Hemorrhoidectomy

What this procedure is

A hemorrhoidectomy is a surgical procedure used to remove hemorrhoids. Hemorrhoids are swollen veins located in the lower rectum and anus. During this surgery, a clinician removes the excess tissue that causes symptoms like bleeding or discomfort.

This procedure is often considered when other less-invasive treatments have not worked. It is typically performed while you are under anesthesia—medicine that prevents pain—so you are comfortable during the surgery.

What it treats or fixes

This surgery is used to treat severe or persistent hemorrhoids that interfere with daily life. Your clinician may suggest it to address:

• Large internal hemorrhoids: These are swollen veins inside the rectum that may push out during bowel movements.
• Painful external hemorrhoids: These are located under the skin around the anus and can cause significant discomfort.
• Persistent bleeding: Surgery can help when hemorrhoids continue to bleed despite other treatments.

The main goal is to provide long-term relief. It is often viewed as the most effective way to clear up large or recurring hemorrhoids.

How common it is & where it's done

Hemorrhoidectomy is a standard and common surgical option for advanced hemorrhoid cases. While many people find relief through diet changes or smaller office procedures, surgery remains a routine choice for those who need more significant treatment.

The procedure is usually done in a hospital or an outpatient surgery center. "Outpatient" means that most patients are able to go home the same day the surgery is performed. Your medical team will ensure you are stable and comfortable before you are discharged to recover at home.

Recovery: What to Expect

After a hemorrhoidectomy (the surgical removal of hemorrhoids), it is normal to feel some discomfort for a week or two. Your clinician may suggest using stool softeners and eating a high-fiber diet to make bowel movements more comfortable. Drinking plenty of water is also important during this time.

To help with healing and comfort, your clinician may recommend the following:

• Sitz baths: Soaking the area in a few inches of warm water several times a day.
• Pain management: Using prescribed or over-the-counter medications as directed by your care team.
• Rest: Avoiding heavy lifting or strenuous activity for a short period while the area heals.

Risks & Possible Complications

While this procedure is generally safe, all surgeries carry some risks. The most common temporary issue is difficulty emptying the bladder (urinary retention) immediately after the procedure. In some cases, this may lead to a temporary urinary tract infection.

Other possible complications, though less common, include:

• Minor bleeding during bowel movements.
• A slow-healing wound or local infection.
• Narrowing of the anal canal (stenosis), which is rare.

You should contact your clinician if you experience a high fever, an inability to urinate, or heavy bleeding that does not stop with gentle pressure.

Outcomes & Long-Term Results

Hemorrhoidectomy is often considered the most effective way to treat severe or recurring hemorrhoids. Most patients experience significant relief from the pain, itching, and swelling they had before the surgery. Long-term success is very high, and the chance of hemorrhoids returning is low for most people.

To maintain these results, your clinician may encourage long-term lifestyle habits. These often include eating plenty of fiber, staying hydrated, and avoiding straining during bowel movements to prevent new hemorrhoids from forming.

Emotional Support & Reassurance

It is completely normal to feel nervous about having surgery in a sensitive area. Many people find that the temporary discomfort of recovery is a worthwhile trade-off for the long-term relief the procedure provides. This is a standard surgery performed frequently by specialists to help patients return to their daily lives without pain.

Remember that your healthcare team is there to support you. Do not hesitate to ask questions about your specific care plan. Taking it one day at a time and following your recovery instructions can help you feel more confident and comfortable as you heal.

Why doctors recommend it

Clinicians usually suggest a hemorrhoidectomy when other treatments haven't provided enough relief. This surgery is often reserved for internal hemorrhoids that have moved out of place and cannot be easily pushed back in. It is also a common choice for large external hemorrhoids, which are swollen veins under the skin around the opening of the rectum.

Your clinician may recommend this procedure if office-based treatments have not worked. For example, if "rubber band ligation" (placing a small band around the hemorrhoid to cut off its blood supply) did not solve the problem, surgery is often the most effective next step for long-term relief.

