Table of ContentsView AllTable of ContentsTypes of SurgeryPurposeHow to PrepareWhat to ExpectRecovery
Table of ContentsView All
View All
Table of Contents
Types of Surgery
Purpose
How to Prepare
What to Expect
Recovery
Hemorrhoid surgery (hemorrhoidectomy) involves the surgical removal of one or morehemorrhoids. These are swollen veins in the rectum or anus that can occur either internally or externally.
This surgery may be indicated when a patient’s hemorrhoids cannot be treated with medical therapies or office-based procedures, and/or if the hemorrhoid is particularly large or causing symptoms (e.g., causing severe, acute pain, or significant bleeding).
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While a highly effective therapeutic option, hemorrhoid surgery carries risks and requires a decent recovery period.
This article covers what a hemorrhoidectomy is and why it’s performed, You’ll also learn how to prepare for an upcoming hemorrhoidectomy, what to do on the day of surgery, and what to expect during recovery.
What Is a Hemorrhoidectomy?
There are different surgical techniques used to remove hemorrhoids. Depending on the procedure, general, regional, or localanesthesiamay be used.
The type of hemorrhoid surgery used in a particular case depends on factors like the type of hemorrhoid involved and surgeon/patient preference.
Surgery for External Hemorrhoids
External hemorrhoids are located near the anus and often cause itching and bleeding. In some cases, an external hemorrhoid may become very painful, large, and/or thrombosed (when a clot forms inside of it) and require surgical removal.
When surgery is warranted, most external hemorrhoids are surgically cut out or excised. This is called ahemorrhoid excision.
Alternatively, anincisional hemorrhoidectomymay be performed for a thrombosed external hemorrhoid. With this type of surgery, a cut is made over the skin of the hemorrhoid. Just the clot (located within the hemorrhoid) is removed.
An incisional hemorrhoidectomy is less likely to be successful if a patient has been experiencing pain for more than 48 hours. In addition, if the incision is too small, blood can reaccumulate and form another clot inside the hemorrhoid.
Surgery for Internal Hemorrhoids
Internal hemorrhoids are located inside the rectum and are not typically visible. They usually cause painless rectal bleeding and are graded 1 to 4 based on the extent that the swollen tissue bulges out of the anus (prolapse).
For internal hemorrhoids, the whole hemorrhoid is usually cut out and removed. This is called aconventional hemorrhoidectomy. Based on the surgeon’s preference, a scalpel, scissors, electrocautery (use of heat from an electric current to destroy tissue), or a more advanced device may be used to remove the hemorrhoid.
A procedure called astapled hemorrhoidopexymay also be performed to remove internal hemorrhoids. With this technique, no incision is made. Instead, the hemorrhoid is lifted and stapled back into the anal canal using a special circular stapling device.
A stapled hemorrhoidopexy may result in less post-surgical pain than the conventional approach. However, with the former, the hemorrhoids are more likely to return.
An additional option for internal hemorrhoid removal is a surgical procedure calleddoppler-guided transanal hemorrhoidal artery ligation (HAL). The surgeon inserts a special tube called an anoscope a few inches into the anus to locate each hemorrhoid’s arterial blood supply. This is called an anoscopy.
The blood supply is closed off in a process called ligation.
What External Hemorrhoids Look Like and How to Get Rid of Them
Contraindications
Any of the following may prevent you from being able to have a hemorrhoidectomy:
Potential Risks
Besides the general risks of surgery (e.g., bleeding, problems with anesthesia), there are specific risks associated with hemorrhoid surgery.
These risks depend on the type and extent of surgery being performed.For example, risks associated with the surgical removal of a thrombosed external hemorrhoid include:
Risks associated with surgical removal of internal hemorrhoids include:
Open vs. Closed HemorrhoidectomyWhen any hemorrhoid is removed, the wound may be sutured closed or left open to heal on its own. Complications of both of these approaches are similar.
Open vs. Closed Hemorrhoidectomy
When any hemorrhoid is removed, the wound may be sutured closed or left open to heal on its own. Complications of both of these approaches are similar.
