Why are they operated on together?
Hemorrhoids and chronic anal fissure often accompany each other: the common cause is constipation and straining, and sphincter spasm during a fissure impairs blood flow from the nodes. Operating on them separately means two anesthetics and two painful healing periods. With a combined intervention, the nodes are removed and the crack is excised along with the scarred edges and the sentinel tubercle; in case of severe spasm, dosed sphincterotomy is additionally performed. Recovery takes place only once.
When should hemorrhoids be operated on?
Conservative treatment - suppositories, ointments, phlebotonics - is effective in the first and second stages, when the nodes do not fall out or correct themselves. It relieves aggravation, but does not remove already formed nodes.
In the third and fourth stages, when the nodes fall out and do not reset on their own, with repeated bleeding with anemia and thrombosis, surgery remains a radical solution.
What are they often doing at the same time?
In a significant proportion of patients, hemorrhoids are combined with an anal fissure or anal polyp. It is irrational to eliminate them with separate operations: this is a second anesthesia and a second recovery period. Therefore, interventions are often combined—in one operation, nodes are removed and a fissure or polyp is excised at the same time.
Recovery
The most sensitive period is the first 7–10 days, especially the first bowel movements. The key condition for a smooth recovery is soft stools: a laxative diet, sufficient fluids and, if necessary, laxatives are prescribed. It is strictly forbidden to push during this period.