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A hemorrhoidectomy is surgery to remove hemorrhoid tissue that has grown too large or keeps coming back. It's the most complete form of hemorrhoid treatment, and it's usually kept for the cases that gentler care couldn't settle.
Maybe you've heard the word from your doctor and it sounded like one single operation. It isn't. There's the classic version, a stapled version, versions done with heat sealing tools, and a few older methods you may still read about. Knowing which is which makes the talk with your surgeon a lot easier.
What a hemorrhoidectomy is
The American Society of Colon and Rectal Surgeons describes it in plain terms: the extra hemorrhoid tissue is removed, and the wound is either closed or left open. It's done under sedation, general anesthesia or a spinal block, so you don't feel the operation.
The NIH says a doctor, most often a surgeon, uses it to remove large external hemorrhoids. Surgeons also use it for large internal hemorrhoids that slip out and stay out. Everyone has hemorrhoidal cushions. The operation takes away the parts that have bulged and swollen, not the whole area.
Who needs a hemorrhoidectomy
Fewer people than you'd think. The American Society of Colon and Rectal Surgeons says fewer than 10% of people seen for hemorrhoid symptoms end up needing surgery. Most do well with fiber, water, better bathroom habits or an office procedure like banding.
A 2018 review in American Family Physician says surgery should be kept for hemorrhoids that keep coming back or for higher grades. Doctors grade internal hemorrhoids from I to IV. Grade III slips out and has to be pushed back. Grade IV stays out. Surgery may also come up for large external hemorrhoids, or for both kinds at once. The same review sums up the trade: removing hemorrhoids gives the best success rates, but more pain and a longer recovery.
The main types of hemorrhoid surgery
Here's how the main options compare, based on American Family Physician and the Cleveland Clinic Journal of Medicine:
| Type | What it does | What to know |
|---|---|---|
| Classic hemorrhoidectomy (closed or open) | Cuts out the hemorrhoid tissue | Lowest chance of return, hardest recovery |
| Hemorrhoidectomy with an energy device | Cuts and seals with heat, such as LigaSure | Less pain early on in studies |
| Stapled hemorrhoidopexy | Lifts internal hemorrhoids back up with a stapling tool | Easier first days, more frequent return |
| Whitehead hemorrhoidectomy | Removes the tissue in a full ring | Older method, wide removal |
The Cleveland Clinic Journal of Medicine says hemorrhoids come back less often after cutting them out than after any other approach. That's why the classic operation is still the standard for large ones.
How hemorrhoid surgery is done
The short version goes like this. You get your anesthesia. The surgeon makes a small cut around each hemorrhoid, closes off the blood vessel that feeds it, and removes the tissue. Then the wound is stitched shut or left open to close by itself. A soft dressing goes on, and many people go home the same day with someone else driving. The operation itself is often shorter than the time you spend checking in and waking up. The full step by step, with the anesthesia choices and the position on the table, has its own page.
Hemorrhoid surgery stapling
Stapling works on internal hemorrhoids only. The NIH explains that the surgeon uses a special stapling tool to remove some internal tissue and pull a hemorrhoid that slips out back into place. Nothing is cut on the outside skin, so the first days are often easier. But American Family Physician reports that symptoms and prolapse come back more often after stapling than after the classic operation. The Cleveland Clinic Journal of Medicine adds that it's not an option for external hemorrhoids or for internal ones with a clot.
Hemorrhoidectomy with LigaSure
LigaSure is a tool that cuts tissue and seals blood vessels with heat at the same time. It's still a hemorrhoidectomy. Only the tool changes. American Family Physician describes two such energy devices, LigaSure and the Harmonic Scalpel. It reports that a Cochrane review of 10 studies found lower pain scores with LigaSure, and that using it during a classic hemorrhoidectomy means less pain in the first days after surgery. Ask your surgeon which tool they use and why.
Whitehead hemorrhoidectomy
The Whitehead method is an older operation. Instead of removing each hemorrhoid as a separate piece, the surgeon removes the hemorrhoid tissue all the way around, in one full ring. You'll still see the name online, so it helps to know what it means. The concern with any wide removal is what's left behind. The Cleveland Clinic Journal of Medicine warns that removing a lot of tissue can cause scarring and a narrowed opening, and that taking too much tissue or harming the muscle can lead to leakage. If a surgeon suggests a full ring, ask how they protect against both.
Surgery for external thrombosed hemorrhoids
A thrombosed hemorrhoid is an outside hemorrhoid with a blood clot in it. It shows up fast as a hard, very sore lump. The American Society of Colon and Rectal Surgeons says that when the pain is severe, a small procedure can be done right in the office. The doctor numbs the area and removes the clot and the skin over it.