Purpose of Hemorrhoid Surgery
The purpose of hemorrhoid surgery is to remove external or internal hemorrhoids. Surgery is an option when treatment with medication, dietary modifications, behavioral therapies, and office-based procedures is unsuccessful or inappropriate.
The upside of hemorrhoid surgery is that it often has a better success rate than office-based procedures. The downside, however, is that it can also cause more pain and prolong recovery.
Therefore, the American Society of Colon and Rectal Surgeons advises that surgery only be considered for a specific and small group of individuals.
Potential candidates for hemorrhoidectomy generally include patients who:
If you prefer surgery, you can also discuss your therapy options with your referring healthcare provider orprimary care physicianand surgeon.
When hemorrhoid surgery is scheduled, various pre-operative tests may need to be run, especially for patients undergoing general anesthesia.
Examples of such tests include:
Once you are scheduled for hemorrhoid surgery, your surgeon will give you instructions on how to prepare.
Location
In select cases of suddenly occurring thrombosed external hemorrhoids that cause severe pain, surgery may be performed in an emergency room.
Food and Drink
On the day before surgery, you will likely be asked to eat a light, non-greasy breakfast and lunch.
After lunch, you will be asked to only drinkclear liquidsup until four hours prior to your surgery (at which point you cannot drink anything).
Medications
You may be advised to stop taking certain medications several days prior to surgery. At the top of the list are those that increase your risk for bleeding, such asnonsteroidal anti-inflammatory drugs (NSAIDs).
You will also be instructed to undergo acleansing bowel regimenprior to the procedure. Typically, the colon cleansing products can be purchased over the counter.
An example regimen may include the following:
How to Use an Enema Safely
What to Wear and Bring
On the day of your surgery, wear comfortable, loose-fitting clothes and avoid wearing makeup or nail polish. Leave all valuables, including jewelry, at home.
Make sure you bring your driver’s license, insurance card, and a list of your medications.
If you are staying overnight in the hospital, pack a bag the night before your surgery. In addition to personal care items (like a toothbrush and hairbrush) and comfort items (like a magazine or hand cream), be sure to pack:
Pre-Op Lifestyle Changes
You should stop smoking at least two weeks (and ideally six to eight weeks) before surgery, as smoking can impair wound healing.
What to Expect on the Day of Surgery
On the day of your hemorrhoid surgery, you will arrive at the hospital, surgical center, or office and check-in.
Before the Surgery
After checking in, you will be taken to a holding area where you will change into a hospital gown.
A surgical nurse will review your medication list, record yourvitals(heart rate, blood pressure, etc.), and place an intravenous (IV) line into a vein in your arm.
You may receive an antibiotic through your IV at this time to help prevent post-operative infection.The IV will also be used for administering fluids and medications during and after surgery.
Your surgeon will then greet you and review the operation with you. They might perform an anoscopy while they are there to double-check the status of your hemorrhoids (e.g., location, volume, etc.).
From there, you will be wheeled into the operating room on a gurney where the anesthesia process and surgery will start.
During the Surgery
Ifgeneral anesthesiais needed, theanesthesiologistwill give you inhaled or intravenous medication to put you to sleep. Once asleep, a breathing tube called anendotracheal tubewill be inserted down your throat to allow for mechanically-assisted breathing during the operation.
Withregional anesthesia, the surgeon injects a numbing medication into your spine. You may feel a stinging sensation as the medication is being injected.
Local anesthesiaalso involves a numbing medication, but it is injected into the area around your anus. You will also probably be given a sedative to help you relax or fall asleep during the surgery.
Your healthcare provider will talk to you about the type of anesthesia that will be used for your procedure.
Compared to spinal (regional) anesthesia, research suggests that local anesthesia for hemorrhoid surgery is associated with less pain and urinary retention after surgery.
The hemorrhoidectomy technique used in your procedure will be dependent on your specific situation. For a conventional internal hemorrhoidectomy, you can generally expect the following sequence of events:
After the Surgery
A nurse will monitor your vital signs in the recovery room as you slowly wake up from general anesthesia or the sedative.
