Hemorrhoid Surgery: Techniques, Recovery, and Aftercare

Hemorrhoid surgery is used to treat advanced or recurrent cases that do not improve with lifestyle changes or office procedures. The best-known operation is a hemorrhoidectomy, in which the surgeon removes hemorrhoidal tissue responsible for bleeding, pain, or prolapse.

Hemorrhoidectomy is one of the most effective treatments for severe hemorrhoidal disease, but not everyone with hemorrhoids needs surgery. The procedure should be selected after confirming the diagnosis, identifying whether the hemorrhoids are internal, external, or combined, and assessing how the symptoms affect the patient’s life.

Hemorrhoid surgery includes different operations designed to remove, reduce, or reposition hemorrhoidal tissue.

A conventional hemorrhoidectomy directly removes the hemorrhoids. Other techniques may reduce their blood supply or return prolapsed tissue to its original position.

The choice depends on:

• Type of hemorrhoids.
• Degree of prolapse.
• Presence of internal and external disease.
• Severity of bleeding.
• Pain and other symptoms.
• Treatments previously attempted.
• The patient’s overall health.
• The surgeon’s experience.

No. Most cases improve with measures such as:

• Gradually increasing fiber intake.
• Maintaining adequate hydration.
• Treating constipation or diarrhea.
• Avoiding straining during bowel movements.
• Limiting time spent sitting on the toilet.
• Using topical treatments for short periods when indicated.

Small internal hemorrhoids may also be treated with rubber band ligation, sclerotherapy, or infrared coagulation.

These are office procedures, not hemorrhoid operations. They are mainly used for internal hemorrhoids and do not remove external hemorrhoids.

Surgery may be considered for:

• Large, symptomatic external hemorrhoids.
• Combined internal and external hemorrhoids.
• Grade III or IV internal hemorrhoids.
• Prolapse that remains outside the anus.
• Recurrent or persistent bleeding.
• Significant difficulty cleaning the area.
• Symptoms that interfere with everyday activities.
• Failure of conservative treatments.
• Recurrence after office procedures.

A severely painful thrombosed external hemorrhoid may also require a minor procedure to remove the clot and affected tissue. This is not the same as a complete hemorrhoidectomy.

Classification helps guide treatment:

• Grade I: Remain inside the anal canal.
• Grade II: Protrude during a bowel movement and return on their own.
• Grade III: Protrude and must be pushed back manually.
• Grade IV: Remain outside and cannot be returned to the anal canal.

Grade I and II hemorrhoids are generally treated without surgery. Some grade III cases respond to rubber band ligation. Surgery is considered more frequently for grade III and IV disease or when significant external hemorrhoids are present.

Classification does not replace an individualized evaluation. Two people with the same hemorrhoid grade may need different treatments.

The procedure may be performed by a general surgeon experienced in anorectal conditions or by a colorectal surgeon, also known as a coloproctologist.

The specialist should evaluate the source of rectal bleeding before attributing it to hemorrhoids. Some patients may need a colonoscopy to rule out polyps, inflammation, colorectal cancer, or other causes.

This is the conventional operation and one of the most effective options for large external hemorrhoids, combined internal and external disease, or advanced prolapse.

The surgeon removes the excess tissue and controls the blood vessels. The wounds may be:

• Closed with stitches, known as a closed hemorrhoidectomy.
• Left partially open to heal, known as an open hemorrhoidectomy.

Both techniques are valid. The choice depends on the disease, surgical findings, and the surgeon’s experience.

Excisional hemorrhoidectomy has a low recurrence rate, but it generally causes more postoperative pain and requires a longer recovery than office procedures.

During this procedure, the surgeon locates and ties off the arteries supplying the hemorrhoidal tissue. Stitches may also be used to lift prolapsed tissue.

It may cause less pain than excisional hemorrhoidectomy, although recurrence can be more likely, particularly with advanced prolapse.

Stapled hemorrhoidopexy repositions prolapsed internal hemorrhoidal tissue and reduces its blood supply.

It does not remove external hemorrhoids. Current recommendations do not routinely consider it a first-line surgical option because of its higher recurrence rate and certain rare but potentially serious complications.

Its use should be individualized after a clear discussion of its benefits and risks.