Urgent vs planned treatment

Most hemorrhoid surgeries are planned in advance. This allows you to discuss the benefits and risks with your care team and try lifestyle changes or smaller procedures first. A planned surgery is often the best path if your symptoms are persistent but not a sudden emergency.

In some situations, treatment may be needed more quickly. Your clinician might suggest a more urgent procedure if a hemorrhoid becomes "strangulated," which means its blood supply has been cut off. Another reason for faster treatment is a "thrombosed" external hemorrhoid, where a blood clot forms and causes sudden, severe discomfort.

Goals of treatment

The primary goal of this surgery is to provide lasting relief from the physical discomfort caused by hemorrhoids. While it is a more involved process than some other treatments, it is often the most successful way to ensure the hemorrhoids do not return in the same location.

• Reducing pain and itching: Removing the swollen tissue helps eliminate the source of daily irritation and discomfort.
• Stopping bleeding: The surgery aims to stop the recurring rectal bleeding that often happens during bowel movements.
• Improving hygiene: Removing large or protruding hemorrhoids can make it much easier to keep the area clean.
• Restoring comfort: The ultimate goal is to help you return to your normal activities without the distraction of hemorrhoid symptoms.

Who may benefit

A hemorrhoidectomy is a surgical procedure to remove hemorrhoids. Your clinician may suggest this option if you have severe internal hemorrhoids that have prolapsed, which means they have stretched or fallen out of the anal opening. It is often considered a highly effective way to treat large or recurring hemorrhoids that do not respond to other treatments.

This surgery may also be helpful for people with large external hemorrhoids that cause significant discomfort or make it difficult to stay clean. If less invasive treatments—such as rubber band ligation (using a small band to cut off blood flow)—have not provided enough relief, surgery might be the next step to improve your quality of life.

When it may not be the right option

Surgery is usually not the first choice for mild or moderate hemorrhoids. Your care team will often recommend starting with conservative treatments, such as increasing fiber and water intake or using over-the-counter creams. Many people find that these simple changes manage their symptoms effectively without the need for an operation.

A hemorrhoidectomy may not be the right fit if you have certain underlying health conditions that could make recovery more difficult. Because this surgery involves a recovery period that can include temporary pain or difficulty urinating, your clinician may discuss other less-intensive procedures first. The decision often depends on the severity of your symptoms and how much they interfere with your daily activities.

Questions to ask your care team

Deciding on surgery is a big step. You may want to bring a list of questions to your next appointment to help you feel more prepared:

• Why is a hemorrhoidectomy the best option for me right now?
• Are there less invasive procedures, like banding, that we should try first?
• What should I expect during the recovery process, and how long will I need to take off work?
• What are the chances that my hemorrhoids will return after this surgery?
• How will we manage my comfort and pain levels after the procedure?

In the procedure room

When you enter the procedure room, the surgical team will help you get into a comfortable position. This is usually lying on your side with your knees tucked or on your stomach with your hips slightly raised. The team will then clean the area to ensure it is sterile and ready for the procedure.

You will be covered with surgical drapes to maintain privacy and a clean environment. The staff will perform a final safety check to confirm all details before the surgeon begins.

High-level steps

The surgeon will carefully remove the hemorrhoids, which are the swollen or bulging veins causing your discomfort. They may use a scalpel, a laser, or a specialized tool that uses heat to seal the area. Your clinician may choose one of two main methods:

• Closed hemorrhoidectomy: The surgeon uses stitches to close the wound. This is often done because it may lead to faster initial healing.
• Open hemorrhoidectomy: The wound is left open to heal naturally from the inside out. This may be done if the area is difficult to stitch or to reduce the risk of certain infections.

In some cases, the surgeon may use a stapling device to lift the hemorrhoids and cut off their blood supply, which helps them shrink over time.

Anesthesia and pain control

To keep you comfortable and pain-free, your care team will use anesthesia. Your clinician may recommend one of the following options:

• General anesthesia: You will be in a deep sleep and will not feel anything during the surgery.
• Spinal or regional block: Medicine is injected near your spine to numb the lower half of your body. You may also receive medicine to help you feel relaxed or sleepy.
• Local anesthesia: The surgical area is numbed with an injection, often combined with sedation to keep you calm.

