What are the options for hemorrhoid surgery?

Hemorrhoids are a common health issue, and they can be uncomfortable and even painful. They usually get better on their own or with simple, over-the-counter hemorrhoid remedies and lifestyle changes, but in some cases, surgery is required. There are different kinds of surgeries, and the choice will depend on the type of hemorrhoids you have, your healthcare provider's recommendation and your own preference. 

• Excision of thrombosed hemorrhoids: This excision (cutting out) of hemorrhoids is a kind of surgery that's usually done in a healthcare provider's office under local anesthesia. It's a good choice for thrombosed hemorrhoids—hemorrhoids with a blood clot inside. A clot normally takes weeks to go away on its own and sometimes a hemorrhoid is too painful to wait that long. With this type of surgery, the healthcare provider  will numb the anal area with lidocaine anesthetic, cut into the hemorrhoid, remove the clot and clean the area. The incision can be left open or closed for healing. This procedure relieves symptoms almost immediately.
• Rubber band ligation: Hemorrhoid banding is a type of surgery that's often performed on people who have many prolapsed hemorrhoids (hemorrhoids that protrude from the anus) that do not resolve with medical treatment. The procedure is performed in a healthcare provider's office or in the operating room with local anesthesia. The doctor places rubber bands around the base of the hemorrhoids and leaves them in place. This causes the stretched hemorrhoid tissue to shrivel up, die, and fall off, leaving a small scar. 
• Many healthcare providers like to start with this procedure when surgical treatment of the hemorrhoids is necessary because it tends to be one of the easiest and least painful options. However, it typically takes five to seven days to heal completely following this procedure.
• Infrared photocoagulation: This procedure involves "baking" the hemorrhoids with infrared light. Similar to a rubber band ligation, photocoagulation can be performed in a healthcare provider's office or an operating room with local anesthesia. The procedure usually leaves only a small scar. It's often less painful than hemorrhoid banding but it’s sometimes less effective. It also takes several days to completely recover from infrared photocoagulation.
• Excisional hemorrhoidectomy (cutting out of the hemorrhoids), open or closed: If banding of the hemorrhoids does not work, or if the piles are too large and prolapsed, an excision may help. This procedure needs to be done in the operating room under anesthesia. The surgeon cuts out the hemorrhoids and the surrounding mucosal tissue, and either leaves the cuts open or stitches them closed, depending on the surgeon's preference, the size of the cuts and the amount of bleeding. Recovery from the excisional hemorrhoidectomy involves a couple of weeks of healing. A special diet is required during this healing process.
• Stapled hemorrhoidopexy: In this procedure, part of the mucosa (the moist lining) is stapled so that the hemorrhoids are pulled upward into the rectum. This option needs to be done in the operating room. The procedure is sometimes less effective than excisional hemorrhoidectomy.  
• Hemorrhoid artery ligation: This procedure involves tying off the artery above the hemorrhoid, causing the mucosal tissues below to scar and shrink. This procedure is performed in the operating room.

There are many ways to remedy hemorrhoids. While most people find relief with simple, over-the-counter medications and lifestyle changes, surgery may be indicated for others. Your healthcare provider can guide you toward the best kind of surgery for you, based on the risks and benefits of each.

Updated by Rebeca Thomas RN, BSN, CPHQ, October 2024