The term “laser hemorrhoid surgery” is used for different techniques. Some use laser energy to shrink tissue, while others combine it with surgical procedures.

Availability, results, and supporting evidence vary. Laser treatment does not guarantee:

• No pain.
• Immediate recovery.
• Complete elimination of hemorrhoidal disease.
• Lower recurrence.
• Better outcomes than conventional techniques.

The choice should not be based only on a procedure being advertised as “laser” or “painless.” The important question is whether it is appropriate for the type and grade of disease.

The surgeon will review:

• Symptoms and how long they have been present.
• Bleeding.
• Pain.
• Degree of prolapse.
• Bowel habits.
• Previous treatments.
• Chronic medical conditions.
• Previous operations.
• Medications and supplements.
• History of anesthesia-related problems.

The evaluation may also include anal inspection, a digital rectal examination, and anoscopy. Some patients may need blood tests, an electrocardiogram, or other preoperative studies.

Tell the surgical team if you use:

• Blood thinners.
• Aspirin.
• Anti-inflammatory medications.
• Diabetes medications.
• Dietary supplements or herbal products.
• Other treatments that affect blood clotting.

Do not stop any medication on your own. The surgeon and anesthesiologist will tell you which treatments need to be adjusted and when.

Also tell the team if you are pregnant or may be pregnant, have allergies, or use tobacco, alcohol, cannabis, or other substances.

Fasting time depends on the anesthesia and hospital protocol. Follow the surgical team’s specific instructions rather than relying on a general fasting rule.

A complete bowel preparation is not always necessary. Some procedures require only an enema or local preparation.

Do not use additional laxatives or enemas before surgery unless instructed.

Hemorrhoid surgery may be performed with:

• General anesthesia.
• Regional or spinal anesthesia.
• Sedation combined with local anesthesia.

The choice depends on the procedure, the patient’s health, the expected duration, and the Anesthesiology evaluation.

You should not feel pain during the operation. Discomfort occurs mainly during the first days of recovery and should be addressed with an established pain-management plan.

In general, the procedure involves:

1. Positioning the patient to provide access to the anal canal.
2. Examining the hemorrhoids and confirming the areas requiring treatment.
3. Carefully removing symptomatic tissue.
4. Controlling the blood vessels.
5. Closing the wounds or leaving them open, depending on the technique.
6. Applying medication or local anesthesia for pain control.

The surgeon avoids removing excessive tissue to reduce the risk of anal narrowing.

The duration depends on the number of hemorrhoids, surgical technique, and extent of the disease. Many operations can be completed in under one hour, although complex cases may take longer.

Time is also needed for anesthesia preparation and monitoring in the recovery room.

It often is. Many patients return home the same day after they:

• Recover from anesthesia.
• Have adequate pain control.
• Tolerate liquids.
• Can walk safely.
• Can urinate.

A longer stay may be necessary when the patient has significant medical conditions, bleeding, difficult-to-control pain, persistent nausea, or trouble urinating.

Someone else must drive the patient home and remain available during the first several hours.

Pain is expected, especially after an excisional hemorrhoidectomy. It commonly worsens during bowel movements and gradually improves.

Complete recovery may take two to four weeks. The timeline depends on:

• The technique used.
• The amount of tissue removed.
• Type of work.
• Constipation control.
• Individual pain tolerance.
• Development of complications.

Feeling better does not mean that the surgical area has completely healed.

Office work may be resumed when pain is controlled, the patient can sit or walk comfortably, and sedating medication is no longer needed.

Physical work, heavy lifting, and activities that increase abdominal pressure may require additional time.

The surgeon should approve the return to work, driving, exercise, and sexual activity.

It is normal to feel anxious about the first bowel movement. The goal is to avoid both hard stools and diarrhea.

The medical team may recommend:

• Fiber.
• Adequate hydration.
• Stool softeners.
• Osmotic laxatives.
• Walking.
• Not delaying bowel movements.

Do not take additional laxative doses without authorization. Diarrhea can also irritate the wound and increase pain.

Contact your surgeon if you cannot have a bowel movement or pass gas within the period specified in your discharge instructions.

Treatment may combine:

• Non-opioid pain medication.
• Local anesthetics.
• Additional medication based on pain severity.
• Short-term opioids in selected cases.

Opioids can worsen constipation, so they are used for the shortest period possible.

