Haemorrhoidectomy for piles: what to expect before and after

Piles are cushions of tissue and blood vessels in the anal canal that have become swollen. The NHS lists bright red blood after a bowel movement, itching, a feeling of incomplete emptying, mucus discharge, lumps around the anus and pain as symptoms. Most piles settle with simple measures, and surgery is for the minority that do not.

The NHS says surgery is considered when conservative treatments have failed or the piles are extensive. The Milton Keynes leaflet puts it as recommended when the enlarged vessels cause problematic symptoms that simpler treatments have not resolved.

Self-care comes first: the NHS recommends enough fluid and fibre to keep stools soft, avoiding straining or long periods on the toilet, paracetamol for pain, ice packs and warm baths, with a pharmacist able to advise on creams and laxatives. The Milton Keynes leaflet adds banding, where an elastic band placed above the pile cuts off its blood supply so it shrinks and falls away.

The NHS also describes other hospital treatments that avoid a full operation: sclerotherapy, electrotherapy and infrared coagulation, carried out under local anaesthetic. Among operations, stapled haemorrhoidopexy repositions the tissue and haemorrhoidal artery ligation interrupts the blood supply. Ask why haemorrhoidectomy is recommended over these in your case.

Pre-assessment checks your health and medicines. The Milton Keynes leaflet says you must not eat, drink or chew gum before the operation and should remove jewellery, dentures, contact lenses and make-up before theatre.

Start building the bowel habit you will need afterwards: plenty of fluid and fibre, and stool softeners if constipation is a problem. Buy simple painkillers and a soft-stool laxative before you go in so they are at home.

According to the Milton Keynes leaflet, the surgeon cuts out or trims the haemorrhoids under general, spinal or local anaesthetic. The NHS notes that general anaesthesia is typically needed for the surgical procedures. The wounds are small and may be left open or stitched with dissolving thread, and a pack or dressing may be placed for a short time.

Local anaesthetic is often injected around the area at the end, to ease the first hours of discomfort.

The Milton Keynes leaflet names pain (managed with medication and local anaesthetic), bleeding that occasionally leads to readmission and rarely needs a transfusion, infection treated with antibiotics, difficulty passing urine that may need a catheter, and changes in bowel control that usually improve gradually over months.

The NHS adds that treatment does not always prevent piles coming back. No percentages were given by the pages used, so none are quoted; ask your surgeon about recurrence and continence for the technique they propose.

Most people go home the same day or the next, with a responsible adult to take them. The Milton Keynes leaflet expects swelling and bruising to settle within weeks, and recommends fruit, vegetables, cereals and brown bread with plenty of fluid to keep movements regular. Do not strain, and use the laxatives recommended so that stools stay soft, not loose.

It gives no driving for 48 hours, then driving when you can make an emergency stop safely, a desk job at about 2 weeks and manual work at about 4. See the recovery timeline page for more detail.

Contact your GP, NHS 111 or the ward if the area becomes hot to the touch, very painful, if you are feverish, if bleeding is heavier than expected or if you cannot pass urine. Heavy, continuing bleeding with dizziness or clots is an emergency: call 999 or go to A&E.

The surgical techniques are available through both routes. The NHS may expect a trial of simpler treatment first, whereas a private patient can often discuss options sooner; either way, ask what is covered if you need review or readmission.

• Why haemorrhoidectomy rather than banding or another technique?

• What anaesthetic do you recommend?

• What pain relief will I go home with?

• What is my follow-up plan if bleeding or pain is worse than expected?