While you should not feel pain, you might notice a sensation of pressure or movement as the team works.

Monitoring and safety steps

Your safety is the top priority during the procedure. A member of the anesthesia team will stay with you the entire time to monitor your vital signs. This includes tracking your heart rate, blood pressure, and the amount of oxygen in your blood using small sensors placed on your skin.

These monitoring steps allow the team to adjust your medication instantly, ensuring you remain stable and comfortable throughout the surgery.

Immediately after the procedure

After the surgery is finished, you will be moved to a recovery room where nurses will watch you closely as the anesthesia wears off. You may feel some numbness, heaviness in your legs, or mild soreness in the surgical area. Your clinician may place a small piece of gauze or medicated packing over the site to protect it and absorb any minor fluid.

Most patients are able to go home the same day. Before you leave, the staff will make sure you can drink fluids and pass urine comfortably. They will also provide instructions on how to manage any soreness at home.

Typical procedure length

A hemorrhoidectomy is a relatively short procedure. It typically takes between 30 and 90 minutes to complete. The exact time depends on the number of hemorrhoids being treated and the specific surgical technique your clinician uses.

Common approaches (open vs minimally invasive)

Surgeons typically use one of two main methods to perform a hemorrhoidectomy. The choice often depends on the severity of your symptoms and your specific anatomy.

• Traditional surgery (excision): In this procedure, the surgeon cuts out the swollen tissue. This is often considered the most complete way to treat severe or recurring hemorrhoids. Depending on the technique, the incision may be stitched shut (closed) or left open to heal naturally (open).
• Stapling (stapled hemorrhoidopexy): This minimally invasive approach uses a circular stapling device. Instead of cutting the tissue out, the device blocks blood flow to the hemorrhoid and lifts the tissue back into its normal position. This method generally involves less pain and a faster recovery than traditional surgery.

Partial vs total

During a hemorrhoidectomy, the goal is to remove the problematic tissue while preserving the healthy skin and lining of the anal canal. Surgeons typically remove only the specific columns of swollen tissue causing symptoms.

A "total" removal of all anal cushion tissue is generally not applicable or recommended. Surgeons must leave bridges of healthy tissue between the removal sites to ensure the area heals without becoming too narrow (stenosis). Your clinician will focus on removing only what is necessary to relieve your symptoms.

Revision or repeat procedures

Surgery is considered the most effective treatment for severe hemorrhoids, but it is possible for them to return. If symptoms reappear years later, a revision or repeat procedure may be necessary.

Studies suggest that stapling procedures may have a higher risk of recurrence (hemorrhoids coming back) compared to traditional excision surgery. If you experience new symptoms after recovering from surgery, your doctor can help you decide if a second procedure or a different management strategy is right for you.

Tests and imaging that may be done

Before scheduling surgery, your clinician will likely perform a physical exam to confirm the diagnosis. This often includes a digital rectal exam, where the provider gently checks the anal canal with a gloved, lubricated finger. To see the internal area more clearly, they may use a short, lighted tube in a procedure called anoscopy or proctoscopy.

If your clinician needs to rule out other digestive conditions or check for colorectal cancer risk, they might recommend a more extensive look at the colon. This is done using a flexible tube during a sigmoidoscopy or colonoscopy.

Routine tests before surgery may also include:

• Blood tests to check your blood cell count and clotting ability
• A urine test (urinalysis)
• A pregnancy test for women of childbearing age

Medication adjustments

Some medications can increase the risk of bleeding during or after the procedure. Your healthcare team will review your full list of medicines, including over-the-counter drugs, vitamins, and herbal supplements.

You may be asked to temporarily stop taking blood thinners several days before surgery. These can include prescription blood thinners as well as common pain relievers like aspirin, ibuprofen, and naproxen.

Important: Do not stop taking any prescribed medication unless your clinician specifically instructs you to do so. If you are unsure about a specific medicine, ask your care team for guidance well in advance.

Day-before and day-of instructions

Your surgical team will provide a checklist to help you get ready. Following these instructions carefully helps ensure your safety during anesthesia and lowers the risk of infection.

