Ark Surgical Practice

Surgery for Piles

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What is Surgery for Piles?

Most patients will benefit from conservative management for piles. Symptomatic piles are referred for intervention especially when symptoms persist after medical therapy. The options are broadly divided into 2 main categories: bedside procedures and day surgery procedures.

Bedside procedures include:

  1. Rubber band ligation
  2. Injection Sclerotherapy

Rubber band ligation is the recommended first option by international guidelines (quote ASCRS website) and widely used. This procedure can be done without any sedation. It is relatively painless and carries a very small risk of bleeding and infection. Most patients will feel some urge to defecate for about 3- 5 days after ligation and this feeling goes away when the rubber band drops off.

Injection sclerotherapy has few reported severe complications due to the systemic dissemination of the sclerosant. Coupled with the similar efficacy compared to band ligation, this technique is not commonly performed and indicated only in small hemorrhoids.

Day surgery procedures include:

  1. Conventional hemorrhoidectomy
  2. Ligasure or Energy-device hemorrhoidectomy
  3. Stapler hemorrhoidopexy
  4. Laser Ablation or HETTM Bipolar System ablation

Conventional hemorrhoidectomy, Milligan-Morgan or Ferguson, including diathermy hemorrhoidectomy are variants of a similar procedure of excisional hemorrhoidectomy. Beyond minor technical differences, these procedures all involve the removal of the dilated hemorrhoids. 

The outcomes are largely similar as well and remain an effective method for the treatment of hemorrhoids. Ligasure hemorrhoidectomy uses an energy sealing device to perform the hemorrhoidectomy. This allows for increased hemostasis for the surgery. The outcomes for this procedure

Stapler hemorrhoidopexy uses a unique device to remove a circular ring of tissue above the dentate line. This results in the interruption of blood flow into the hemorrhoids thereby leading to shrinkage and resolution of symptoms. 

As the surgery is performed above the line of tactile sensation, this procedure is proven to have lesser post-operative pain and faster recovery to work. Similar to other surgeries, this is performed under general anesthesia or spinal and patients can be discharged on the same day.

Ablation techniques involve using heat to ablate the hemorrhoids. These techniques avoid cutting the inner lining of the anal canal which has the possible benefit of lesser pain and less postoperative bleeding.

Why is Piles Treatment Necessary?

In its early stages, hemorrhoids or piles may not be that serious and can be treated with conservative measures such as changes in diet, increased water intake, and using stool softeners. However, for many people, the symptoms can worsen over time, and surgical removal is the only way to get rid of the piles. 

A hemorrhoidectomy is a surgical procedure that involves the removal of the hemorrhoidal tissue from the rectal area. This procedure is often done by a specialist in a clinic or hospital. Hemorrhoidectomy is the preferred method of treatment for piles because it offers the greatest chance of a successful outcome. 

It is also the most effective way to get rid of the enlarged veins responsible for the symptoms. Surgery also reduces the risk of recurrence of the condition, as well as the risk of complications. 

Although hemorrhoidectomy is a more invasive form of treatment, it is still safer and the risks are very uncommon. However if you had previous hemorrhoid surgery done before, it is important to consider the different options as not all options are suitable for recurrent hemorrhoids. 

Many people are embarrassed to see the doctor until the pain and discomfort become unbearable, or when there is bleeding. This is why it is important for patients to seek medical help as soon as possible to ensure that their condition does not worsen. A hemorrhoidectomy procedure is usually done under local or general anesthesia. 

The procedure typically lasts for between 1 to 2 hours and patients can usually leave the hospital within 24 hours. If piles are left untreated, they can worsen over time and lead to more serious complications. These can include rectal bleeding, rectal prolapse, and even rectal cancer. Therefore, it is essential for patients to seek medical help as soon as symptoms are present.

How Can One Prepare for a Piles Surgery?

Preparation is key to ensure a successful surgery and quick recovery. Here are some important steps to take before your piles surgery. 

