Hemorrhoid surgery involves removing or shrinking swollen hemorrhoid tissue through one of several procedures, typically performed as an outpatient operation under local or general anesthesia. Surgery is generally reserved for hemorrhoids that haven’t responded to conservative treatments like dietary changes, topical creams, or office-based procedures such as rubber band ligation. Most people go home the same day, but recovery takes two to four weeks on average and can be quite painful, particularly during the first few days.
When Surgery Becomes Necessary
Not every hemorrhoid needs surgery. Most cases respond to fiber supplements, sitz baths, stool softeners, and topical treatments. About half of patients with hemorrhoid symptoms are managed with these non-surgical approaches alone. Surgery enters the picture when hemorrhoids are large, prolapsing (bulging outside the anus), causing persistent bleeding, or haven’t improved with weeks of conservative care. Thrombosed external hemorrhoids, where a painful blood clot forms under the skin near the anus, also sometimes require surgical removal. Research comparing surgical excision of thrombosed hemorrhoids to less invasive options found significantly less pain by day four with full excision compared to simply draining the clot or using topical treatments.
Types of Hemorrhoid Surgery
There are three main surgical approaches, and which one your surgeon recommends depends on the size, location, and severity of your hemorrhoids.
Excisional Hemorrhoidectomy
This is the most traditional approach and the most effective for large or severe hemorrhoids. The surgeon cuts out the hemorrhoid tissue entirely using a scalpel, laser, or electrocautery tool. It has the lowest recurrence rate of any hemorrhoid procedure, but it also causes the most postoperative pain. The wound may be left open to heal on its own or stitched closed, depending on the surgeon’s preference and the specific situation.
Stapled Hemorrhoidopexy
Sometimes called “procedure for prolapse and hemorrhoids,” this technique uses a circular stapling device to reposition prolapsing internal hemorrhoids back into place while removing a ring of tissue above the hemorrhoid. It cuts off blood supply to the hemorrhoids, causing them to shrink. Recovery tends to be less painful than a traditional hemorrhoidectomy, but the trade-off is a somewhat higher chance of hemorrhoids returning over time.
Hemorrhoidal Artery Ligation
This approach uses an ultrasound probe inserted into the anal canal to locate the arteries feeding the hemorrhoids. The surgeon then stitches those arteries closed, starving the hemorrhoids of blood flow. Because there’s no cutting of tissue and less stretching of the sphincter muscles, it’s considered the gentlest option. Some surgeons prefer this technique for women specifically because it poses less risk to the sphincter complex. For large prolapsing hemorrhoids, however, excision or stapling may be more appropriate.
What Happens on the Day of Surgery
Hemorrhoid surgery is almost always done on an outpatient basis, meaning you arrive and leave the same day. You’ll be asked to fast beforehand and may receive an enema to clear the lower bowel. Depending on the procedure, you’ll receive either local anesthesia (the area is numbed while you stay awake), regional anesthesia (a spinal block that numbs you from the waist down), or general anesthesia that puts you fully to sleep. The procedure itself typically takes 30 to 45 minutes. You’ll spend time in a recovery area afterward while the anesthesia wears off, and you’ll need someone to drive you home.
Recovery Week by Week
Recovery from hemorrhoid surgery is notoriously uncomfortable, and being prepared for that makes a real difference. The most significant pain comes with your first bowel movement after surgery. Pain generally improves after the first three days and continues to get better over the following two weeks. Most people say the pain is largely gone by the two-week mark.
Light bleeding and clear or yellow discharge from the surgical site are normal and can last one to two months. The anal area will typically feel sore or achy for two to four weeks. After one to two weeks, most people can handle everyday activities and return to sedentary or light-duty work, though this depends on the type of job. Strenuous exercise and heavy lifting should wait until six to eight weeks after surgery. The full recovery window ranges from two to eight weeks, with most people landing somewhere in the two-to-four-week range.
Managing Pain After Surgery
Pain management is a central part of hemorrhoid surgery recovery. Your surgeon will likely prescribe pain medication for the first several days, along with over-the-counter options like anti-inflammatory drugs for ongoing discomfort. Sitz baths, where you soak the area in a few inches of warm water for 10 to 15 minutes several times a day, provide significant relief and help keep the area clean. Ice packs can also reduce swelling in the first 24 to 48 hours.
Stool softeners and fiber supplements are essential, not optional. The goal is to keep your stools soft enough that bowel movements don’t strain the surgical site. Hard stools after hemorrhoid surgery can cause intense pain and increase the risk of complications. Drinking plenty of water alongside the fiber is important because fiber without adequate hydration can actually make constipation worse.
Possible Complications
Urinary retention is the most common complication, affecting roughly 25% of patients across various hemorrhoid procedures. This means temporary difficulty urinating after surgery, often related to the anesthesia and swelling in the pelvic area. It usually resolves within a day or two, sometimes with the help of a temporary catheter.
Other possible complications include postoperative bleeding (which can occur up to two weeks after surgery as stitches dissolve or wounds heal), infection at the surgical site, and anal stenosis, a narrowing of the anal canal caused by scar tissue. Fecal incontinence, or difficulty controlling bowel movements, can occur if the sphincter muscles are damaged during surgery but is uncommon with experienced surgeons. Recurrence of hemorrhoids is possible with any procedure, though traditional excisional hemorrhoidectomy has the lowest recurrence rate.
What to Expect at Home
Plan for one to two weeks off work at minimum. Stock your bathroom with sitz bath supplies, stool softeners, and gentle wipes or a handheld bidet attachment, as regular toilet paper can be too abrasive on the surgical area. Loose, breathable clothing and a cushion for sitting can make the first week much more tolerable.
Avoid heavy lifting and straining with bowel movements throughout your recovery. Eating high-fiber foods, staying hydrated, and taking stool softeners daily will help keep things moving without putting pressure on the healing tissue. Most people find that by the third or fourth week, they’ve returned to their normal routine, though the area may still feel slightly tender during bowel movements for a bit longer.