Hemorrhoidectomy: What It Is, Why It’s Done

A hemorrhoidectomy is surgery to remove hemorrhoids, whether they’re internal or external.

Surgery is typically not the first line of treatment. But when all else fails, hemorrhoidectomy is a safe, effective treatment that doesn’t just make hemorrhoids easier to live with — it gets rid of them altogether.

If your hemorrhoids are severe, they can cause itching, bleeding, and pain. They can continue to swell, increasing in size over time.

Prolapsed internal hemorrhoids can cause some mild fecal incontinence, mucus discharge, and irritated skin. When the blood supply to internal hemorrhoids is cut off (strangulated), they can become gangrenous.

Hemorrhoids are fairly common, affecting nearly three out of four adults at some point in their lives. Most people are able to use noninvasive methods to manage symptoms. When those don’t work, hemorrhoidectomy can be an effective treatment.

Less invasive treatment options

Hemorrhoidectomies are generally reserved for the most severe cases or when other, less invasive treatment methods have failed. These milder treatments include the following.

Lifestyle modifications

Getting regular exercise and not straining, especially when you go to the bathroom, can help you avoid irritating the hemorrhoids.

Diet is also a factor. Try increasing your fluid intake and reducing consumption of fats. Add more fiber with fruits, vegetables, and whole grains. You can also take fiber supplements.

Symptom relief

To ease symptoms such as swelling, itching, and pain, you can try the following remedies:

• Topicals. Over-the-counter (OTC) hemorrhoid creams, pads, or suppositories can ease symptoms. Look for products that contain hydrocortisone, lidocaine, or witch hazel.
• Baths. Relax in a plain, warm bath. A sitz bath that fits on the toilet seat can also be helpful. You can soak for 10 to 15 minutes several times a day.
• Oral medications. Use OTC anti-inflammatories and pain relievers.
• Stool softeners. OTC stool softeners can help you avoid straining when you move your bowels.

Be sure to read labels and use only as directed. If you have any concerns at all, review your OTC medications with your doctor or pharmacist.

Nonsurgical treatments

Minimally invasive treatments to get rid of painful hemorrhoids include the following:

• Sclerotherapy. This procedure involves injecting a chemical solution into the hemorrhoid to shrink it.
• Coagulation. This technique involves laser or infrared light or heat to shrivel internal hemorrhoids.
• Rubber band ligation. In the procedure, the doctor ties rubber bands around the base of an internal hemorrhoid. This cuts off circulation so the hemorrhoid falls off, usually within a week.
• External hemorrhoid thrombectomy. When a blood clot forms in an external hemorrhoid, it can be removed under local anesthesia in a doctor’s office.

Most people with hemorrhoids don’t require hemorrhoidectomy. Any type of surgery carries certain risks from the procedure itself, as well as from general anesthesia. For that reason, your doctor will likely recommend other, nonsurgical remedies first.

Surgical removal of hemorrhoids may be an option if:

• less invasive methods haven’t worked for you
• your hemorrhoids are severe and causing a lot of discomfort
• internal hemorrhoids are strangulated
• external hemorrhoids are swollen due to a clot
• you have both internal and external hemorrhoids
• you need surgery for other anorectal conditions

Other considerations are your age, overall health, and how well you can be expected to react to surgery.

Hemorrhoidectomy takes place in a hospital setting. It’s usually an outpatient procedure, but in some cases, it may require an overnight stay.

Pre-op instructions will advise you when to stop eating, which is usually 6 to 8 hours before surgery. You won’t be able to drive immediately, so be sure to arrange transportation home.

An IV will be inserted into your arm for medications to prevent infection, swelling, and bleeding. You’ll need either general anesthesia or local anesthesia with sedation to help you sleep through the procedure.

Once you’re asleep, the surgeon will insert a scope into the anal canal for closer examination of internal hemorrhoids. They’ll then cut the hemorrhoidal tissue with a scalpel or laser and close the wound with dissolvable sutures. This is called a closed hemorrhoidectomy.

In some cases, such as when there’s a high risk of infection or the area is very large, the incision isn’t sutured. This is called an open hemorrhoidectomy.

Another procedure, called hemorrhoidopexy, is somewhat less involved than hemorrhoidectomy. The surgeon uses staples to block blood flow, remove excess tissue, and lift hemorrhoids into a better position. This procedure comes with a greater risk of recurrence and rectal prolapse.

Once the surgeon is done, you’ll be moved to a recovery area where your vital signs will be monitored for several hours.

You’ll be able to drink and eat soon afterward. Within a few hours, you’ll be able to get out of bed. You’ll be discharged when you’re fully awake and stable.

Recovery is different for everyone, but you should be able to return to normal activities within 1 to 2 weeks. During this time, you may have some:

• bruising
• irritation
• minor bleeding
• discharge
• soreness

While recovering, self-care measures can include:

• staying well-hydrated
• taking pain relievers
• soaking in a sitz bath or regular warm bath
• applying ice packs
• taking stool softeners to avoid constipation and straining

Stitches will dissolve on their own within a week. Follow discharge instructions and contact your doctor with any concerns.

Hemorrhoidectomy is an invasive and sometimes painful treatment option, but it can be an effective, even permanent fix.

Complications are rare and not usually serious. These include:

• slow healing
• small tears that can cause pain that lasts several months
• narrowing of the anus (stenosis) due to scar tissue
• damage to sphincter muscles, which can lead to incontinence
• urinary retention

Infection after hemorrhoidectomy isn’t common, but alert your doctor if you have:

• fever, chills
• nausea, vomiting
• increasing pain
• redness
• swelling
• severe discharge or bleeding
• difficulty passing urine
• constipation lasting more than 3 days, even after taking laxatives

Hemorrhoidectomy is a surgical procedure to remove hemorrhoids. It’s usually a treatment of last resort when less invasive interventions have failed or the condition is severe.

As with any type of surgery, hemorrhoidectomy has a few risks. But when called for, it’s considered a safe, effective treatment for hemorrhoids.

If you have hemorrhoid pain, swelling, and itching, talk to your doctor about your options for treatment.