In medicine there is a saying “when you hear hoofbeats, think horses, not zebras”. On rare occasions, when expecting to see a horse, we find a Unicorn. My recent experience with a Painless Hemorrhoidectomy was one such scenario because in most instances a Hemorrhoidectomy is anything but painless. A real Hemorrhoidectomy, or what we refer to as a “three-quadrant internal and external excisional hemorrhoidectomy” is one of the most painful procedures that a person can have. Thankfully, the procedure is rarely needed. Most hemorrhoid issues can be treated with less painful office-based procedures by proctologists. Examples of such procedures include external hemorrhoid excision, rubber band ligation, & infrared coagulation.
A painless hemorrhoidectomy, on the other hand, is a Unicorn. It’s a mythical creature that is absent from our medical textbooks and scientific literature. Yet, like all creatures of lore, one can find it all over the internet.
There are many practices that advertise “Painless Hemorrhoidectomy” online. Eventually, these doctors end up treating their patients with somewhat painful procedures that aren’t really hemorrhoidectomies at all.
We’ll get to my encounter with the Unicorn in a bit, but first let’s talk about love. The concept of love is the subject of many poetic ruminations. Deeper than infatuation, it’s not uncommon for people to lose themselves in love. This loss of self, equates to the end of selfishness. A true lack of selfishness is my current understand of Love.
Recently, a married couple visited my office. The husband had some issue with hemorrhoids and they wanted my opinion on management options. The pair talked about each other as if they were talking about themselves. There was absolutely no hesitation or judgement between them. Their love was apparent in their lack of formality, of being asked or allowed, being thanked or appreciated.
This is when I encountered the Unicorn. This unexpected experience caught me by surprise. Having treated over 1000 patients for hemorrhoid issues, I’d become comfortable informing my patients about their treatment options, risks, benefits, and expected recovery. My conversation with this couple would be different. I took a short time to gather my thoughts. Then, for the first time in my career, I offered an excisional hemorrhoidectomy without hesitation as their recovery from this surgery will be quick and painless.
The hemorrhoid surgery for this gentleman was painless for the same reason that “rubber banding ligation of hemorrhoids” and “infrared coagulation of hemorrhoids” are “painless”. These procedures treat hemorrhoids at a location in the rectum that lacks pain-sensing nerves. The nerves in these locations sense pressure, so the procedures technically don’t cause “pain” but they cause a pressure sensation that can sometimes cause “discomfort”.
My patient didn’t feel pain or pressure during or after the surgery. This is because he had a spinal cord injury resulting from a car accident 5 years before seeing me. He had no touch, pain, or pressure sensation below his navel. Unfortunately, this resulted in him needing digital manipulation of the rectum to pass his bowels. Over time, his wife noticed occasional blood on her gloved finger. A Gastroenterologist evaluated him and performed a colonoscopy. It identified Bleeding Internal hemorrhoids. The rest of the examination was normal.
The rectal bleeding from the hemorrhoids continued due to the ongoing and necessary trauma, and the pair were eventually referred to me by one of their friends. I performed the surgery without anesthesia and the husband’s recovery was quick and painless. He healed well and remains symptom free. For my part, I am thankful and feel blessed to have had the opportunity to help improve their quality of life.