Do not take aspirin or anti-inflammatory medication unless your surgeon has authorized it, particularly when there is a risk of bleeding.

Sitting in warm water for 10 to 15 minutes may relieve pain and help with hygiene. Sitz baths may be used several times a day and after bowel movements, following medical instructions.

Do not add alcohol, perfume, disinfectants, or other irritating substances.

• Clean the area gently with water.
• Avoid rubbing.
• Pat dry.
• Use gauze or pads if there is discharge.
• Do not insert creams or suppositories unless instructed.

A small amount of blood or discharge may be expected during healing.

A fiber-rich diet helps maintain soft, formed stools. It may include:

• Fruits.
• Vegetables.
• Legumes.
• Whole grains.
• Psyllium when recommended.

Increase fiber gradually and maintain adequate hydration.

Walking supports circulation and bowel function. During the period specified by your surgeon, avoid:

• Heavy lifting.
• Strenuous exercise.
• Sitting for prolonged periods.
• Driving while taking sedating medications.

Possible complications include:

• Pain.
• Bleeding.
• Infection.
• Difficulty urinating.
• Fecal impaction.
• Delayed wound healing.
• Narrowing of the anal canal.
• Recurrence.
• Continence problems, which are uncommon.
• Fistula or other rare complications.

Hemorrhoidectomy is generally safe when appropriately indicated and performed by an experienced surgical team.

Urinary retention is a recognized temporary complication. It may be related to pain, anesthesia, swelling, or the intravenous fluids given during the procedure.

If you cannot urinate after discharge, contact your surgeon immediately or go to the Emergency Department. Do not wait until the next day, as catheterization may be necessary to empty the bladder.

Contact the surgical team if you experience:

• Pain that worsens or cannot be controlled.
• Fever.
• Foul-smelling discharge.
• Increasing redness or swelling.
• Persistent vomiting.
• Inability to have a bowel movement or pass gas.
• Difficulty urinating.
• More bleeding than expected.

Go to the Emergency Department immediately if you have:

• Heavy or continuous bleeding.
• Large blood clots.
• Fainting, confusion, or severe weakness.
• Difficulty breathing.
• Severe pain accompanied by fever.
• Complete inability to urinate.
• A severely swollen or rigid abdomen.

Hemorrhoidectomy has a low recurrence rate, but it does not eliminate the factors that contribute to hemorrhoidal disease.

To reduce the risk:

• Maintain adequate fiber intake.
• Avoid straining.
• Treat constipation and diarrhea.
• Limit time spent on the toilet.
• Maintain a healthy weight.
• Exercise regularly.
• Follow your surgeon’s instructions.

At BlueNetHospitals Los Cabos, our Advanced General Surgery team can evaluate the type and grade of hemorrhoidal disease and determine whether you need conservative management, an office procedure, or surgery.

If your symptoms persist, you have prolapse, or surgery has already been recommended, schedule a consultation to learn which procedure is appropriate for you.

📲 Appointments via WhatsApp: +52 (624) 151 0693

If you have heavy bleeding, fainting, fever, severe pain, or an inability to urinate:

📞 24-hour Emergency Care: +52 (624) 1043 911

It is an operation that removes hemorrhoidal tissue responsible for bleeding, prolapse, pain, or other symptoms.

It may be recommended for large external hemorrhoids, combined internal and external disease, grade III or IV prolapse, or symptoms that do not respond to other treatments.

No. It is an office procedure for internal hemorrhoids. It is not the same as a hemorrhoidectomy and does not treat external hemorrhoids.

You should not feel pain during the operation because anesthesia is used. Pain is expected after a hemorrhoidectomy, especially during bowel movements, but it can be managed with an appropriate plan.

Many operations take less than one hour, although the duration depends on the technique and extent of the disease.

Complete recovery generally takes two to four weeks. Less invasive procedures may require less time.

It depends on the procedure, pain, and type of work. Physical occupations generally require more recovery time than office work.

Not necessarily. Evidence and outcomes depend on the specific technique. No procedure guarantees a painless recovery or prevents every recurrence.

Recurrence is uncommon after a hemorrhoidectomy, but it can happen. Managing constipation and improving bowel habits can reduce the risk.

It is performed by a general surgeon with anorectal experience or by a colorectal surgeon or coloproctologist.