Yes, a hemorrhoidectomy is one of the more painful surgical procedures, particularly during the first few days of recovery. In studies measuring pain on a 0-to-10 scale, patients undergoing traditional excisional surgery reported average pain scores around 5 out of 10 on the first day, dropping to about 1.4 by day three and 0.5 by day seven. The pain is real and significant, but it’s also temporary and manageable with the right approach.
Why This Surgery Hurts So Much
The anal canal is one of the most nerve-dense areas in the body. That dense network of sensory nerves is what makes the region so sensitive to touch, pressure, and temperature under normal circumstances. When a surgeon removes hemorrhoid tissue from this area, the resulting wound sits right in the middle of all that nerve activity. Every time the surrounding muscles contract, stretch, or come into contact with stool, those nerves fire pain signals.
To make things worse, the internal anal sphincter (the muscle that controls your bowel) tends to spasm after surgery. These spasms are involuntary and can cause sharp, cramping pain that comes in waves, especially during the first 48 hours. The combination of an open wound in a nerve-rich area and muscle spasms around that wound is what gives hemorrhoidectomy its reputation.
What the First Week Feels Like
The first 24 hours after surgery are typically the worst. Most patients describe a deep, throbbing ache that intensifies with sitting or any movement that puts pressure on the area. Pain scores on the first day average around 5 out of 10 for traditional surgery, though individual experiences vary widely. Some people rate it higher, particularly if they had large or multiple hemorrhoids removed.
By day three, most patients notice meaningful improvement, with average pain dropping to the 1-to-2 range. By the end of the first week, pain is typically mild for most people, hovering around 0.5 on a 10-point scale. That said, the pain doesn’t follow a perfectly straight downward line. You’ll likely have flare-ups, especially around bowel movements, that temporarily spike discomfort before it settles again.
The First Bowel Movement
Nearly every patient and surgeon agrees: the most significant pain occurs with your first bowel movement after surgery. Passing stool directly over a fresh surgical wound is exactly as uncomfortable as it sounds, and many patients dread this moment more than the surgery itself.
The key to reducing this pain is keeping your stool soft so it passes with minimal pressure. Start fiber supplements and stool softeners before or immediately after surgery, not days later when constipation has already set in. Drinking plenty of water alongside the fiber matters just as much, since fiber without fluid can make things worse. Applying a topical lidocaine cream to the wound area before a bowel movement can also help numb the surface. Each subsequent bowel movement gets easier as the wound heals, but the first several can be rough.
How Pain Differs by Technique
Not all hemorrhoidectomies cause the same level of pain. The traditional excisional approach, where the surgeon cuts out the hemorrhoid tissue with a scalpel or electrocautery tool, consistently produces the highest pain scores. Newer techniques can reduce that pain significantly.
Stapled hemorrhoidopexy, which repositions the hemorrhoid tissue rather than cutting it out, tends to be less painful. In one comparative study, patients who had the stapled procedure reported an average pain score of about 1.8 on day one, compared to nearly 5.0 for conventional surgery. The stapled group also had lower pain at every follow-up point through the first two weeks. A large Cochrane review covering 11 studies and over 800 patients found a consistent trend toward less pain with the stapled approach, though the stapled method may carry a slightly higher risk of hemorrhoid recurrence over time.
Energy-sealing devices (tools that use heat to cut and seal tissue simultaneously) also reduce pain compared to traditional electrocautery. Studies show that patients treated with these devices report lower daily pain scores throughout the first postoperative week and need fewer painkillers during the first 24 hours. The wounds tend to heal with less surrounding tissue damage, which translates to less inflammation and soreness.
How Pain Is Managed
Modern pain management for hemorrhoidectomy uses a combination of different medications that each target pain through a different pathway. A typical regimen includes an anti-inflammatory drug, acetaminophen taken on a regular schedule (not just when pain flares), and a nerve-pain medication like gabapentin. Opioid painkillers are usually available as a backup for breakthrough pain, but the goal of combining the other medications is to minimize opioid use, since opioids cause constipation, which is the last thing you want after this surgery.
At home, sitz baths are one of the most effective comfort measures. Sitting in about 3 to 4 inches of warm water (around 104°F or 40°C) for 15 to 20 minutes relaxes the anal sphincter and soothes the wound. Most surgeons recommend three to four sitz baths per day during the first week, and many patients find the relief is immediate, even if temporary. Ice packs wrapped in a cloth can also help between baths, especially during the first 48 hours when swelling peaks.
Recovery Timeline
The sharpest pain resolves within the first week for most people. Weeks two and three involve a lower-grade soreness that flares with bowel movements and prolonged sitting but is generally manageable with over-the-counter pain relief. By four to six weeks, most patients feel close to normal, though the surgical site may still be sensitive.
Returning to a desk job is realistic for many people within one to two weeks, though comfort varies. Jobs that require heavy lifting, prolonged standing, or physical exertion typically require a longer absence, sometimes three to four weeks. Planning your surgery around a period when you can take it easy makes a noticeable difference in how tolerable the recovery feels.
Chronic Pain After Surgery
Most pain from hemorrhoidectomy is finite. In one study tracking patients over several months, about 6% still had some pain at the one-month mark. By four months, that dropped to 2.4%, and by six months, only 1.6% of patients reported ongoing discomfort. In rare cases, retained staples or scar tissue at the surgical site can cause persistent pain that requires further treatment, but the vast majority of patients are pain-free within a few months.
Signs That Pain Isn’t Normal
Some pain after hemorrhoidectomy is expected. But certain patterns suggest a complication rather than routine healing. Contact your surgical team if you experience pain that keeps getting worse instead of gradually improving, pain that doesn’t respond at all to your prescribed medications, fever, pus or foul-smelling drainage from the wound, red streaks spreading from the surgical area, or an inability to pass stool or gas. Urinary retention (being unable to urinate) is also a common early complication that needs prompt attention. These issues are treatable, but catching them early makes a difference.