Common preparations include:

• Fasting: You will likely need to stop eating and drinking for a specific time before surgery, often starting at midnight the night before.
• Bowel preparation: Your clinician may ask you to use an enema or a mild laxative to clear the rectum before you arrive.
• Hygiene: You might be instructed to shower or bathe with a specific soap on the morning of the procedure.
• Transportation: Since anesthesia is used, you will not be allowed to drive yourself home. You must arrange for a responsible adult to pick you up after the surgery.

General surgical risks

As with any operation, hemorrhoidectomy carries some standard risks. While your surgical team takes many safety precautions, it is possible to experience bleeding during or after the procedure. There is also a small risk of infection at the surgical site.

Reactions to anesthesia can also occur. These reactions vary depending on whether you receive general anesthesia (being asleep) or local anesthesia (numbing the area). Your anesthesia provider will monitor you closely to manage these risks.

Procedure-specific complications

In addition to general risks, there are side effects specific to hemorrhoid surgery. Pain is the most common issue during recovery, though it usually improves with time. Other possible complications include:

• Urinary retention: Difficulty emptying the bladder is a common temporary issue caused by pelvic muscle spasms or pain.
• Anal stenosis: Rarely, the healing process causes the anal canal to narrow, which can make bowel movements difficult.
• Incontinence: Some patients may experience temporary trouble controlling gas or stool, although long-term leakage is uncommon.
• Recurrence: While surgery is very effective, it is possible for hemorrhoids to return over time.

How complications are treated

Most complications are manageable and often resolve on their own or with simple treatments. Your care team will provide a plan to help you heal comfortably.

• Pain management: Discomfort is typically treated with pain relievers and warm water soaks, known as sitz baths.
• Bladder support: If you have trouble urinating, a thin tube called a catheter may be used briefly to empty your bladder until normal function returns.
• Treating narrowing: If anal stenosis occurs, your clinician can gently stretch the area using a special dilator tool to widen the passage.
• Infection care: In the rare event of an infection, antibiotics are prescribed to clear it up.

Pain control medicines

Managing discomfort is a priority after a hemorrhoidectomy. Your clinician may suggest over-the-counter pain relievers, such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen. These help reduce swelling and soreness. In some cases, they may prescribe stronger pain medicine for a short period to help you stay comfortable during the initial recovery.

Topical treatments are also common. These are creams, ointments, or suppositories (medicine inserted into the rectum) that may contain numbing agents like lidocaine or soothing ingredients. Your clinician might also recommend stool softeners to make bowel movements easier and less painful while the surgical site heals.

Antibiotics

Antibiotics are medicines used to treat or prevent infections caused by bacteria. For a standard hemorrhoidectomy, antibiotics are not always required. Your clinician will decide if you need them based on your specific health history or if they identify certain risks for infection during the procedure.

If you are prescribed antibiotics, it is important to take the full course exactly as directed. Always let your care team know if you have any known allergies to specific medicines to ensure they choose the safest option for you. Your clinician will tailor this choice to your needs.

Blood thinners and clot prevention

Blood thinners, also called anticoagulants, are medicines that help prevent blood clots from forming. Because these medicines can increase the risk of bleeding during and after surgery, your clinician will carefully review any you are currently taking. This includes common over-the-counter items like aspirin as well as prescription medications for heart or vein health.

Your surgical team will provide specific instructions on when to stop taking these medicines before the procedure and when it is safe to start them again. It is important to follow these instructions closely and not to change your medication routine without guidance, as these medicines are often vital for managing other health conditions.

Emergency warning signs

While recovery takes time, certain symptoms require immediate medical attention. Go to the emergency department or call emergency services if you experience:

• Heavy, uncontrolled bleeding: Passing large amounts of bright red blood or large clots from the rectum that does not stop with pressure.
• Inability to urinate: If you feel the need to urinate but cannot pass any urine at all (urinary retention), this requires urgent care to relieve the bladder.
• Signs of severe infection: High fever with shaking chills, confusion, or extreme pain that spreads beyond the surgical area.

