Hemorrhoids are vascular structures located in the anal canal and lower rectum. When these cushions of tissue become inflamed, they can cause symptoms like pain, bleeding, and itching. For advanced cases that do not respond to less invasive treatments, a surgeon may recommend a major intervention like an excisional hemorrhoidectomy or stapled hemorrhoidopexy (PPH). Patients often view surgery as a definitive solution, but the underlying question remains whether this procedure guarantees a permanent end to the condition.
The Likelihood of Recurrence
Recurrence is possible after hemorrhoid surgery, though rates are generally low following certain procedures. Studies suggest recurrence rates range from approximately 5% to 25% over five years, depending on the technique used and the patient’s habits. Excisional hemorrhoidectomy, which removes the damaged tissue entirely, is associated with one of the lowest recurrence rates, sometimes reported as low as 1.9% to 6.5%.
By contrast, procedures like stapled hemorrhoidopexy (PPH) or less invasive office-based treatments may have slightly higher rates. Surgery addresses only the existing, diseased tissue; it does not alter the underlying anatomical structure or the patient’s tendency to develop new hemorrhoids. New hemorrhoids can form if the conditions that led to the original problem persist, as the vascular cushions are a normal part of the anatomy.
Underlying Causes of Recurrence
The primary reason hemorrhoids reappear is the continuation of habits that increase pressure in the rectal area. The most common contributing factor is chronic straining during bowel movements, which puts pressure on the rectal veins, causing them to swell. This straining often results from chronic constipation, where hard, dry stools are difficult to pass. A lack of sufficient dietary fiber or inadequate hydration contributes significantly to this issue.
Conversely, chronic diarrhea can also be a factor, as frequent bowel movements cause irritation and inflammation that weakens tissue support. Other lifestyle issues include prolonged sitting on the toilet, which causes blood to pool in the pelvic veins, and heavy lifting, which temporarily raises intra-abdominal pressure. Furthermore, some individuals have a genetic predisposition, meaning their connective tissue or vein walls are naturally weaker, making them more susceptible to recurrence.
Post-Surgical Lifestyle Changes
Minimizing recurrence requires permanent lifestyle modifications that promote soft, regular bowel movements. A foundational change is increasing dietary fiber intake, aiming for 25 to 30 grams daily, sourced from fruits, vegetables, whole grains, and legumes. Since this bulk-forming fiber absorbs water, it must be coupled with drinking plenty of fluids, such as at least six to eight glasses of water daily, to ensure stools remain soft and easy to pass.
Establishing consistent, healthy bowel habits is paramount, meaning responding to the urge to defecate immediately. Avoiding prolonged sitting on the toilet is important, as spending more than a few minutes increases pressure on the anal cushions. Using a small footstool to elevate the knees can adjust posture, helping to relax the puborectalis muscle and straighten the anorectal angle, making stool passage less strenuous. Regular physical activity, such as walking for 20 to 30 minutes daily, supports digestive health and improves circulation, reducing the chance of venous pooling.
Treatment Options for Recurring Hemorrhoids
If hemorrhoids return, the required treatment is often less aggressive than the initial surgery. Recurring hemorrhoids can typically be managed using minimally invasive, office-based procedures. One common option is rubber band ligation, where a small band is placed around the base of the hemorrhoid to cut off its blood supply, causing it to wither and fall off within a week.
Another effective method is sclerotherapy, which involves injecting a chemical solution directly into the hemorrhoidal tissue to cause it to shrink and scar. Infrared coagulation (IRC) is also used, applying a focused beam of infrared light to create scar tissue that restricts blood flow to the hemorrhoid. These procedures offer a high success rate for recurrent issues and involve less pain and recovery time compared to a repeat surgical hemorrhoidectomy.