By Ekaterina Brodski-Quigley, MD May 10, 2022 • 5 min
Hemorrhoids are a common health issue, and they can be uncomfortable or 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 surgery, and the choice will depend on the type of hemorrhoids you have, your doctor'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 doctor'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 doctor will numb the anal area with lidocaine anesthetic, open the hemorrhoid, remove the clot and clean the area. The cut 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 doctor'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, die and fall off, leaving a small scar.
Many doctors like to start with this procedure when surgical treatment of the hemorrhoids is needed because it tends to be one of the easiest and least painful options. However, it takes five to seven days for complete healing following this procedure.
This procedure involves "baking" the hemorrhoids with infrared light. Like rubber band ligation, photocoagulation can be performed in a doctor's office or an operating room with local anesthesia, and it leaves a small scar. It's often less painful than hemorrhoid banding, but it’s sometimes less successful. 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 takes a couple of weeks for healing, and a special diet is required during the healing process.
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 successful 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, others require surgery. Your healthcare provider can guide you toward the best kind of surgery for you, based on the risks and benefits of each.
Published May 2022.