Conditions We Treat
Hemorrhoids
Hemorrhoids are swollen blood vessels in and around the anus and lower rectum. When they cause persistent bleeding, pain, prolapse (tissue protruding from the anus), or do not respond to conservative measures (fiber, sitz baths, topical treatments), surgical removal may be recommended.
Dr. Kakarla performs excisional hemorrhoidectomy — surgical removal of both internal and external hemorrhoid tissue. This is the most effective treatment for severe or recurrent hemorrhoids and provides the lowest recurrence rate of any hemorrhoid procedure.
Anal Fistula
An anal fistula is an abnormal tunnel between the inside of the anal canal and the skin near the anus, usually resulting from a prior anal abscess. Fistulas rarely heal on their own and typically require surgery. The specific technique — fistulotomy (opening the tract), seton placement (a small drain to promote gradual healing), or other approach — depends on the complexity and location of the fistula. Dr. Kakarla evaluates each case individually.
When to seek care
Call our office first if you have worsening rectal pain, bleeding, or signs of infection near the anus — we can often evaluate you quickly. If you have heavy rectal bleeding, high fever with anorectal pain, or inability to urinate, go to the emergency room or call 911.
The Procedure
Both hemorrhoidectomy and anal fistula repair are performed under general anesthesia at Gwinnett Surgery Center. The procedure typically takes 30–60 minutes. Dr. Kakarla uses local anesthetic blocks during surgery for extended post-operative pain relief. You go home the same day.
Preparing for Surgery
You will receive a phone call from the surgery center 1–2 days before with your arrival time and final instructions.
- No solid food after midnight. Clear liquids may be permitted up to 2 hours before
- Medications: Dr. Kakarla will specify which to take and which to hold
- Blood thinners and antiplatelet medications: If you take any blood-thinning or antiplatelet medication, you will receive specific stop and restart instructions from our office. Common medications and typical guidance:
- Warfarin (Coumadin) — typically stopped 5 days before surgery; INR checked the day before
- Eliquis, Xarelto, Pradaxa, Savaysa — typically stopped 1–3 days before depending on kidney function
- Plavix — stopped 5–7 days before; Brilinta — 3–5 days; Effient — 7 days
- Aspirin — may be continued or stopped depending on why you take it
- GLP-1 medications (Ozempic, Wegovy, Mounjaro, etc.): Inform our office. You may need special instructions based on current anesthesia guidance
- No need to shave the surgical area
- Transportation: You must have someone to drive you home and stay with you the first night
Recovery
What Is Normal After Anorectal Surgery
- Pain and discomfort — anorectal surgery is typically uncomfortable for the first several days. Pain management includes local blocks placed during surgery, prescription pain medication, and over-the-counter acetaminophen and ibuprofen
- Bleeding — small amounts of bleeding with bowel movements are normal for 1–2 weeks
- Swelling around the anus is expected and improves over days
- Anxiety about the first bowel movement is very common — stool softeners are prescribed to make this easier
Recovery Guidelines
- Sitz baths — warm water soaks for 10–15 minutes, 3–4 times daily and after each bowel movement. This is the single most helpful thing for comfort and healing
- Stool softeners — prescribed to keep stools soft and avoid straining. Stay hydrated and eat fiber-rich foods
- Pain medication — take as directed. Narcotic and non-narcotic options provided. Most patients transition to over-the-counter medication within a few days
- Activity — walking from day 1. Most patients return to full physical activity within one week
- Follow-up — visit with Dr. Kakarla within 1–2 weeks
When to call after surgery
Call our office first for: fever over 101.5°F · heavy bleeding (soaking through a pad) · severe pain not controlled by medication · inability to urinate · increasing swelling or drainage with odor. We can often evaluate you quickly.
Call 911 for: heavy uncontrolled bleeding · fainting · chest pain or difficulty breathing.
Frequently Asked Questions
How painful is hemorrhoid surgery?
Hemorrhoidectomy is typically uncomfortable for the first several days. Dr. Kakarla uses local anesthetic blocks during surgery for extended pain relief, and prescribes both narcotic and non-narcotic pain medication. Sitz baths and stool softeners help significantly. Most patients find the pain manageable and improving by day 4–5.
How long until I can go back to work?
Most patients return to desk work within 3–5 days and full physical activity within one week. Plan for about a week off if your job involves sitting for long periods or physical labor.
Will hemorrhoids come back after surgery?
Excisional hemorrhoidectomy has the lowest recurrence rate of any hemorrhoid treatment. However, new hemorrhoids can develop over time, especially with chronic straining, constipation, or prolonged sitting. Maintaining adequate fiber, hydration, and healthy bowel habits helps prevent recurrence.
What is a seton for anal fistula?
A seton is a small, flexible drain placed through the fistula tract. It promotes gradual healing and drainage, and is used for complex fistulas where a simple fistulotomy might risk damage to the anal sphincter muscles. The seton is typically removed at a follow-up visit once healing has progressed.
What happens at my first appointment?
Dr. Kakarla examines you, discusses your symptoms and treatment options, and explains the procedure. The visit takes about 30 minutes. You are welcome to bring a companion.
Will I be asleep during surgery?
Yes. All anorectal procedures are performed under general anesthesia. Local anesthetic blocks are placed during surgery for extended pain relief after you wake up.
Do I need a referral?
No. You can call our office directly unless your specific insurance plan requires a referral.
When do hemorrhoids need surgery vs. over-the-counter treatment?
I’m embarrassed about this problem. Is that normal?
