What are hemorrhoids?
Hemorrhoids are enlarged, swollen veins in the tissues that surround and support the rectum and anus.
The rectum is the lower part of the colon (large intestine) and is about 15 cm long. The anus is the last 4 cm of the intestine, located at the end of the rectum, and is where stool comes out of the body.
There is a change in the type of lining between the rectum and anus. The transition occurs at the dentate line. Internal hemorrhoids are swollen veins in the rectum above the dentate line and external hemorrhoids are swollen veins in the anus below the dentate line.
Hemorrhoid severity is graded 1 through 4:
- Grade 1: There is some bleeding from the anus, but the hemorrhoid does not prolapse (protrude)
- Grade 2: The hemorrhoid prolapses through the anus with straining but reduces (returns back to its normal place spontaneously)
- Grade 3: The hemorrhoid prolapses with straining and has to be manually replaced into the anal canal
- Grade 4: The hemorrhoids remain prolapsed all the time and cannot be replaced into the anal canal
What is stapled hemorrhoidectomy?
Internal hemorrhoids can be treated with a surgical procedure called a stapled hemorrhoidectomy.
In a regular hemorrhoidectomy, the surgeon identifies the enlarged hemorrhoids and excises or cuts them out.
In a stapled hemorrhoidectomy, a stapling device is inserted into the anus and a circular strip of hemorrhoidal tissue is cut away. This allows the hemorrhoidal tissue to be lifted back into its normal place in the anus and it decreases blood supply to the area, allowing the swollen veins to shrink.
Because the anus has to be stretched to introduce the stapler, the procedure is usually done under general anesthesia. The operation takes about 30 minutes to complete.
Who is a good candidate for stapled hemorrhoidectomy?
Patients with Grade 3 and grade 4 hemorrhoids are candidates for stapled hemorrhoidectomy.
Patients with circumferential hemorrhoids, or who have large grade 2 hemorrhoids that would likely fail more conservative treatments, may benefit from the procedure.
How long is the recovery from stapled hemorrhoid surgery?
After surgery, most daily activities can begin within 1-2 days. A bowel movement should also happen in that time, and some blood might be expected. Full recovery from the surgery takes about 2 weeks.
During recovery, home treatment includes staying well hydrated, and liberal use of sitz baths. Sitting in shallow warm water helps relax the muscles in the perineal area around the anus, and decreases pain and irritation.
The surgeon may prescribe pain medications for the first couple days after the operation.
Can hemorrhoids come back after stapled hemorrhoidectomy?
Hemorrhoids can often return after stapled hemorrhoidectomy. The recurrence rate depends upon the patients and their situation, but can be more than 20%.
The risk of recurrent hemorrhoids can be minimized by staying well hydrated, eating a high fiber diet to prevent constipation, exercising often, and avoiding long periods of sitting.
What are the complications or side effects from stapled hemorrhoidectomy?
As with any operation, there is a risk of bleeding and infection.
After the operation, some people develop muscle spasm and pain in the rectal area. They can have short term tenesmus, the constant feeling of the need to defecate, urgency to urinate, and sometimes the inability to urinate.
Rare complications include perforating (tearing) the rectum, formation of a fistula (connection) between the rectum and vagina in women, and scarring and narrowing of the anal tissues.
What happens to the staples from a stapled hemorrhoidectomy?
As the tissue lining of the anus heals, the staples gradually fall out and are passed in bowel movements. The patient may or may not notice them.
SLIDESHOW
How to Get Rid of Hemorrhoids: Types, Causes, and Treatments See SlideshowJong-Sun Kim, Yogesh K, et al. Stapled Hemorrhoidopexy Versus Milligan–Morgan Hemorrhoidectomy in Circumferential Third-Degree Hemorrhoids: Long-Term Results of a Randomized Controlled Trial. Journal of Gastrointestinal Surgery. 2013. 17(7).1292-1298
Lohsiriwat V. Hemorrhoids: from basic pathophysiology to clinical management. World J Gastroenterol. 2012. 18(17):2009-17.
Pablo P, Nicolas A, Augusto. Stapled Hemorrhoidopexy. Indications in 2021. Rev Argent Coloproct2021. 32 (1): 28-30
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