First, you should consult your doctor about any prescription medications you’re using and make sure to stop any medications that may thin your blood, such as aspirin. Your doctor will advise you if there are any other medications that you should stop taking before your surgery. 

Second, it’s important to refrain from eating or drinking anything 8 hours before your surgery. This precaution is in place to ensure the best possible outcome and reduce the risk of any complications. 

Third, you may also need to undergo a colonoscopy before your piles surgery. This procedure will help your doctor to identify any other potential issues in your colon that may affect the piles surgery. Importantly, it excludes other causes of your symptoms that may present like piles.   

Finally, it’s important to relax and get plenty of rest. Make sure to get lots of sleep the night before your surgery and be sure to take any prescribed medications that may help to reduce anxiety. 

By following these simple steps, you will be well-prepared for your piles surgery procedure. You can be sure that your doctor is committed to providing you with the best care and making sure that you have a successful surgery and quick recovery.

What Can One Expect After Piles Surgery?

Piles surgery comes with a range of benefits from relief from the discomfort caused by piles to a decrease in the risk of complications resulting from the condition. However, while the procedure can be very effective in treating piles, there are some changes that you should be aware of in order to ensure a smooth recovery. Here’s what you should expect after undergoing piles surgery.

Pain and Bleeding

Pain and mild bleeding are common in the days and weeks following a piles surgery especially after conventional hemorrhoidectomy. While some pain and bleeding is normal, it is important that you keep an eye on any excessive bleeding or pain that is severe and requires medication. In these cases, you should speak to your doctor as soon as possible to ensure that you receive the necessary medical treatment and pain relief.

Ice Packs and Sitz Baths

Ice packs are a great way to reduce swelling and pain in the area around the surgery. You should apply the ice pack to the anal area for about fifteen minutes at least four times a day for the first week following the surgery. Additionally, you should take frequent sitz baths throughout the day to help ease any pain and help reduce any muscle spasms.

Antibiotics

In some cases, it may be necessary to take antibiotics after a piles surgery. This usually helps to reduce pain. Based on meta-analysis for clinical studies, the use of metronidazole helps to reduce postoperative pain. 

However, if your piles are smaller or one of the newer techniques is used, antibiotics may not be necessary. Thus, your doctor will be able to advise you on the best type of antibiotics for you, depending on the severity of your condition and the extent of the surgery.

Recovery Period

The recovery period for piles surgery varies from person to person, depending on the severity and extent of the surgery. Most people are able to return to work within one to two weeks, however, it is important to take it easy and avoid any strenuous activities for the first few weeks after the surgery.

By following your doctor’s advice and taking the time to properly recover from your piles surgery, you should have a successful outcome. If you experience any excessive pain or bleeding, or any other symptoms that are out of the ordinary, then you should speak to your doctor as soon as possible.

Frequently Asked Questions

  • Will piles go away on their own?

    The natural history for piles is that they will get engorged and result in bleeding and then shrink again. This happens repeatedly depending on our lifestyle and diet. As piles are actually made of normal vascular tissue in our body, so they don’t really “go away”. 

    They can shrink to a normal state where it will no longer cause any symptoms. This is usually the aim of any treatment to relieve the symptoms. Hence, it is not always needed to treat piles especially when they are asymptomatic. 

    It is better to change your lifestyle and diet to prevent constipation and worsening of piles. This is especially true as we get older as piles do tend to worsen over age. Some of the key factors to avoid are smoking, alcohol, lack of fiber diet and straining during bowel movement.

  • When should I worry about piles?

    Piles are not cancerous nor dangerous. The main symptoms they cause are bleeding and painful swelling. Should the bleeding not improve after medications, you should seek a doctor for consultation. 

    The bleeding can sometimes be worrisome as patients can have severe anemia from continuous bleeding. This really is uncommon and it refers to literally weeks of bleeding and bleeding with clots.

    If a swelling doesn’t go away or seems to be getting painful, do seek a doctor’s advise about whether it really indeed is piles. This is again very uncommon but there are other causes of swelling in the anus like polyps. 