Call your surgeon or clinic if…

Contact your healthcare provider during office hours—or the on-call line after hours—if you notice issues that are not life-threatening but seem abnormal. Your clinician may want to adjust your medication or check your healing progress if you have:

• Fever: A temperature over 100.4°F (38°C).
• Unmanaged pain: Pain that is not relieved by your prescribed pain medication or sitz baths.
• Difficulty urinating: If you are straining to urinate or cannot empty your bladder completely, let your care team know before it becomes a total blockage.
• New or worsening discharge: Pus or foul-smelling drainage from the anal area.
• Delayed bleeding: Bleeding that starts suddenly 1 to 2 weeks after surgery.

Expected vs concerning symptoms

It can be hard to tell the difference between normal recovery discomfort and a complication. Here is a general guide to help you decide when to act.

• Pain:Expected: Moderate to severe pain is common, especially during and after bowel movements for the first week or two.Concerning: Pain that suddenly gets much worse days after surgery or is accompanied by swelling and redness.
• Bleeding:Expected: Small amounts of blood on toilet tissue or in the toilet bowl after a bowel movement are normal as the area heals.Concerning: Passing cupfuls of blood, continuous dripping, or passing large clots. Note that bleeding can sometimes happen 7 to 14 days later when stitches dissolve; if this is heavy, seek care.
• Urination:Expected: Some hesitation or difficulty starting a stream is common immediately after surgery due to swelling and muscle spasms.Concerning: Being completely unable to urinate despite a full bladder.

Non-surgical treatments

Before considering surgery, your clinician may suggest lifestyle changes or simple office procedures. Eating more fiber—found in beans, whole grains, and vegetables—can help soften stools and reduce straining. Drinking plenty of water and taking warm sitz baths (soaking the area in plain water for 10 to 15 minutes) can also provide relief and reduce swelling.

If lifestyle changes aren't enough, your clinician might recommend minimally invasive options that can often be done in a doctor's office:

• Rubber band ligation: A tiny band is placed around the base of an internal hemorrhoid to cut off its blood supply, causing it to wither and fall off.
• Sclerotherapy: A chemical solution is injected into the hemorrhoid tissue to shrink it.
• Coagulation: Techniques using laser, infrared light, or heat are used to harden and shrivel small, bleeding internal hemorrhoids.

Watchful waiting

Watchful waiting means keeping an eye on your symptoms while using home care methods to see if they improve on their own. Many mild hemorrhoids resolve with time and better bowel habits, such as avoiding straining or sitting on the toilet for long periods. Your clinician may suggest this approach if your symptoms are infrequent or mild.

During this period, you may be asked to monitor for any changes in discomfort or bleeding. If your symptoms remain manageable and do not interfere with your daily activities, continuing with conservative care is often a reasonable first step before moving toward more invasive treatments.

When surgery becomes the best option

Surgery is usually considered when other treatments have not provided enough relief. If hemorrhoids are very large, cause significant pain, or continue to bleed despite office procedures, a hemorrhoidectomy may be the most effective way to resolve the problem. This procedure involves the surgical removal of the excess tissue causing the symptoms.

Your clinician might recommend surgery if the hemorrhoids are prolapsed (protruding outside the body) and cannot be pushed back in, or if they are causing persistent complications. While surgery requires a recovery period, it is often the most reliable way to treat severe or recurring cases and has a lower chance of the hemorrhoids returning compared to other methods.

Hospital services that commonly perform this surgery

A hemorrhoidectomy is usually performed in a hospital's surgical department or an ambulatory (outpatient) surgery center. These facilities are designed to handle day surgeries, which means you can often go home the same day the procedure is finished. Your clinician may recommend a specific facility based on the equipment available and your overall health needs.

The procedure is typically performed by a general surgeon or a colorectal surgeon, who is a specialist in the lower digestive tract. During your stay, you will likely interact with a specialized surgical team, including nurses and an anesthesia care team. These professionals work together to ensure the procedure is safe and that you are comfortable throughout the process.

Patient resources and support services

Hospitals and surgical centers often provide resources to help you manage your recovery. Since post-surgical comfort is a priority, many facilities offer access to pain management specialists. These experts help coordinate the best ways to reduce discomfort using medications or other soothing techniques as you heal.

