Piles Surgery

What are the surgical options for piles?

Surgery is performed under general or regional anaesthesia, and a same-day discharge is normally expected. There are a few surgical options available, the choice of which will depend on your circumstances and choice, after knowing the advantages and relative limitations of each method. Your surgeon will explain all these in detail before you make your choice.

conventional piles removal (conventional haemorrhoidectomy)

piles are removed together with the adjoining external tag of skin, creating in an open wound at the anus that might take 6-8 weeks to completely heal. There is a little more post-operative pain as compared to the other methods, and the post-operative care of the wound is simple, requiring a regular shower hosing after bowel movement.

Stapler procedure (stapled haemorrhoidectomy)

Piles are removed on the inside of the anal canal with a special stapler device, without the need for an external wound. By the stapling of the anal canal with a row of tiny titanium staples, the blood supply to any possibly remaining piles is reduced, causing their eventual shrinkage. Post-operative pain, as a result, is expected to be less and a faster return to work is expected.

THD (transanal haemorrhoidal dearterialisation)

A thin viewing device is used to locate the blood vessels that supply the piles in the anal canal, and these vessels are tied off using sutures. Once the blood supply is cut off, the piles are expected to shrink over several weeks. While there is less pain associated with this procedure (as there is no external wound), there can be some anal discomfort and tenesmus (feeling of wanting to open bowels) as a result of the swelling caused by the stitching, which will resolve once the piles shrink.

What are the possible complications of piles surgery?

After the effects of the anaesthesia wear off, there will be some discomfort and tenesmus in the anus. The discomfort or pain can be controlled with medication, and will resolve eventually when the wounds heal.

Some patients might have difficulty passing urine after the operation, and will need a temporary tube to help with urinary passage.

During the recovery period the following uncommon complications can possibly occur:

Bleeding
- Which is usually mild, but rarely excessive, occurring 7-10 days
  after surgery

Constipation
- Which can lead to a painful anal tear (anal

Infection
Scar tissue causing a tightening of the anal canal (anal stenosis)

The following are rare complications of piles surgery

Faecal incontinence
Tear in the rectum (rectal perforation)
Tear of the rectum leading into the vagina if you are a woman (anovaginal

What kind of care should I have after surgery for piles?

Most patients are able to return home on the same day as surgery, and can expect to have a combination of medications to relieve pain, smoothen bowel movement and normalise anal blood circulation.

If you have undergone conventional piles removal, you should use a gentle shower spray with lukewarm water for clean yourself after bowel movement. Dap (not rub) the area dry gently with a soft cotton towel. Alternatively, use a hair dryer. No dressing is required, but most patients find it convenient to use a panty liner to prevent staining of undergarments from the expected wound discharge.

If there is significant swelling in the anal area, most patient find relief in soaking the area with plain warm water 10-15 minutes 2-3 times a day in a sitz bath.

How can I prevent piles?

Piles can be managed or possibly prevented with the following measures

adopting a high fibre diet
- more fibre increases the bulk of the stools, and with plenty of fluids, keeps it soft and smooth. It will help avoid the straining which can cause piles
- if fruits and vegetables are not readily accessible, consider taking dietary fibre supplements, which can be conveniently packaged as in Fybogel satchets
- drinking plenty of fluids
  - to keep the stools soft, keep adequately hydrated especially in hot weather and after exercise
- do not strain during bowel movement
  - this increases the pressure in the lower rectal and anal veins
- do not read or surf the internet while on the toilet
  - minimising the time spent toileting can help prevent high pressures in the lower rectum and anal veins
- exercise
  - stay active to prevent prolonged sitting or standing, and to lose weight