small elastic band is applied to the base of the hemorrhoid, which will interrupt blood transport and cause the hemorrhoid to die, being common in the treatment of grade 2 and 3 hemorrhoids.
5. Sclerotherapy
In this technique, a product that causes tissue death is injected into the hemorrhoid vessels, being used for the treatment of grade 1 and 2 hemorrhoids. Learn more about this procedure.
In addition, there are also other methods that can be used to remove hemorrhoids, such as infrared coagulation, cryotherapy and laser, for example and the choice of the technique will depend on the type and degree of hemorrhoids that you want to treat.
6. Infrared coagulation
This is a technique that can be used to treat internal bleeding in hemorrhoids.For this, the doctor uses a device with an infrared light that warms the place and creates a scar in the hemorrhoid, making the blood to stop passing and, consequently, the hemorrhoid tissues harden and end up falling.
Infrared coagulation usually has very few side effects and causes very little discomfort.
Classification of the degree of internal hemorrhoids
Internal hemorrhoids are those that develop and remain inside the anus, and can present different degrees, such as:
- Grade 1 - Hemorrhoid that is found inside the anus, with a slight enlargement of the veins;
- Grade 2 - Hemorrhoid that leaves the anus during defecation and returns to the interior spontaneously;
- Grade 3 - Hemorrhoids that come out of the anus during defecation and that need to be re-introduced into the anus by hand
- Grade 4 - Hemorrhoid that develops inside the anus but that due to its enlargement it comes out through the anus, which can cause rectal prolapse, which is the exit of the final part of the intestine through the anus.
External hemorrhoids are those that are on the outside of the anus, and these can also be removed through surgery, because they cause discomfort especially when sitting and defecating.
How is the surgery done
In most cases, surgeries to remove hemorrhoids are performed under general anesthesia and require the patient to be hospitalized for about 2 days.
To remove hemorrhoids, the proctologist must choose the most appropriate technique for each case, because they vary depending on the type of hemorrhoid the patient has.
How is the postoperative
Although the surgery does not cause pain, in the postoperative period it is normal for the patient to experience pain in the perineal region, especially when sitting and on his first evacuation after surgery, as this region is more sensitive. Thus, the doctor usually indicates:
- Use of analgesics to control pain and discomfort, such as paracetamol every 8 hours;
- Use of laxatives to make stools softer and easier to evacuate;
- Performing a cold water sitz bath for 20 minutes, the number of times necessary to reduce discomfort;
- Avoid using toilet paper, and wash the anal area after evacuation with warm water and mild soap;
- Use an ointment guided by the doctor, twice a day, to help heal the area.
After surgery, it is recommended to use a round buoy-shaped pillow to sit, in order to decrease the risk of bleeding and reduce pain. In addition, during the first month after surgery, foods rich in fiber and drinking plenty of water should be preferred, so that stools are softer and easier to evacuate.
Normally, the patient does not need to remove the stitches and, after total healing, there are no scars.
Check out in the video below how food should be to facilitate intestinal transit and prevent hemorrhoids:
What is the recovery time
The recovery from hemorrhoid surgery depends on the type and degree of hemorrhoid and the surgical technique performed, and can vary between 1 week and 1 month, so that the patient can normally resume their day-to-day activities.
It is normal that during the first week after surgery, the patient has small blood losses through the anal area, however, if this bleeding is severe it is recommended to go to the hospital to check if he is recovering correctly.