Support services may also include:

• Nursing Support: Many centers provide a dedicated phone line or a patient portal where you can ask questions about your recovery or report any concerns after you return home.
• Dietary Counseling: Because a high-fiber diet and proper hydration are essential for healing and preventing future issues, some hospitals offer consultations with a dietitian.
• Educational Materials: You will likely receive clear, written guides on how to perform sitz baths (soaking the area in warm water) and how to use stool softeners correctly.

Questions for choosing where to have surgery

When deciding where to have your procedure, it is helpful to gather information about the facility's experience and the support they offer. You may want to use this checklist when speaking with your clinician:

• Is this facility equipped for outpatient surgery, or should I prepare for an overnight stay?
• What specific type of hemorrhoidectomy does the surgeon perform most often?
• What options for anesthesia are available at this location to ensure I am comfortable?
• Does the facility provide a 24-hour contact number in case I have questions during my recovery at home?
• Are there on-site resources, such as a pharmacy or a nutrition specialist, to help me prepare for life after surgery?

Conditions commonly treated by this procedure

A hemorrhoidectomy is a surgical procedure used to remove hemorrhoids, which are swollen veins in the lower rectum and anus. Your clinician may suggest this option if other treatments, such as lifestyle changes or less invasive procedures, have not provided enough relief. This surgery is typically reserved for more severe or persistent cases.

Conditions that may be treated with this procedure include:

• Internal hemorrhoids: These occur inside the rectum. Surgery is often used for "prolapsed" hemorrhoids, which are internal veins that have stretched down and protrude outside the anus.
• External hemorrhoids: These develop under the skin around the anal opening. They can cause significant discomfort or make hygiene difficult.
• Thrombosed hemorrhoids: This happens when a blood clot forms within an external hemorrhoid. While some clots resolve on their own, others may require surgical intervention if they are very painful.

Related symptoms people search for

Many people seek medical advice when they notice changes or discomfort in the rectal area. While these symptoms can be associated with hemorrhoids, they may also be signs of other conditions. Your clinician can help determine the cause of your symptoms and whether a procedure is necessary.

Common symptoms that people often search for include:

• Painless bleeding: You may see small amounts of bright red blood on your toilet tissue or in the toilet bowl after a bowel movement.
• Itching or irritation: The sensitive skin in the anal region may feel itchy or uncomfortable.
• Pain or soreness: Discomfort can occur, especially when sitting or during a bowel movement.
• Swelling or lumps: You might feel a sensitive or firm lump near the anus, which may indicate a swollen vein or a blood clot.

Evidence overview

Medical research and clinical guidelines generally consider hemorrhoidectomy the most effective and complete way to treat severe or recurring hemorrhoids. It is often described as the "gold standard" for advanced cases where less invasive treatments, such as rubber band ligation, have not worked.

Studies suggest that while this surgery offers the best chance of preventing hemorrhoids from coming back, it typically requires a longer recovery time than office-based procedures. Your care team will weigh the high success rate against the need for a recovery period to determine if this is the right option for you.

Safety notes and individualized care

Hemorrhoidectomy is a standard procedure, but like all surgeries, it carries certain risks. Your clinician will discuss these with you to ensure it is safe for your specific health needs. Common considerations include:

• Post-surgical pain: Discomfort is common after the anesthesia wears off. Your care team will provide a plan to manage pain during healing.
• Urinary retention: Some patients may have temporary difficulty emptying their bladder immediately after surgery.
• Bleeding or infection: While less common, these are risks associated with any surgical incision and are monitored closely.

Rare complications can include narrowing of the anal canal (stenosis) or changes in bowel control. Because recovery can be uncomfortable, doctors usually recommend this surgery only when symptoms are severe and affect your quality of life.

Sources used

The information provided here is based on current clinical guidelines and medical literature from reputable health organizations. Key sources include:

• Academic Medical Centers: Major research hospitals that publish patient education on surgical outcomes, such as the Mayo Clinic.
• National Medical Libraries: Databases that host peer-reviewed studies and clinical summaries, such as the National Library of Medicine (StatPearls).