Hemorrhoidectomy (Removal of Hemorrhoids): What You Need to Know
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What Are Hemorrhoids?
Hemorrhoids are normal structures in the body—clusters of veins and soft tissue in the lower rectum and anus that help cushion and support bowel movements. Everyone has hemorrhoids.
They become a problem only when these veins become swollen, inflamed, or enlarged, which can cause symptoms such as bleeding during bowel movements, itching, pain, swelling, or a noticeable lump.
Both internal hemorrhoids (inside the rectum) and external hemorrhoids (under the skin around the anus) can become symptomatic. Factors such as constipation, straining, pregnancy, prolonged sitting, and chronic diarrhea can increase pressure and lead to hemorrhoid enlargement.
Hemorrhoids are classified into grades based on how enlarged they are and whether they protrude outside the anus. This grading system helps determine the most appropriate treatment.
Most cases improve with lifestyle changes, but more severe or persistent hemorrhoids may require medical or surgical treatment.
What Is a Hemorrhoidectomy?
A hemorrhoidectomy is a surgical procedure to remove enlarged or symptomatic hemorrhoids—swollen veins in the rectum or anus that can cause pain, bleeding, itching, or protrusion.
This procedure is typically recommended when hemorrhoids are large, severely symptomatic, or not responding to other treatments such as medications, banding, or lifestyle changes.
Why Is It Done?
A hemorrhoidectomy may be recommended for patients who have:
- Grade III or IV internal hemorrhoids (prolapse that doesn’t reduce easily)
- Large external hemorrhoids causing significant discomfort
- Mixed hemorrhoids
- Persistent bleeding or pain
- Failure of less invasive treatments (rubber band ligation, sclerotherapy, infrared coagulation)
The goal is to remove the hemorrhoidal tissue and relieve symptoms long-term.
Preparing for Surgery
- Bowel prep: Your surgeon may recommend an enema or laxative prior to surgery.
- Enemas can be bought at any regular grocery store.
- Laxative Preps have special instructions that can be downloaded on our website at the link below.
- Medications: Tell your care team about all medications and supplements. Some, like blood thinners or weight-loss medications like Ozempic, Mounjaro or Trulicity, may need to be paused.
- Fasting: Do not eat or drink for 6–8 hours before surgery unless instructed otherwise.
- Transportation: Arrange for someone to drive you home after the procedure.
What to Expect During Surgery
- Performed under general, spinal, or local anesthesia with sedation
- Takes about 30–60 minutes
- Hemorrhoidal tissue is removed, and the area may be left open or partially closed (depending on technique)
- Most patients go home the same day
There are three main methods/treatments for removing the gallbladder:
Excisional Hemorrhoidectomy
- Most common and most effective surgical treatment for severe hemorrhoids
- Enlarged hemorrhoidal tissue is removed through small incisions
- Typically used for large or mixed internal/external hemorrhoids
- Higher postoperative discomfort than other treatments
- Offers the best long-term outcomes with low recurrence rates
Stapled Hemorrhoidopexy
- Primarily used for internal hemorrhoids
- A circular stapling device removes excess tissue and repositions remaining hemorrhoids
- Generally less painful immediately after surgery
- Not suitable for external hemorrhoids
- Best for patients without significant external disease
Hemorrhoid Banding (Rubber Band Ligation)
- Non-surgical treatment for Grade I–III internal hemorrhoids
- Small elastic band placed at the base of the hemorrhoid to cut off blood supply
- Hemorrhoid shrinks and falls off naturally in a few days
- Quick recovery with minimal discomfort
- Multiple sessions may be needed depending on the number of hemorrhoids
Recovery After Surgery
Recovery from hemorrhoidectomy can be uncomfortable, especially during bowel movements, but symptoms gradually improve over several weeks.
Typical recovery experience:
- Pain and swelling for 1–2 weeks
- Difficulty with bowel movements initially
- Possible small amounts of bleeding with bowel movements
- Gradual return to normal activity in 1–2 weeks, depending on comfort
- Full recovery may take 4–6 weeks
Helpful recovery tips:
- Take prescribed pain medications or use sitz baths for comfort
- Keep the area clean and dry
- Eat a high-fiber diet and drink plenty of water
- Use stool softeners to avoid straining
- Avoid heavy lifting and strenuous exercise until cleared by your surgeon
Risks and Possible Complications
Complications are uncommon but can include:
- Pain (most common)
- Bleeding
- Infection
- Difficulty urinating for a short time after surgery
- Anal stenosis (rare)
- Hemorrhoid recurrence (uncommon after excisional hemorrhoidectomy)
Contact your surgeon if you experience:
- Heavy bleeding
- Fever or chills
- Inability to urinate
- Severe or worsening pain
- Foul drainage from the incision area
Frequently Asked Questions (FAQs)
Is the procedure painful?
Some discomfort is expected, especially with bowel movements, but medication, sitz baths, and stool softeners help significantly.
When can I go back to work?
Most patients return to desk work within 1 week. More physical jobs may require 2–3 weeks.
Will I need bowel prep?
Your surgeon will let you know. Some cases require a small prep, but not all.
How long until bowel movements feel normal?
Initial bowel movements may be uncomfortable, but this improves over 1–2 weeks as the area heals.
Can hemorrhoids come back after surgery?
Recurrence is rare with traditional hemorrhoidectomy but can occur if underlying causes (straining, constipation) continue.
Will I need follow-up visits?
Yes. A follow-up appointment is usually scheduled within 2–4 weeks to ensure proper healing.
Is it normal to have bleeding after surgery?
Light bleeding with bowel movements is common in the first couple of weeks. Heavy or persistent bleeding should be reported.
Long-Term Outlook
Most patients experience excellent relief of symptoms and do not require further treatment. Maintaining healthy bowel habits—including high fiber intake, hydration, and avoiding straining—helps prevent recurrence.
Need Support or Have Questions?
Your care team is here to help. If you’ve been diagnosed with hemorrhoids or are recovering from a hemorrhoidectomy, don’t hesitate to contact us with questions about your treatment or recovery.