Since urinary retention is a potential complication of hemorrhoid surgery, you may be asked to urinate before being approved to go home (for a same-day surgery).
If you are staying in the hospital, you will be wheeled on a gurney to your hospital room.
Recovery can take anywhere from one to six weeks, depending on the type and extent of your surgery.
As you recover at home or in the hospital, expect to experience pain and a sensation of anal fullness or tightness for the first week or so.
To ease your pain, your surgeon will advise the following:
It’s important to follow up with your surgeon as advised. During these appointments, your surgeon will check your wound site, monitor for complications, access your pain, and remove any sutures (if applicable).
Wound Care
Mild bleeding and a yellow-red discharge from the anal area are common after surgery. This drainage usually lasts seven to 14 days. Mild bleeding may increase with bowel movements and activity.
Your surgeon will advise you to wear pads to monitor the drainage and to avoid soiling your underwear and pants.
You may also have a gauze dressing over your anal wound or some sort of packing in your anal area. Talk to your surgeon about when to remove this and how to change or replace it (if applicable and necessary).
Check with your surgeon, but you can probably shower the day after surgery. That said, you should avoid submerging your wound in a soapy bath for one week (sitz baths are OK).
If you have any stitches, they will dissolve around 10 to 14 days after surgery or be removed at one of your follow-up appointments.
What if the Discharge Smells?
While some amount of discharge after hemorrhoid surgery is to be expected, smelly discharge after hemorrhoidectomy could indicate a complication. Causes of smelly discharge include:
Physical Activity
You will have specific activity guidelines to follow after surgery. For instance:
When to Call Your SurgeonCall your surgeon right away if you experience any of the following symptoms:High fever or chillsSignificant problems urinatingSevere or worsening pain that is not eased with medicationHeavy rectal bleeding and/or bleeding with clotsExpanding redness, swelling, or foul-smelling, pustular discharge from your wound
When to Call Your Surgeon
Call your surgeon right away if you experience any of the following symptoms:High fever or chillsSignificant problems urinatingSevere or worsening pain that is not eased with medicationHeavy rectal bleeding and/or bleeding with clotsExpanding redness, swelling, or foul-smelling, pustular discharge from your wound
Call your surgeon right away if you experience any of the following symptoms:
Long-Term Care
Besides keeping in touch with your surgeon as instructed, you should adopt lifelong habits that will prevent hemorrhoids from forming again:
Talk to a nutritionist or dietician to figure out what your fiber needs are and help you meet them. If you are struggling with constipation, talk with your healthcare provider about taking an occasionallaxativeor using an enema.
Possible Future Surgeries
Future surgical interventions or medical therapies may be required if the hemorrhoid(s) recurs and/or if a complication from surgery develops.
Such complications might include anal stenosis or fecal incontinence.Anal stenosisoccurs when the anal canal narrows to the point where bowel movements become difficult.Fecal incontinence, however, is when there is an involuntary passing of stools.
Summary
Most patients with symptomatic hemorrhoids notice that their discomfort and irritation ease within about a week or so of implementing conservative strategies—making surgery moot.
That said, if surgery is needed, know that it’s often very effective. It will also require a commitment to your post-operative care.
If you are considering surgery for your hemorrhoids, talk with your healthcare provider about what the best surgical technique is for you. Also, remember to review potential risks, the type of anesthesia used, and any concerns or questions you have.
