Hemorrhoids are swollen veins that develop in the anal canal and lower rectum. They can cause symptoms like itching, bleeding, and pain. In some cases, hemorrhoids don’t respond well to at-home treatments and may require surgery. But how often is surgery really necessary for hemorrhoids?
What Are Hemorrhoids?
Hemorrhoids form when the blood vessels around the anus become swollen and inflamed. There are two types:
- Internal hemorrhoids form inside the rectum.
- External hemorrhoids form under the skin around the anus.
Hemorrhoids can cause the following symptoms:
- Itching and irritation around the anus
- Pain or discomfort during bowel movements
- Bleeding during bowel movements
- A lump near the anus, which may need to be pushed back in after passing stool
Hemorrhoids are very common, especially in adults ages 45-65. By age 50, about half of adults have experienced hemorrhoid symptoms.
What Causes Hemorrhoids?
Hemorrhoids can develop due to:
- Chronic constipation or diarrhea: Straining during bowel movements can put extra pressure on blood vessels.
- Pregnancy: Hormonal changes and extra pressure from the baby can cause hemorrhoids.
- Obesity: Extra weight and pressure can lead to hemorrhoids.
- Sitting for long periods: This can increase pressure on the blood vessels.
- Aging: The tissues supporting the blood vessels can weaken over time.
How Are Hemorrhoids Treated?
In many cases, hemorrhoids can be treated at home with over-the-counter remedies and lifestyle changes. This may include:
- Over-the-counter ointments, creams, or suppositories containing hydrocortisone to reduce itching and pain
- Medications like stool softeners or fiber supplements to prevent straining
- Sitz baths to soothe the area
- Ice packs to reduce swelling
- Gently cleaning the area after each bowel movement
- Wearing loose, comfortable clothing and cotton underwear
Lifestyle changes can also help prevent hemorrhoid flare-ups:
- Increasing fiber intake through diet or supplements to prevent constipation
- Staying hydrated by drinking plenty of fluids
- Exercising regularly to prevent constipation
- Avoiding lengthy sitting periods
- Losing weight if overweight or obese
When Might Surgery Be Needed?
If home treatments do not improve hemorrhoid symptoms, or if hemorrhoids are severe, surgery may be recommended. Here are some instances when surgery may be advised:
- Prolapsed internal hemorrhoids that bulge from the anus and cannot be pushed back in
- Very large external hemorrhoids that cause persistent discomfort
- Internal or external hemorrhoids that continue to bleed after other treatments
- Both internal and external hemorrhoids present
- Hemorrhoids that cause persistent pain that interferes with daily activities and bowel movements
Surgery may also be an option when hemorrhoids have not improved with other approaches, such as over-the-counter remedies, lifestyle changes, office-based treatments, and prescription medications.
How Common is Hemorrhoid Surgery?
Although hemorrhoids are very prevalent, surgery is actually not that common. Here are some statistics on how frequently hemorrhoid surgery is performed:
- Around 10 million Americans report hemorrhoid symptoms each year. Of those, only about 500,000 seek medical treatment.
- Of patients who seek medical treatment, only about 10-20% end up requiring surgery.
- This suggests around 50,000 to 100,000 hemorrhoid surgeries are performed in the U.S. each year.
- This means only about 0.5-1% of patients with symptomatic hemorrhoids have surgery.
So while hemorrhoid surgery may seem common, it is actually only utilized for a small fraction of hemorrhoid patients when other treatments are inadequate.
Hemorrhoid Surgery Rate Statistics
| Number of Americans with Hemorrhoid Symptoms Per Year | Around 10 million |
|---|---|
| Number Who Seek Medical Treatment | Around 500,000 |
| Of Those Treated Medically, Number Requiring Surgery | 10-20% or 50,000 – 100,000 |
| Surgery Rate Among All Hemorrhoid Patients | Around 0.5-1% |
Types of Hemorrhoid Surgery Procedures
There are several types of surgeries that may be used to treat hemorrhoids. The most common procedures include:
Hemorrhoidectomy
This surgery removes the hemorrhoids. It is done under anesthesia. The surgeon makes small incisions to cut away the hemorrhoidal tissue. Hemorrhoidectomy is very effective, but patients may experience pain afterwards. It has the longest recovery time.
Hemorrhoidopexy
Also called stapling, hemorrhoidopexy uses a stapling device to reposition hemorrhoids back inside the rectum. This shrinks the hemorrhoids by cutting off their blood supply. It typically causes less pain than a hemorrhoidectomy.
Hemorrhoidal Artery Ligation
This procedure cuts the tiny arteries that supply blood to the hemorrhoids, causing them to shrink. It is sometimes done along with a hemorrhoidopexy. There is little pain afterwards and recovery is quicker.
Recovery After Hemorrhoid Surgery
Recovery depends on the specific procedure, but may involve:
- Light activity for 1-2 weeks after surgery
- Sitz baths several times a day
- Taking stool softeners, fiber supplements, and over-the-counter pain relievers
- Avoiding straining or heavy lifting for several weeks
- Keeping stools soft to avoid re-injury during bowel movements
- Using external hemorrhoid cream for residual swelling or discomfort
Most patients are able to return to work within 7-10 days after hemorrhoid procedures like stapling or vessel ligation. Recovery after hemorrhoidectomy may take 2-4 weeks. Pain, bleeding, and swelling generally improve within several weeks.
Can Hemorrhoids Come Back After Surgery?
Unfortunately, hemorrhoids can recur even after surgery. Recurrence rates may be as high as 50% within 10 years. However, surgery may still be helpful for managing symptoms that have not responded to other treatments.
To help prevent hemorrhoids from returning, patients should maintain soft stools, avoid constipation and straining, avoid sitting for long periods, maintain a healthy weight, and consider supplements that help vascular health.
When to See a Doctor
You should see a doctor for hemorrhoids if:
- Symptoms persist after 1-2 weeks of at-home treatments
- You experience severe pain or rectal bleeding
- You have prolapsed hemorrhoids that cannot be pushed back in
- Hemorrhoids are interfering with daily activities
Your doctor can help determine if surgical removal of the hemorrhoids is appropriate based on your individual case and symptoms.
Conclusion
Although hemorrhoids are very common, only about 0.5-1% of cases require surgery. Surgical procedures like hemorrhoidectomy, hemorrhoidopexy, and hemorrhoid artery ligation can be effective when hemorrhoids are severe or do not respond to other treatments. But even after surgery, hemorrhoids may return. Patients can help prevent recurrence by maintaining healthy bowel habits and vascular health. If hemorrhoids persist or cause significant discomfort, see your doctor to determine if surgery might be appropriate for your situation.
