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

Acute Hemorrhoidectomy (Urgent Emergency)

While very uncommon, if an emergent hemorrhoidectomy is needed:

Assessment & stabilization: Evaluate symptoms (thrombosis, strangulation), review history/medications, and monitor vitals for instability or infection.
Pre-op prep: Ensure NPO status, manage medications (hold blood thinners/NSAIDs if directed), and confirm advance directives if needed.
Bowel prep (if ordered): Enemas or laxatives may be used; encourage clear fluids if appropriate.
Hygiene & site prep: Shower with antibacterial soap, avoid shaving unless instructed, and remove jewelry and contacts.
Anesthesia & positioning: Confirm anesthesia plan (general, spinal, or sedation) and position patient for surgery.

Elective Hemorrhoidectomy

Pre-Op Tests: Some but not all patients may require blood tests and an EKG before surgery. Please complete all blood tests and EKGs within 30 days of surgery, and no later than two weeks before, to allow time for any needed repeats.
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.
- Use antibacterial soap to wash the area the night before and morning of the surgery. This excludes hemorrhoid procedures.
- Clean clothes and clean sheets the night before gets you prepared for surgery.
Smoking: Stop smoking any and all substances before surgery to promote better healing. Some insurances may require this step in order to authorize surgery. Check with your healthcare provider if you have questions about this.
Bowel prep: Your surgeon may recommend an enema or laxative prior to surgery.
- Enemas can be bought at any regular grocery or drug store.
- Laxative bowel preps can be recommended prior to the procedure. This can be discussed with your doctor who can assist you in finding the right bowel prep option.

Fasting: Do not eat or drink for 6–8 hours before surgery unless instructed otherwise.
Transportation: It is required that you arrange for someone to drive you home after the procedure.

It is very important that you properly prepare yourself for surgery as it allows for your doctor to perform the surgery safely and effectively. If you’re preparing for a hemorrhoidectomy, please visit the link below to view more detailed instructions on how to prepare for surgery.

Visit our Preparing for Surgery Page

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 excising hemorrhoids:

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 a hemorrhoidectomy will be uncomfortable, especially during bowel movements, but symptoms gradually improve over several weeks. It is sometimes recommended to undergo a fleet enema, or a bowel prep prior to the procedure to create more time in-between surgery and your first post-op bowel movement. Talk with your physician to learn more about how to reduce or prevent post-operative symptoms.

Typical recovery experience:

Pain and swelling for 1–2 weeks
Difficulty and pain 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

Contact your surgeon if you experience:

Fever over 100.4°F (38°C) or chills
Inability to urinate
Heavy bleeding
Severe or worsening pain
Foul drainage from the incision area

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)

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.

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.

Can I shower after surgery?
Yes, you may shower the day after surgery unless otherwise instructed. Sitz baths are often recommended for comfort and healing.

What are sitz baths and how often should I do them?
Sitz baths involve soaking the surgical area in warm water to reduce pain and promote healing, typically 2–3 times per day and after bowel movements. Sitz bath kits can be bought without a prescription at most local pharmacy stores.

Are there dietary restrictions after surgery?
No strict restrictions, but a high-fiber diet and plenty of fluids are strongly encouraged to prevent constipation.

When can I return to exercise?
Light walking is encouraged early, but you should avoid strenuous exercise, core work, and heavy lifting for several weeks.

Is it normal to feel a lump or swelling after surgery?
Yes, temporary swelling or a firm area at the surgical site is common and should gradually resolve during healing.

What if I am unable to have a bowel movement after surgery?
This can happen initially; your care team may recommend stool softeners, laxatives, or other measures to help get things moving.

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.