  • How can I prevent piles?

    Prevention of piles should be targeted at lifestyle and diet modifications. Lifestyle measures include:

    1. Avoiding straining or specifically breath holding during bowel movement or urination
    2. Avoid taking too long a time in the restroom. Activities like using ipad, smartphones, reading papers etc will result in the prolongation of bearing down sensation and cause increase in propensity for piles development. 
    3. Avoid smoking as these do lead to increase piles formation
    4. Avoid alcoholic binges. It is quite common for patients to develop symptoms of bleeding or swelling especially after a heavy alcoholic intake. 
    5. Consult a doctor if you have any constipation or urination issues as medications can help to relieve these symptoms
    6. Exercising regularly helps to improve bowel function

     

    Diet measures include:

    1. Increase the amount of daily fiber. Fruits and vegetables are both acceptable and it is advised to have about 4-5 portions of fiber daily. Each portion is limited to the size of a small apple. 
    2. Increase the amount of water consumption. This really helps with preventing constipation especially amidst our busy schedule. Do try to take at least 2L of water a day. 
    3. Supplements are not necessary but it may improve your bowel symptoms. In general, avoid spending too much on expensive supplements as the evidence around these are not supportive of routine use. This shows that the above measures are by far more important. Do consult a doctor for a balanced view of how supplements can help your individualized needs.

  • What should I avoid after piles surgery?

    Essentially you should avoid all the measures as stated in the section under “How do i prevent piles”. In addition, avoid doing strenuous exercise which includes weight lifting and sea sports during this period of time. A patient actually went sky-diving within a week after surgery. 

    Although that is not absolutely contraindicated, breath-holding and over-using of core-muscles are not good during this period as it can potentially lead to increased risk of bleeding. Practically, most patients can resume all these activities once the wound is completely healed. 

  • Which surgery is best for piles?

    There are many options and simply put piles can be divided into internal and external piles. Internal piles have a lot more options than external piles. For external piles, excision is the main option. For internal piles, ligation is a good bedside procedure which is usually done during the endoscopy as a first line treatment when medication fails. 

    Conventional hemorrhoidectomy is similar to excision for external piles and is useful for patients with both internal and external piles. Stapler hemorrhoidectomy is useful for prolapsing and circumferential piles and has a faster recovery and return to work. 

    Laser, HET and transanal hemorrhoidectomy de-arterialisation are good as they minimize the wound size which decreases postoperative pain, but can mainly treat smaller and specific areas for piles. For details between the pros and cons of individual treatment, it is best to seek a surgeon’s advice.

  • Are there side effects of piles surgery?

    Yes. Most will experience some pain and postoperative discharge. These are self-limiting and usually do not last longer than 1 month depending on the type of surgery. Other side effects are uncommon and include postoperative severe bleeding needing admission, stool incontinence, tenesmus and anal stenosis. 

    Some male patients with an underlying benign prostatic hyperplasia (BPH) may experience difficulty in passing urine after surgery. This is usually temporary and will resolve shortly after surgery. During which, they may have to bear with the inconvenience of inserting a urine tube into the bladder and stay overnight for monitoring.

  • How much will piles surgery cost in Singapore?

    As of January 2023, the estimated cost for piles surgery in private hospitals is about 4,500 to 5,500 SGD. This depends on the nature of surgery and also the venue of surgery. 

    Most of it can be covered by insurance depending on your policy. For Singaporeans and PR, medisave can also be used to cover a portion of this. Do see under insurance and the reference to the maximum amount that can be claimed according to the surgery code.

  • What is the success rate of piles surgery?

    Almost all piles surgery will lead to resolution of symptoms and thus the success rate is invariably high. The chance of recurrence does vary between procedures. Having said that, it is important to note that piles are not dangerous in general and uncommonly leads to severe bleeding that requires admission and transfusion. 

    It is hence, safe to treat conservatively for most patients and the need to manage your lifestyle and diet is the mainstay for all patients with piles.