Hemorrhoid removal is performed in two main settings: a doctor’s office for minor procedures and an outpatient surgery center or hospital for more advanced cases. Where you go depends on the severity of your hemorrhoids. Most people with early-stage hemorrhoids can have them treated right in a specialist’s office in under 30 minutes, while larger or more complex hemorrhoids require a surgical procedure under anesthesia.
Which Doctors Perform Hemorrhoid Removal
Your primary care doctor can diagnose hemorrhoids and manage mild cases with medication, but removal procedures are performed by specialists. The two main types are gastroenterologists, who focus on the digestive tract and typically handle office-based procedures, and colorectal surgeons, who complete additional surgical training beyond general surgery specifically for conditions of the colon and rectum. If your hemorrhoids need more than conservative treatment, your primary care doctor will refer you to one of these specialists.
Colorectal surgeons handle the full spectrum, from in-office banding to formal surgical removal. Gastroenterologists tend to focus on the less invasive end. If you’re unsure where to start, calling your insurance company for a list of in-network colorectal surgeons is the most direct route to someone who can evaluate your options and perform whatever procedure you need.
Office Procedures for Early-Stage Hemorrhoids
Grade 1 and 2 internal hemorrhoids (those that bleed but don’t protrude, or protrude only during a bowel movement and retract on their own) are almost always treated in an office setting. Some grade 3 hemorrhoids, which protrude and need to be manually pushed back in, can also be handled this way. These procedures don’t require general anesthesia, and you typically go home the same day with minimal downtime.
Rubber band ligation is the most widely used and effective office treatment. A small band is placed around the base of the hemorrhoid, cutting off blood flow so it shrinks and falls off within a few days. Success rates at one year are around 96%, and the procedure takes only a few minutes. Some discomfort and pressure are normal for a day or two afterward.
Sclerotherapy involves injecting a chemical solution into the hemorrhoid tissue, causing it to shrink. Pain after the procedure tends to be lower than with banding, but it’s less effective at controlling bleeding and prolapse long-term. It’s most often used for smaller, grade 1 or 2 hemorrhoids.
Infrared coagulation uses heat to shrink hemorrhoid tissue. It’s a quick procedure, but head-to-head comparisons show it controls symptoms less reliably than other options, with about 28% of patients needing a repeat procedure compared to 9% with alternative methods.
Laser Hemorrhoidoplasty
A newer option gaining traction is laser hemorrhoidoplasty, which uses laser energy to shrink hemorrhoid tissue from the inside without cutting or removing it. In a randomized trial comparing it to rubber band ligation for grade 2 hemorrhoids, laser treatment came out ahead on several measures: significantly less pain during the first week, much lower bleeding rates (3% versus 40% on the first day), and a faster return to normal activities (about 3.5 days versus nearly 8 days).
One-year recurrence rates were similar between the two, around 6% for laser and 11% for banding. The trade-off is that laser is less effective at correcting prolapse, where tissue bulges outward. Not all practices offer it yet, so you may need to specifically search for colorectal surgeons or gastroenterologists who have the equipment. It tends to be available at larger specialty centers and private practices that focus on hemorrhoid treatment.
Surgical Removal for Severe Hemorrhoids
Grade 3 hemorrhoids that don’t respond to office procedures and grade 4 hemorrhoids (permanently protruding and unable to be pushed back in) generally require surgery. This is also the path when you have both internal and external hemorrhoids, very large hemorrhoids, or when previous treatments like banding haven’t worked.
The gold standard is conventional hemorrhoidectomy, where the hemorrhoidal tissue is surgically cut away. It has the lowest recurrence rate of any option and leaves the highest proportion of patients symptom-free. The downside is a more difficult recovery. Surgical centers have adopted techniques to reduce postoperative pain, with some reporting 30% less pain and 45% fewer opioid prescriptions using long-acting local anesthetics injected during the procedure.
Stapled hemorrhoidopexy is an alternative that repositions the tissue rather than removing it. Because the staple line sits above the nerve-rich area of the anal canal, it causes less pain initially. However, a large Cochrane review found it comes with a significantly higher recurrence rate: about 8% of stapled patients had hemorrhoids return compared to 2% in the conventional surgery group. Stapled patients were also nearly three times more likely to need an additional operation. For this reason, conventional excision remains the preferred surgical approach when long-term results matter most.
These surgeries are performed at outpatient surgery centers or hospitals. You go home the same day in most cases, though you’ll need someone to drive you.
What Recovery Looks Like
Recovery from office procedures is relatively quick. Most people return to work within a day or two after banding or sclerotherapy, with mild discomfort managed by over-the-counter pain relievers.
Surgical hemorrhoidectomy is a different story. The average recovery takes two to four weeks, with most people saying pain resolves around the two-week mark. Strenuous exercise and physical labor may need to wait six to eight weeks. Some bleeding after bowel movements is normal and can continue for up to a month. The surgery itself is short, but the healing period is the real commitment.
Before surgery, you’ll likely need to do a bowel prep with an enema or laxative. If you take blood thinners or aspirin, your surgeon will tell you when to stop them beforehand, since they increase bleeding risk. Make sure your surgeon knows about all medications, vitamins, and supplements you’re taking.
Insurance and Cost Considerations
Most insurance plans cover hemorrhoid removal when it meets medical necessity criteria. Approval typically requires that you have very large internal hemorrhoids, symptoms that persist after nonsurgical treatment, large external hemorrhoids causing significant discomfort or hygiene problems, or a history of failed prior procedures like banding. In practice, this means insurers generally expect you to try conservative measures first (dietary changes, topical treatments, and possibly an office procedure) before approving surgery.
Office procedures like rubber band ligation are less expensive and more likely to be covered without extensive prior authorization. Surgical hemorrhoidectomy carries higher costs but is usually approved when the documentation shows previous treatments were inadequate. Calling your insurance company before scheduling lets you confirm coverage, find in-network surgeons, and understand any out-of-pocket costs.