Yes, hemorrhoids can be removed, and there are several ways to do it depending on the type and severity. Most hemorrhoids improve with lifestyle changes alone, but when they don’t, options range from quick office procedures that take minutes to surgical removal under anesthesia. The right approach depends on whether you’re dealing with internal or external hemorrhoids and how much they’ve progressed.
How Hemorrhoid Severity Determines Treatment
Internal hemorrhoids are classified into four grades based on how far they protrude from the anal canal. This grading system drives most treatment decisions.
- Grade I: Hemorrhoids bleed but don’t protrude. These almost always respond to dietary changes and fiber supplements.
- Grade II: Hemorrhoids bulge out during straining but slide back in on their own. Office procedures or surgery are both options if conservative treatment fails.
- Grade III: Hemorrhoids protrude and need to be pushed back in manually. These often require a procedure or surgery.
- Grade IV: Hemorrhoids stay prolapsed permanently and can’t be pushed back in. Emergency surgical removal is sometimes necessary, particularly if the tissue becomes trapped or develops a blood clot.
External hemorrhoids follow a different path. When an external hemorrhoid develops a blood clot (thrombosis), the decision to remove it hinges largely on timing. If severe pain started within the past 72 hours, surgical excision is most effective. After that window, the worst of the pain has typically peaked, and the clot will gradually resolve on its own over a few weeks.
Office Procedures That Don’t Require Surgery
For grade I and II hemorrhoids that don’t respond to fiber, fluids, and better bathroom habits, three office-based procedures can eliminate the problem without an operating room. The American Society of Colon and Rectal Surgeons considers these a first-line option backed by strong evidence, with rubber band ligation as the most effective choice.
Rubber band ligation is the most widely used office procedure. A doctor places a small elastic band around the base of the hemorrhoid using a scope, cutting off its blood supply. The tissue dies and falls off within a few days. In a meta-analysis comparing it to injection therapy, banding controlled symptoms overall in about 78% of patients and reduced prolapse in 93%. Patient satisfaction was also notably higher at 78%, compared with 47% for injection therapy. The tradeoff: about 24% of patients experience some post-procedure pain, and roughly 10% see symptoms return within three months.
Sclerotherapy involves injecting a chemical solution into the hemorrhoid to shrink it by scarring the blood supply. It’s less effective overall, controlling symptoms in about 62% of patients, but it causes less post-procedure pain (around 14% of patients report it). It’s a reasonable choice for smaller, bleeding hemorrhoids where prolapse isn’t the main problem.
Infrared coagulation uses a burst of infrared light to scar hemorrhoidal tissue and cut off blood flow. Like sclerotherapy, it works best for grade I and II hemorrhoids.
Surgical Removal Options
When hemorrhoids are large, prolapsing, or haven’t responded to office procedures, surgical removal becomes the next step. Surgery is the primary treatment for grade IV hemorrhoids and is an option for grades II and III.
Conventional Hemorrhoidectomy
The Milligan-Morgan open hemorrhoidectomy remains the gold standard. The surgeon cuts away the hemorrhoid tissue entirely, and the wound may be left open or stitched closed. It’s the most thorough approach, with the lowest long-term recurrence rate of any surgical option. The downside is a more painful recovery.
Stapled Hemorrhoidopexy
Introduced in 1998 as an alternative to traditional surgery, this technique uses a circular stapling device to reposition prolapsed tissue back into the anal canal and remove a ring of excess tissue. Early studies showed less pain, shorter operating times, and faster return to normal activity compared to conventional surgery. However, a Cochrane Review found that patients who had stapled procedures were significantly more likely to have hemorrhoids come back. In long-term follow-up, stapled patients had more than three times the odds of recurrence compared to those who had conventional surgery. They were also more likely to need a second operation. Short-term complication rates are similar between the two approaches.
Laser Hemorrhoidoplasty
A newer option that uses laser energy to shrink hemorrhoidal tissue from the inside. In a comparison trial of patients with grade III and IV hemorrhoids, the laser procedure averaged about 16 minutes versus 27 minutes for open surgery. Pain during the first month was significantly lower in the laser group. Research from a Brazilian university also found advantages in faster healing, less bleeding, and fewer complications like narrowing of the anal canal. Laser treatment is increasingly available but not yet as widely offered as conventional surgery.
What Recovery Looks Like
Recovery varies significantly depending on the procedure. Office-based treatments like banding typically involve mild discomfort for a day or two, and most people resume normal activities almost immediately.
Surgical recovery is a different experience. For a conventional hemorrhoidectomy, pain usually peaks in the first three days and steadily improves over the following two weeks. Most people describe the pain as gone by the two-week mark. The average recovery period is two to four weeks, though it can stretch to eight weeks in some cases. You can generally expect six to eight weeks before returning to heavy exercise or physical labor.
Some bleeding after surgery is normal, especially with bowel movements. You may notice blood on toilet paper or in your stool, along with clear or yellowish discharge, for up to a month. This is part of the healing process.
Risks of Hemorrhoid Removal
All removal procedures carry some risk, though serious complications are uncommon. The profile changes depending on the method.
Urinary retention is the most common complication after any anorectal surgery, affecting around 15% of patients in most studies (though reported rates range from 3% to 50% depending on the type of anesthesia and fluid management). It’s usually temporary and resolves within a day or two.
Anal narrowing, where scar tissue tightens the anal canal, occurs in 1% to 7.5% of cases after conventional or stapled hemorrhoidectomy. Mild cases respond to gradual dilation. Severe cases can require additional surgery.
New fecal incontinence is a concern many people have, and the actual risk is relatively low. One trial found it occurred in 2.5% of patients after stapled hemorrhoidopexy and 7.5% after conventional hemorrhoidectomy at one year. A larger study of stapled procedures found a rate of about 5% over six years of follow-up. The incontinence is often minor, involving occasional urgency or difficulty controlling gas rather than complete loss of bowel control.
For office procedures, the risks are milder. Rubber band ligation causes post-procedure bleeding in about 11% of patients and pain in about 24%. Serious complications like infection are rare.
Choosing the Right Approach
The decision tree is fairly straightforward. If you have grade I or II internal hemorrhoids, start with dietary changes: more fiber, more water, and avoiding prolonged straining. If symptoms persist, rubber band ligation is the most effective office procedure. For grade III hemorrhoids, banding can work in select cases, but many people end up needing surgery. Grade IV hemorrhoids almost always require surgical removal.
If surgery is on the table, the choice between conventional and stapled approaches involves weighing short-term comfort against long-term durability. Stapled procedures hurt less initially and get you back to daily life faster, but they carry a meaningfully higher chance of hemorrhoids returning and needing another operation. Conventional hemorrhoidectomy is tougher to recover from but provides the most lasting results. Laser procedures offer a promising middle ground with less pain and shorter operating times, though availability varies by location and surgeon experience.