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Day Surgery Unit at the Treatment Centre Tel No: 01908 995468 or 995469.

Your Consultant has suggested that you may benefit from an operation called a haemorrhoidectomy. This booklet aims to answer some of the questions you may have. If you require further information, please speak to a member of the surgical team who will be happy to help.

What are Haemorrhoids?
They are enlarged blood vessels within the back passage (the lower part of the rectum or anus). They are often called piles, although piles refer to any lump around the anus. Haemorrhoids usually occur in groups of three, around the inside of the anus. Symptoms vary according to size, small ones cause a loss of bright red blood with bowel motions and a trace of blood may be seen on the toilet paper. Larger haemorrhoids may drop down (prolapsed) and can be pushed back inside following opening your bowels.

The largest haemorrhoids may stay permanently prolapsed and cannot be pushed back. Haemorrhoids themselves are usually painless, but the complications of having haemorrhoids can be painful.

How do they occur?
Many people have haemorrhoids, but not everybody may know. People who eat a low fibre diet or suffer from constipation are prone to haemorrhoids which may be painful. You may be prone to haemorrhoids if other people in your family have them. They can also occur during pregnancy due to the pressure of the baby on the pelvic blood vessels.

What are my choices for treatment?
Haemorrhoids do not need treatment unless they cause you a problem. Different options are available depending on your symptoms.

• Diet – by increasing the amount of fibre in your diet and drinking plenty of fluids, which can be found in fruit, vegetables and bran – this helps avoid straining to have your bowels open.
• Banding – a tight elastic band is placed above the haemorrhoid which reduces the blood supply to it. This causes the haemorrhoid to shrink and it will fall off and be passed naturally within several days, usually unnoticed when you have a bowel motion. This is usually done without an anaesthetic. You may feel uncomfortable when the bands are applied, please take painkillers such as
paracetomol if you are uncomfortable.

You may already have had one of the treatments outlined above and it has been unsuccessful. This would lead to you having a haemorrhoidectomy.

What does the operation involve?
The operation involves cutting the haemorrhoids out or trimming them, under either a general, spinal or local anaesthetic.

What are the risks?
Surgery is usually very safe and effective. However, risks and complications can occur. You need to be aware of them in order to make an informed decision about surgery. Knowing about them will also help with early detection of a problem and help with early treatment. If you are worried about anything, whether in hospital or at home, ask a member of the healthcare team. They should be able to reassure you or identify and treat any complications.

General Complications of any Operation
Pain – occurs with every operation. Efforts will be made to minimise the pain. A local anaesthetic may be injected into the skin to ease the pain for several hours after the operation. You will be given medication to control the pain and it is important that you take it as instructed so you can move about and cough freely.
Bleeding – can occur either during or after the operation. This rarely needs a blood transfusion or another operation, but it is common to get bruising around the area operated on. Occasionally, around 10 days following your operation, you may pass some bright red blood. This is due to the surgical thread separating from the wall of the bowel. This bleeding usually settles on its’ own. Sometimes patients need to be re-admitted to hospital. Very occasionally a blood transfusion or further surgery is required.
• Infection – in the surgical wound, which needs treatment with antibiotics. This usually settles after a few days.
• Difficulty passing Urine – Some patients may find it difficult to pass urine after the operation. This is more common in people who have difficulty passing urine, such as men with prostate problems. If this happens, you may require a catheter (a tube into your bladder) to drain your urine for several days.
• Other – Some patients find that their ability to go to the toilet regularly and pass wind is reduced after the operation. This is because the surgery is near to the anal sphincter (the circular muscle
that regulates the passage of bowel motion) and may not work normally at first. If this occurs, the situation gradually improves over a period of months. Very occasionally, the back passage can become narrow. This is caused by shrinkage of the operation scars and can be resolved by inserting an instrument to stretch it.

What if my haemorrhoids were left untreated?
If the bleeding continues, you can become anaemic. In general, the longer you leave haemorrhoids, the less likely you are to respond to simple treatments. Large haemorrhoids can get stuck outside the anal canal and clot (thrombus), which is usually very painful and requires admission to hospital for treatment. You may also experience some leakage of mucus from the back passage which can cause soreness and irritation to the skin around the anus. Any bleeding that is different should be reported to your GP as it may not be caused by your haemorrhoids.

All patients who are coming for elective surgery will attend for a pre-assessment. This assessment will allow the nurse to provide a full health screen. This helps us to know that you are fit for an anaesthetic and your operation. Our main aim is to minimise the chance of your procedure being cancelled on the day of surgery.

Day of Surgery
Please follow the instructions that you are given. You must not eat or drink anything or chew chewing gum before your operation. This is to make sure your stomach is empty, as it is dangerous for you to have an anaesthetic if your stomach is full. If you do not follow these instructions, your operation will be cancelled. An anaesthetist (the Doctor who looks after you when you are asleep) will come to the ward to ask some questions. You will also be seen by a member of the surgical team who will want to ask you some questions and will obtain your consent for your operation. One of the ward nurses will also ask you some questions. There will be many patients admitted for surgery and some waiting is to be expected. Before proceeding to theatre, a checklist will be performed and you will be asked to remove all jewellery, dentures, contact lenses, makeup and change into your gown.

When it is time for your operation you will be taken to the theatre department where a member of the theatre team will meet you. You will be asked similar questions to those you were asked on the ward, these are routine checks for your own safety. After this you will be taken into the Anaesthetic room where some monitoring equipment will be attached to you. At this time the anaesthetic will be given to you.

After the Surgery
Following surgery you will be taken to the recovery room where you will be monitored before returning to the ward. You will normally be discharged either the same, or the following day. You may experience pain and discomfort, which can be relieved by taking painkillers. These are usually supplied for you to take home on discharge.

On discharge – at home
• It is essential that you have a responsible adult to take you home, either by car or taxi.
• During the first few days you may be tired easily, but this will pass and gentle exercise is beneficial.
• It is normal to have swelling/bruising around your wound and this will settle over a week or two. However, if the area becomes hot to touch, very painful, or you are feverish, please contact your
own GP.
• Avoid heavy lifting or strenuous exercise for 1 (one) week.
• Depending upon the nature of your job you may return to work as soon as you are comfortable. This is normally about 2 weeks for a desk job and 4 weeks for a manual job.
• You must not drive for at least 48 hours after your operation due to the effects of the anaesthetic drugs. You can begin to drive when you feel comfortable and confident enough to do an
emergency stop safely. It is always best to check with your insurance company over cover as they may have their own guidelines for you to follow.
• You may resume your sex life when you are ready.
• A general anaesthetic remains in your system for 24 – 48 hours. Therefore, it is important to have a responsible adult to care for you following your operation.
• Avoid staying in bed for long periods, gentle exercise is important as soon as you can.

Will my haemorrhoids come back?
Haemorrhoids can recur, but this is unusual following a haemorrhoidectomy. If they do, please contact your own GP.

Is there anything I need to do after the surgery?
It is important that you maintain regular bowel movements. Make sure you drink plenty of fluids and eat a well balanced diet. Foods such as fruit, vegetables, cereals and brown bread help to maintain regular bowel movements. After discharge, if you have any problems, please contact your own GP or NHS Direct on 0845 46 47.

References for the information used in this leaflet may be obtained from the author. People are unique and the alternatives, risks and benefits will of course vary from person to person. We hope this leaflet will support the information you have already received from your doctor in enabling you to make an informed decision.

If you would like further information please call: Treatment Centre Reception. Telephone No: 01908 995468 or 995469  and ask to speak to the Pre-Assessment Team.