We Do Not Operate on Patients Who Sit on the Toilet for More Than 10 Minutes
Not all hemorrhoid cases require surgery.
Thrombosed hemorrhoids (recent, painful swellings) do not require surgery. There is no risk of abscess formation or generalized thrombosis following hemorrhoidal thrombosis.
There is no surgical procedure that allows patients to remain on the toilet for more than five minutes.
Conservative Treatment of Hemorrhoids
When hemorrhoids are diagnosed, the first step a patient must take is to correct their bowel habits. It is inappropriate and ineffective to undergo surgery while still using a mobile phone on the toilet.
Correcting defecation behavior is both essential and effective prior to any decision regarding surgery. If strict adherence to these habits fails to improve the condition, then a more interventional approach can be considered.
Simple skin tags protruding from the anus do not require removal or treatment.
Thrombosed hemorrhoids are very painful swellings caused by constipation, prolonged sitting on the toilet, intense physical activity, or exhaustion.
There is no danger of thrombosis spreading to the heart or abscesses reaching the testicles due to hemorrhoidal thrombosis.
What is truly needed is rest—not surgery.
The feeling of incomplete evacuation, more common in women, refers to the sensation that a bowel movement wasn’t fully completed, affecting quality of life. It may be due to hemorrhoids or internal rectal prolapse and requires a different treatment approach.
Conservative Treatment Is Usually the First Line for First- and Second-Degree Hemorrhoids
In such cases, symptoms are usually mild and can be managed through lifestyle changes, diet modifications, and local care.
Everyday Habits to Avoid Surgery
Before any surgical procedure, patients should commit to certain lifestyle changes that may reduce symptoms and prevent progression, thus eliminating the need for surgery. These changes include:
Diet and Daily Habits
Constipation is one of the primary aggravating factors for hemorrhoids. Therefore, dietary changes are essential:
- High fiber intake: Diet should be rich in fruits, vegetables, and whole grains to ensure soft stool and avoid constipation.
- Adequate fluid intake: Drinking plenty of water daily helps prevent dehydration and constipation.
- Avoid prolonged toilet sitting: Time on the toilet should not exceed 5–10 minutes, as pressure worsens hemorrhoids.
Local Hygiene and Care
- Avoid soaps and standard toilet paper, as they can irritate the sensitive anal area. Excessive cleaning should be avoided.
- Warm sitz baths: Daily warm water baths help relieve irritation and pain. Soaking for 10–15 minutes can significantly reduce inflammation.
Medication
- Creams and ointments: Topical treatments containing corticosteroids or anesthetics can relieve pain and inflammation.
- Anti-inflammatory medications: In cases of severe pain, pain relievers and anti-inflammatories may be used.
Surgical Treatment
Hospital-based surgical procedures are only indicated for advanced cases. A high volume of hemorrhoid surgeries by certain surgeons may indicate an aggressive treatment approach.
According to international data, hospital admissions for hemorrhoids in Greece should not exceed 4,000 annually.
The traditional hemorrhoidectomy (Milligan-Morgan) has largely been replaced by less painful and bloodless surgeries. Many effective surgical options now exist. Over the last 20 years, around 20 different devices and techniques have emerged (Longo, HAL, THD, Rafaelo, Laser–LHP, etc.).
A specialized proctologist should be able to perform 4–5 of these techniques, choosing the right one—or a combination—based on the patient’s clinical condition and personality.
Some surgeons promote trendy or exotic procedure names for marketing, which do not always reflect superior outcomes.
The appropriate treatment is chosen after detailed proctoscopy, often involving patient effort to simulate defecation, revealing hemorrhoids that are not visible at rest. In rare cases, the patient may be asked to defecate to reveal full prolapse.
Some hemorrhoids are treated with rubber band ligation, others with laser, and some require surgical excision. Each technique must be applied strictly based on its indications. Preoperative counseling for proper bowel habits is essential.
Techniques like laser and ultrasound-based treatments (either alone or in combination) provide excellent results in selected cases.
Laser is ideal for small external hemorrhoids with mucosal prolapse, while HAL-RAR using ultrasound is best for internal, bleeding hemorrhoids.
Rubber band ligation is suitable for select second-degree hemorrhoids and yields excellent results. Pain after ligation typically results from poor technique or inappropriate candidate selection.
When Is Surgery Necessary?
Hemorrhoids do not always require surgery, and it is best to treat them when they are not in an acute state. Surgery during inflammation can lead to more traumatic recovery.
Surgery is only necessary when:
- Hemorrhoids bleed heavily, especially if anemia is present.
- Hemorrhoids prolapse either occasionally during defecation or permanently.
- Fluid discharge is present from the anus.
- Thrombosed hemorrhoids during the first 2–3 days cause unbearable pain.
- Skin tags are painful, cause hygiene issues, or are removed for cosmetic reasons.
Key Rule: Time on the toilet should not exceed 5 minutes. Otherwise, hemorrhoids will recur after treatment.
Treatment Options by Hemorrhoid Stage
Hemorrhoids are classified into stages and forms, but these don’t always reflect severity.
For example, some fourth-degree hemorrhoids require no surgery, while third-degree ones may demand urgent treatment.
The patient’s personality and pain sensitivity should be considered.
Painful methods are not suitable for sensitive patients, while others may choose definitive treatment regardless of pain.
- First-degree hemorrhoids: Rarely need treatment.
- Second-degree hemorrhoids: Treated with sclerosing injections or rubber band ligation if a stalk is present. If the dentate line is involved or there’s no stalk, laser is preferred.
- Third and fourth-degree hemorrhoids: In circumferential prolapse or large hemorrhoids, HAL/THD ultrasound techniques or laser are preferred. For very large external hemorrhoids, surgical excision may be required.