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20 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Rivadeneira DE, Steele SR.Surgical treatment of hemorrhoidal disease. Weisner M, ed. UpToDate. Waltham, MA: UpToDate.Mott T, Latimer K, Edwards C.Hemorrhoids: Diagnosis and treatment options.Am Fam Physician.2018;97(3):172-179Rivadeneira DE, Steele SR.Surgical treatment of hemorrhoidal disease. Weisner M, ed. UpToDate. Waltham, MA: UpToDate.Lin G, Ge Q, He X, Qi H, Xu L.A novel technique for the treatment of stages III to IV hemorrhoids: Homemade anal cushion suspection clamp combined with harmonic scalpel.Medicine (Baltimore).2017 Jun;96(26):e7309. doi:10.1097/MD.0000000000007309Sadeghi PMM, Rabiee M, Darestani NG, Alesaheb F, Zeinalkhani F.Short term results of stapled versus conventional hemorrhoidectomy within 1 year follow-up.Int J Burns Trauma. 2021;11(1):69-74University of California San Francisco General Surgery.Hemorrhoidectomy.Mott T, Latimer K, Edwards C.Hemorrhoids: Diagnosis and treatment options.Am Fam Physician. 2018;97(3):172-179.Davis BR, Lee-Kong SA, Migaly J, Feingold DL, Steele SR.The American Society of Colon and Rectal Surgeons clinical practice guidelines for the management of hemorrhoids.Dis Colon Rectum. 2018;61(3):284.292. doi:10.1097/DCR.0000000000001030Johns Hopkins Medicine.Tests done before surgery.Lohsiriwat V.Anorectal emergencies.World J Gastroenterol.2016 Jul 14; 22(26): 5867–5878. doi:10.3748/wjg.v22.i26.5867University of Washington Health.Hemorrhoidectomy.Emory Healthcare.Hemorrhoidectomy.Khan KI, Akmal M, Mahmood S.Role of prophylactic antibiotics in Milligan Morgan hemorrhoidectomy - a randomized control trial.Int J Surg. 2014;12(8):868-71. doi: 10.1016/j.ijsu.2014.06.005Mohamedahmed AYY, Stonelake S, Mohammed SSS et al.Haemorrhoidectomy under local anaesthesia versus spinal anaesthesia: a systematic review and meta-analysis.Int J Colorectal Dis.2020 Dec;35(12):2171-2183. doi:10.1007/s00384-020-03733-5Qi-Ming X, Jue-Ying X, Ben-Hui C, Jing W, Ning L.Risk Factors for Postoperative Retention After Hemorrhoidectomy: A Cohort Study.Gastroenterol Nurs.Nov-Dec 2015;38(6):464-8. doi:10.1097/SGA.0000000000000121The University of Tennessee Medical Center.Anorectal surgery — Discharge instructions.University of Michigan Medicine.Hemorrhoidectomy post procedure instructions.Kaiser Permanente.Hemorrhoidectomy.MedlinePlus.Hemorrhoids.Kunitake H, Poylin V.Complications following anorectal surgery.Clin Colon Rectal Surg.2016 Mar; 29(1): 14–21. doi:10.1055/s-0035-1568145
20 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Rivadeneira DE, Steele SR.Surgical treatment of hemorrhoidal disease. Weisner M, ed. UpToDate. Waltham, MA: UpToDate.Mott T, Latimer K, Edwards C.Hemorrhoids: Diagnosis and treatment options.Am Fam Physician.2018;97(3):172-179Rivadeneira DE, Steele SR.Surgical treatment of hemorrhoidal disease. Weisner M, ed. UpToDate. Waltham, MA: UpToDate.Lin G, Ge Q, He X, Qi H, Xu L.A novel technique for the treatment of stages III to IV hemorrhoids: Homemade anal cushion suspection clamp combined with harmonic scalpel.Medicine (Baltimore).2017 Jun;96(26):e7309. doi:10.1097/MD.0000000000007309Sadeghi PMM, Rabiee M, Darestani NG, Alesaheb F, Zeinalkhani F.Short term results of stapled versus conventional hemorrhoidectomy within 1 year follow-up.Int J Burns Trauma. 2021;11(1):69-74University of California San Francisco General Surgery.Hemorrhoidectomy.Mott T, Latimer K, Edwards C.Hemorrhoids: Diagnosis and treatment options.Am Fam Physician. 2018;97(3):172-179.Davis BR, Lee-Kong SA, Migaly J, Feingold DL, Steele SR.The American Society of Colon and Rectal Surgeons clinical practice guidelines for the management of hemorrhoids.Dis Colon Rectum. 