Incisions are made in the tissue around the hemorrhoid. The swollen vein inside the hemorrhoid is tied off to prevent bleeding, and the hemorrhoid is removed. The surgical area may be sewn closed or left open. Medicated gauze covers the wound.
Surgery can be done with a knife (scalpel), a tool that uses electricity (cautery pencil), or a laser.
The operation is usually done in a surgery center. You will most likely go home the same day (outpatient).
There is a procedure that uses a circular stapling device to remove hemorrhoidal tissue and close the wound. No incision is made. In this procedure, the hemorrhoid is lifted and then "stapled" back into place in the anal canal. This surgery is called stapled hemorrhoidopexy. People who have stapled surgery may have less pain after surgery than people who have the traditional hemorrhoid surgery. But the stapled surgery is more expensive. And people who have stapled surgery are more likely to have hemorrhoids come back and need surgery again.1
Doppler-guided hemorrhoidectomy is a procedure that uses a scope with a special probe to locate the hemorrhoidal arteries so that less tissue is removed. Some studies show that it is less painful but more long term studies are needed to compare it with other procedures.1
What To Expect After Surgery
Recovery takes about 2 to 3 weeks.
Going home after surgery
Right after the surgery, when you are still under anesthesia, you will be given a long-acting local anesthetic. It should last 6 to 12 hours to provide pain relief after surgery. If you are not going to stay overnight in the hospital after surgery, you will leave only after the anesthesia wears off and you have urinated. Inability to urinate (urinary retention) sometimes occurs because of swelling (edema) in the tissues or a spasm of the pelvic muscles.
Someone should drive you home.
Care after surgery
You can expect some pain after surgery. If your doctor gave you a prescription medicine for pain, take it as prescribed. Ask your doctor what over-the-counter medicines are safe for you.
Some bleeding is normal, especially with the first bowel movement after surgery.
For a few days after surgery, drink liquids and eat a bland diet (plain rice, bananas, dry toast or crackers, applesauce). Then you can return to regular foods and gradually increase the amount of fiber in your diet.
You may apply numbing medicines before and after bowel movements to relieve pain.
Ice packs applied to the anal area may reduce swelling and pain.
Frequent soaks in warm water (sitz baths) help relieve pain and muscle spasms.
Some doctors may recommend that you take an antibiotic (such as metronidazole) after surgery to prevent infection and reduce pain.
Doctors recommend that you take stool softeners that contain fiber to help make your bowel movements smooth. Straining during bowel movements can cause hemorrhoids to come back.
Follow-up exams with the surgeon usually are done 2 to 3 weeks after surgery to check for problems.
Why It Is Done
Hemorrhoidectomy is appropriate when you have:
Very large internal hemorrhoids.
Internal hemorrhoids that still cause symptoms after nonsurgical treatment.
Large external hemorrhoids that cause significant discomfort and make it difficult to keep the anal area clean.
Both internal and external hemorrhoids.
Had other treatments for hemorrhoids (such as rubber band ligation) that have failed.
How Well It Works
Surgery usually cures a hemorrhoid. But the long-term success of hemorrhoid surgery depends a lot on how well you are able to change your daily bowel habits to avoid constipation and straining. About 5 out of 100 people have hemorrhoids come back after surgery.2
Pain, bleeding, and an inability to urinate (urinary retention) are the most common side effects of hemorrhoidectomy.
Other relatively rare risks include the following:
Bleeding from the anal area
Collection of blood in the surgical area (hematoma)
Inability to control the bowel or bladder (incontinence)
Infection of the surgical area
Stool trapped in the anal canal (fecal impaction)
Narrowing (stenosis) of the anal canal
Recurrence of hemorrhoids
An abnormal passage (fistula) that forms between the anal or rectal canal and another area
Rectal prolapse, which happens when the rectal lining slips out of the anal opening
What To Think About
The success of hemorrhoidectomy depends a lot on your ability to make changes in your daily bowel habits to make passing stools easier. Hemorrhoidectomy may provide better long-term results than procedures that cut off blood flow to hemorrhoids (fixative procedures). But surgery is more costly, has a greater risk of complications, and usually is more painful.
Most internal hemorrhoids improve (they get smaller and discomfort decreases) with either home treatment or fixative procedures. When compared with surgery, fixative procedures involve less risk, are less painful, and require less time away from work and other activities.
Surgery is not recommended for small internal hemorrhoids (unless you also have large internal hemorrhoids or internal and external hemorrhoids).
Lasers are often advertised as being a less painful, faster-healing method of removing hemorrhoids. But none of these claims have been proved. Lasers are more expensive than traditional techniques. The procedure takes longer, and it may cause deep tissue injury.
Lumb KJ, et al. (2010). Stapled versus conventional surgery for hemorrhoids. Cochrane Database of Systematic Reviews (9).
Society for Surgery of the Alimentary Tract (2008). SSAT Patient Care Guidelines: Surgical Management of Hemorrhoids. Available online: http://www.ssat.com/cgi-bin/hemorr.cgi.
The Health Encyclopedia contains general health information. Not all treatments or services described are covered benefits for Kaiser Permanente members or offered as services by Kaiser Permanente. For a list of covered benefits, please refer to your Evidence of Coverage or Summary Plan Description. For recommended treatments, please consult with your health care provider.