Timing matters. American Family Physician reports that removing the clot within the first two to three days leads to quicker relief. After that, the operation helps less, and the review says creams and other care at home are a reasonable choice. A sudden, painful lump is worth a same week call to your doctor.
Avoiding the operating room
Getting rid of external hemorrhoids without surgery
Most outside hemorrhoids never need an operation. The American Society of Colon and Rectal Surgeons says they're usually handled with diet changes and creams, and only once in a while removed with surgery. The NIH lists the home basics:
- eat foods high in fiber and drink enough water
- don't strain, and don't sit on the toilet for long
- take warm sitz baths a few times a day
- use an OTC cream or a pain reliever for a short time
American Family Physician notes that warm water baths ease pain for a while. If home care doesn't help after one week, the NIH says to see your doctor.
Can you live with hemorrhoids without surgery
Yes. Most people do. Hemorrhoids that stay small and quiet don't need to be removed. American Family Physician reports that fiber supplements cut hemorrhoid bleeding by 50% and improve symptoms overall. Soft stools and short bathroom visits keep a lot of flares away. Office procedures like banding are there when home care isn't enough. Surgery is for the ones that stay out, keep bleeding, or keep coming back. And any bleeding should be checked by your doctor first, because hemorrhoids aren't the only cause.
After a hemorrhoidectomy
Skin tags after a hemorrhoidectomy
Lumps after surgery scare a lot of people. Most of the time, it's swollen tissue that settles over a few weeks. Sometimes a small flap of skin stays. That's a skin tag, and American Family Physician lists skin tags among the later effects of the operation. The American Society of Colon and Rectal Surgeons says skin tags usually need nothing beyond reassurance, though removal is sometimes considered.
Dr. Albert Chung, a board certified colorectal surgeon in Orange County, California, explains on his channel that he doesn't rush it: "I usually wait about anywhere from two to three months after a surgery to see what the hemorrhoids are looking like." If a bigger piece of skin is still there, a small trim can be done later.
How many times can you have hemorrhoid surgery
No US guideline we found sets a limit on the number. The good news first. The American Society of Colon and Rectal Surgeons says it's uncommon to have any significant return after a hemorrhoidectomy. Still, American Family Physician lists hemorrhoids coming back among the later complications, and new ones can form in other spots over the years. A second operation is possible, but each one takes tissue away. The Cleveland Clinic Journal of Medicine notes that wide removal can lead to scarring and narrowing. That's why surgeons weigh every repeat operation carefully, and often try banding or other office care first.
What the operation removes, and what it leaves
A hemorrhoidectomy removes the tissue that bulged. It doesn't change what pushed it there. The cushions that remain still take the same pressure every day: hard stools, straining, long sits on the toilet, long hours in a chair. Harvard Health explains that the tissue that supports the cushions can weaken with age, which is part of why they slide in the first place.
That's why surgeons send you home with the same advice as before: fiber, water, short bathroom visits and regular walks. The recovery itself, day by day, has its own page. So does the question of whether surgery is worth it for you, and what it costs. Whatever you choose, make the decision with your doctor.
Sources
- American Society of Colon and Rectal Surgeons, Hemorrhoids expanded information
- NIDDK (NIH), Treatment of hemorrhoids
- Mott and colleagues, American Family Physician, 2018, Hemorrhoids: Diagnosis and Treatment Options
- Cengiz and Gorgun, Cleveland Clinic Journal of Medicine, 2019, Hemorrhoids: A range of treatments
- Harvard Health Publishing, Hemorrhoids and what to do about them
- Your Friendly Proctologist, Bumps on my anus after Hemorrhoidectomy, what are they? (YouTube)
This article is for general information and is not medical advice. If you have rectal bleeding, severe pain or a change in your bowel habits, see your doctor.
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FAQs
Is a hemorrhoidectomy the same as a hemorrhoidopexy?
No. A hemorrhoidectomy cuts out the hemorrhoid tissue. A hemorrhoidopexy uses staples to lift internal hemorrhoids back into place. The second one is usually easier at first, but hemorrhoids come back more often after it.
Does a hemorrhoidectomy remove internal and external hemorrhoids?
It can remove both. It's used for large external hemorrhoids, for internal ones that stay out, and for both kinds at once. Your surgeon decides which ones to take after an exam.
What causes chronic hemorrhoids?
Pressure from straining, hard stools and long sitting, landing on cushions whose support has weakened. When those habits don't change, flares tend to come back.
How long does it take to get back to normal?
The surgeons' society says it may take up to 2 to 4 weeks to get back to your full activities. The first week is usually the hardest.
Who does a hemorrhoidectomy?
A surgeon, most often a general surgeon or a colon and rectal surgeon. It's done in a hospital or an outpatient surgery center, not as a quick office visit.