2018;61(3):284.292. doi:10.1097/DCR.0000000000001030Johns Hopkins Medicine.Tests done before surgery.Lohsiriwat V.Anorectal emergencies.World J Gastroenterol.2016 Jul 14; 22(26): 5867–5878. doi:10.3748/wjg.v22.i26.5867University of Washington Health.Hemorrhoidectomy.Emory Healthcare.Hemorrhoidectomy.Khan KI, Akmal M, Mahmood S.Role of prophylactic antibiotics in Milligan Morgan hemorrhoidectomy - a randomized control trial.Int J Surg. 2014;12(8):868-71. doi: 10.1016/j.ijsu.2014.06.005Mohamedahmed AYY, Stonelake S, Mohammed SSS et al.Haemorrhoidectomy under local anaesthesia versus spinal anaesthesia: a systematic review and meta-analysis.Int J Colorectal Dis.2020 Dec;35(12):2171-2183. doi:10.1007/s00384-020-03733-5Qi-Ming X, Jue-Ying X, Ben-Hui C, Jing W, Ning L.Risk Factors for Postoperative Retention After Hemorrhoidectomy: A Cohort Study.Gastroenterol Nurs.Nov-Dec 2015;38(6):464-8. doi:10.1097/SGA.0000000000000121The University of Tennessee Medical Center.Anorectal surgery — Discharge instructions.University of Michigan Medicine.Hemorrhoidectomy post procedure instructions.Kaiser Permanente.Hemorrhoidectomy.MedlinePlus.Hemorrhoids.Kunitake H, Poylin V.Complications following anorectal surgery.Clin Colon Rectal Surg.2016 Mar; 29(1): 14–21. doi:10.1055/s-0035-1568145
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Rivadeneira DE, Steele SR.Surgical treatment of hemorrhoidal disease. Weisner M, ed. UpToDate. Waltham, MA: UpToDate.Mott T, Latimer K, Edwards C.Hemorrhoids: Diagnosis and treatment options.Am Fam Physician.2018;97(3):172-179Rivadeneira DE, Steele SR.Surgical treatment of hemorrhoidal disease. Weisner M, ed. UpToDate. Waltham, MA: UpToDate.Lin G, Ge Q, He X, Qi H, Xu L.A novel technique for the treatment of stages III to IV hemorrhoids: Homemade anal cushion suspection clamp combined with harmonic scalpel.Medicine (Baltimore).2017 Jun;96(26):e7309. doi:10.1097/MD.0000000000007309Sadeghi PMM, Rabiee M, Darestani NG, Alesaheb F, Zeinalkhani F.Short term results of stapled versus conventional hemorrhoidectomy within 1 year follow-up.Int J Burns Trauma. 2021;11(1):69-74University of California San Francisco General Surgery.Hemorrhoidectomy.Mott T, Latimer K, Edwards C.Hemorrhoids: Diagnosis and treatment options.Am Fam Physician. 2018;97(3):172-179.Davis BR, Lee-Kong SA, Migaly J, Feingold DL, Steele SR.The American Society of Colon and Rectal Surgeons clinical practice guidelines for the management of hemorrhoids.Dis Colon Rectum. 2018;61(3):284.292. doi:10.1097/DCR.0000000000001030Johns Hopkins Medicine.Tests done before surgery.Lohsiriwat V.Anorectal emergencies.World J Gastroenterol.2016 Jul 14; 22(26): 5867–5878. doi:10.3748/wjg.v22.i26.5867University of Washington Health.Hemorrhoidectomy.Emory Healthcare.Hemorrhoidectomy.Khan KI, Akmal M, Mahmood S.Role of prophylactic antibiotics in Milligan Morgan hemorrhoidectomy - a randomized control trial.Int J Surg. 2014;12(8):868-71. doi: 10.1016/j.ijsu.2014.06.005Mohamedahmed AYY, Stonelake S, Mohammed SSS et al.Haemorrhoidectomy under local anaesthesia versus spinal anaesthesia: a systematic review and meta-analysis.Int J Colorectal Dis.2020 Dec;35(12):2171-2183. doi:10.1007/s00384-020-03733-5Qi-Ming X, Jue-Ying X, Ben-Hui C, Jing W, Ning L.Risk Factors for Postoperative Retention After Hemorrhoidectomy: A Cohort Study.Gastroenterol Nurs.Nov-Dec 2015;38(6):464-8. doi:10.1097/SGA.0000000000000121The University of Tennessee Medical Center.Anorectal surgery — Discharge instructions.University of Michigan Medicine.Hemorrhoidectomy post procedure instructions.Kaiser Permanente.Hemorrhoidectomy.MedlinePlus.Hemorrhoids.Kunitake H, Poylin V.Complications following anorectal surgery.Clin Colon Rectal Surg.2016 Mar; 29(1): 14–21. doi:10.1055/s-0035-1568145
Rivadeneira DE, Steele SR.Surgical treatment of hemorrhoidal disease. Weisner M, ed. UpToDate. Waltham, MA: UpToDate.
