Introduction
Haemorrhoids (piles) are extremely common, but not every patient requires surgery. Most cases respond well to lifestyle modification, medications, and office-based procedures. However, haemorrhoidectomy is indicated in selected patients with severe or persistent symptoms.
Indications
1. Advanced Haemorrhoids (Grade III & IV)
Grade III haemorrhoids require manual reduction, while Grade IV haemorrhoids are irreducible. These patients often experience persistent discomfort, prolapse, and hygiene issues, making surgery the definitive treatment.
2. Failure of Conservative Management
Patients who do not respond to dietary modifications, stool softeners, sitz baths, medications, or office procedures such as band ligation may require surgical intervention.
3. Mixed Haemorrhoids
When both internal and external haemorrhoids are present and the external component is significant, conservative or office procedures may not be effective. Surgical excision is preferred.
4. Recurrent Bleeding Causing Anaemia
Chronic bleeding leading to anaemia is a clear indication for surgery. Addressing only symptoms is insufficient; the source must be treated definitively.
5. Complicated Haemorrhoids
Conditions such as thrombosed haemorrhoids, strangulation, or severe pain affecting quality of life may necessitate surgical management.
Important Considerations
Indications for surgery are relative and depend on symptom severity and patient quality of life. Surgery is not without risks, including pain, bleeding, and urinary retention, so careful patient selection is essential.
Conclusion
Not all haemorrhoids require surgery. However, in appropriately selected patients, haemorrhoidectomy provides significant and lasting relief.