Hemorrhoidectomy and Anorectal Surgery

Hemorrhoid Surgery in Puerto Vallarta

Hemorrhoids, anal fissures, abscesses and fistulas are common, treatable problems, and a good share of cases can be handled without surgery. Every case gets a full evaluation to decide what it actually calls for, and bleeding with a bowel movement is never assumed to be hemorrhoids until it has been examined.

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What are the symptoms?

These are complaints people rarely bring up, and that often get labeled hemorrhoids without anyone having looked. These are the reasons patients come in most often:

• Bright red bleeding with a bowel movement: on the paper, in the toilet, or dripping at the end
• A lump that comes out when you strain and goes back on its own, or that you have to push back in with a finger
• Sharp, intense pain during and after a bowel movement that can go on for a while afterward (typical of an anal fissure)
• A hard, very painful lump that shows up from one day to the next (a thrombosed hemorrhoid)
• Constant pain with swelling and redness beside the anus, sometimes with fever or feeling generally unwell (an abscess)
• Pus or drainage from an opening near the anus that closes and then opens up again (a fistula)
• Itching, dampness, burning, or staining on your underwear

When is surgery necessary?

Most cases never reach the operating room. Grade I and II internal hemorrhoids, and some grade III, improve with enough fiber and fluids, correcting bowel habits, and topical treatment. There are also office-based treatments — rubber band ligation, sclerotherapy, infrared coagulation — that are not offered here; when medical management isn't enough, what is offered is surgery. An acute anal fissure heals with sitz baths and fiber alone in about half of cases, and a chronic fissure is treated first with ointments: nifedipine or diltiazem are usually preferred, because nitroglycerin gives a headache to a high proportion of the people who use it. Surgery comes into the picture when there is an external component or significant prolapse (grades III and IV), when bleeding or symptoms haven't improved with the measures above, and for chronic fissures that haven't healed with medical treatment. With a thrombosed hemorrhoid, taking the clot out within the first 72 hours relieves the pain faster than waiting; after that window, non-surgical management is usually the better choice, because the problem is already settling down on its own. An anal abscess is the exception: it is always drained, and without delay, and some abscesses go on to leave a fistula that needs a second procedure.

What does the procedure involve?

There is no single operation. What gets done depends on what the examination finds: some procedures take a few minutes in the office, and others are done in the operating room, most of the time on an outpatient basis.

1. Your history comes first — how long this has been going on, what the bleeding looks like, your bowel habits, family history, and the medications you take — followed by an anorectal examination with anoscopy. That is what establishes the grade of the hemorrhoids and shows whether your case also calls for a study of the colon.
2. If your case needs the operating room, the procedure is done under regional or general anesthesia, depending on the type of surgery and on what the preoperative evaluation shows. Anesthesia carries risks of its own, and those are gone over with you before you sign the consent form.
3. Hemorrhoidectomy: the hemorrhoidal cushions are removed. It is the most effective option for advanced prolapse and also the most painful one. Chronic fissure: lateral internal sphincterotomy, which can leave altered control of gas or stool — permanently, in some cases — so the sphincter is assessed beforehand and a flap is sometimes the better choice. Abscess: incision and drainage. Fistula: fistulotomy when the tract is simple, or sphincter-sparing techniques when it is complex; with a fistula there is both a risk of it coming back and a risk to continence, and both are explained before anything is chosen.
4. Most of these procedures are outpatient, and when your recovery allows it you go home the same day with pain medication, fiber, and sitz baths prescribed in writing. A follow-up visit is set for a few days later, and the warning signs that mean coming back sooner are written down for you as well.

Bleeding with a bowel movement is never taken for granted: hemorrhoids are the most common cause, but not the only one — polyps, inflammatory bowel disease, and colon and rectal cancer bleed too. When bleeding starts after age 45, or comes along with a change in bowel habits, weight loss, anemia, or a family history of colon cancer, a full study of the colon is indicated before any of it is attributed to hemorrhoids. Having hemorrhoids does not rule out something higher up.

What is recovery like?

It depends on the procedure and on the person; what follows are rough ranges, not guaranteed timelines. Hemorrhoidectomy is the hardest one: pain is worst in the first few days and bowel movements hurt, the first one especially. Most people are back to their usual activities somewhere between the second and fourth week, and some take longer. In every case you get fiber, fluids, sitz baths and a combination of pain medications, because constipation is what slows healing down the most. The possible complications — bleeding, urinary retention that can mean a catheter or being admitted to the hospital, infection, narrowing of the anus, altered control of gas or stool, and the problem coming back — are gone over in the consultation, before anything is decided. And do not wait for your follow-up visit if you have heavy bleeding, fever, pain that keeps growing instead of easing, or trouble urinating: get medical attention right away.

Frequently asked questions

Can hemorrhoids be treated without surgery?

In a lot of cases the symptoms are controlled without it. Grade I and II, and plenty of grade III, improve with fiber, fluids, correcting bowel habits, and topical treatment. There are office treatments as well, such as rubber band ligation, which are not offered here. When those measures fall short — an external component, significant prolapse, or symptoms that don't let up — surgery is what's offered, and it is explained to you before you decide. Surgery treats the hemorrhoids you have now; it does not remove the tendency for them to come back, so fiber, not straining, and not spending long stretches sitting on the toilet still matter afterward.

Does hemorrhoid surgery hurt, and how long is the recovery?

Hemorrhoidectomy does hurt, especially in the first few days and with bowel movements; there's no reason to tell you otherwise. It is handled with a combination of pain medications, which keeps opioid use down. Most people get back to their usual activities somewhere between the second and fourth week, but treat that as a rough range: it varies from person to person and with the procedure that was done.

Do hemorrhoids turn into cancer?

No, they don't. The concern is a different one: colon and rectal cancer can bleed exactly the way a hemorrhoid does, and when bleeding is taken for granted, the diagnosis gets delayed. That is why bleeding is examined, and why from age 45 on — earlier if there are other findings — a colonoscopy is considered.

How do I know if it's hemorrhoids or an anal fissure?

The kind of pain is the main clue. A fissure hurts sharply and intensely during the bowel movement and can keep hurting for a while after, with scant, bright red bleeding. An internal hemorrhoid usually bleeds without hurting, and an external one hurts when it clots, showing up as a hard lump out of nowhere. Either way, the distinction is settled by examination, not by description.

How much does it cost, and do you take insurance?

The consultation is $800 MXN. What the procedure costs depends on which one it is, on the hospital, and on the anesthesia, and you get that in writing before anything is scheduled. Major medical insurance is accepted, as is private payment. If your policy is from outside Mexico, check with your insurer first — what they cover abroad, and whether they reimburse you afterward, varies from one company to the next.

How long do I need to stay in Puerto Vallarta, and when can I fly home?

Most of these procedures are outpatient, so you go home the same day. The follow-up visit is a few days later, so plan to still be in town for it. When it is reasonable to fly depends on which procedure was done and on how you are healing, so that gets decided at the follow-up rather than promised ahead of time.

Bleeding, pain, or a lump with bowel movements?

Book a consultation for a full anorectal evaluation and a straight explanation of the options that apply to your case. Consultations in English and Spanish.

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