Mott T, Latimer K, Edwards C.Hemorrhoids: Diagnosis and treatment options.Am Fam Physician.2018;97(3):172-179
Lin G, Ge Q, He X, Qi H, Xu L.A novel technique for the treatment of stages III to IV hemorrhoids: Homemade anal cushion suspection clamp combined with harmonic scalpel.Medicine (Baltimore).2017 Jun;96(26):e7309. doi:10.1097/MD.0000000000007309
Sadeghi PMM, Rabiee M, Darestani NG, Alesaheb F, Zeinalkhani F.Short term results of stapled versus conventional hemorrhoidectomy within 1 year follow-up.Int J Burns Trauma. 2021;11(1):69-74
University of California San Francisco General Surgery.Hemorrhoidectomy.
Mott T, Latimer K, Edwards C.Hemorrhoids: Diagnosis and treatment options.Am Fam Physician. 2018;97(3):172-179.
Davis BR, Lee-Kong SA, Migaly J, Feingold DL, Steele SR.The American Society of Colon and Rectal Surgeons clinical practice guidelines for the management of hemorrhoids.Dis Colon Rectum. 2018;61(3):284.292. doi:10.1097/DCR.0000000000001030
Johns Hopkins Medicine.Tests done before surgery.
Lohsiriwat V.Anorectal emergencies.World J Gastroenterol.2016 Jul 14; 22(26): 5867–5878. doi:10.3748/wjg.v22.i26.5867
University of Washington Health.Hemorrhoidectomy.
Emory Healthcare.Hemorrhoidectomy.
Khan KI, Akmal M, Mahmood S.Role of prophylactic antibiotics in Milligan Morgan hemorrhoidectomy - a randomized control trial.Int J Surg. 2014;12(8):868-71. doi: 10.1016/j.ijsu.2014.06.005
Mohamedahmed AYY, Stonelake S, Mohammed SSS et al.Haemorrhoidectomy under local anaesthesia versus spinal anaesthesia: a systematic review and meta-analysis.Int J Colorectal Dis.2020 Dec;35(12):2171-2183. doi:10.1007/s00384-020-03733-5
Qi-Ming X, Jue-Ying X, Ben-Hui C, Jing W, Ning L.Risk Factors for Postoperative Retention After Hemorrhoidectomy: A Cohort Study.Gastroenterol Nurs.Nov-Dec 2015;38(6):464-8. doi:10.1097/SGA.0000000000000121
The University of Tennessee Medical Center.Anorectal surgery — Discharge instructions.
University of Michigan Medicine.Hemorrhoidectomy post procedure instructions.
Kaiser Permanente.Hemorrhoidectomy.
MedlinePlus.Hemorrhoids.
Kunitake H, Poylin V.Complications following anorectal surgery.Clin Colon Rectal Surg.2016 Mar; 29(1): 14–21. doi:10.1055/s-0035-1568145
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