A colorectal surgeon, also called a proctologist, is the specialist who removes hemorrhoids. These doctors complete at least five years of general surgery training plus an additional year focused specifically on conditions of the colon, rectum, and anus. While other doctors play important roles in diagnosing and managing hemorrhoids, a colorectal surgeon is the one most likely to perform the actual removal.
Which Doctors Handle Hemorrhoids
Several types of doctors can be involved in your care, but they do very different things. Your primary care physician is usually the first stop. They can diagnose hemorrhoids, recommend dietary changes and over-the-counter treatments, and refer you to a specialist if symptoms persist. Some primary care doctors also perform rubber band ligation, a common in-office procedure.
A gastroenterologist focuses on the entire digestive tract. They can confirm a hemorrhoid diagnosis, rule out other causes of rectal bleeding, and prescribe medications. However, gastroenterologists generally stick to non-surgical treatments and lifestyle recommendations. They don’t typically perform hemorrhoid removal surgery.
A colorectal surgeon is where the expertise narrows. In the U.S., these surgeons train for six years total and pass both written and oral exams to earn certification from the American Board of Colorectal Surgery. They can do everything the other doctors do, plus they perform office-based procedures like banding and surgical procedures like hemorrhoidectomy. They’re also trained to differentiate hemorrhoids from other conditions like anal fissures, fistulas, and colorectal cancer. A general surgeon can also perform hemorrhoid removal, though colorectal surgeons have deeper training in the specific anatomy and physiology of the anorectal area.
Not All Hemorrhoids Need Surgery
Doctors grade internal hemorrhoids on a scale from I to IV based on how far they protrude from the anal canal. Grades I and II are typically managed with fiber supplements, topical treatments, and lifestyle changes. If those fail, office-based procedures are the next step. Surgery is generally reserved for grades III and IV, or for lower-grade hemorrhoids that don’t respond to other treatments.
The American Society of Colon and Rectal Surgeons recommends office-based procedures over surgery when possible, since they offer similar benefits with fewer complications. These procedures include:
- Rubber band ligation: Small elastic bands are placed above the hemorrhoid to cut off its blood supply. The tissue shrinks and falls off within days. This is the most common office procedure and takes just a few minutes with no anesthesia.
- Infrared coagulation: A device applies infrared light to the hemorrhoid tissue, causing it to shrink. This works best for grade I and II internal hemorrhoids.
- Injection sclerotherapy: A chemical solution is injected into the hemorrhoid, causing scar tissue to form and the hemorrhoid to shrink.
All of these are outpatient procedures done in a doctor’s office without anesthesia, which means no hospital stay and minimal time away from work.
When Surgical Removal Is Necessary
For larger or more advanced hemorrhoids, particularly grade III and IV internal hemorrhoids or symptomatic external hemorrhoids, excisional hemorrhoidectomy is the standard. This is a full surgical procedure performed under anesthesia where the hemorrhoid tissue is cut away. The two main techniques are the Ferguson (closed) hemorrhoidectomy, which is most common in the U.S., and the Milligan-Morgan (open) hemorrhoidectomy, more common in the U.K. and Europe.
Another option is Doppler-guided hemorrhoidal artery ligation, where a surgeon uses ultrasound to locate the arteries feeding the hemorrhoid and ties them off. The ASCRS guidelines note this can be considered as an alternative to excisional surgery for internal hemorrhoids. Stapled hemorrhoidopexy, once popular, is no longer recommended as a first-line surgical treatment due to marginal effectiveness and a higher risk of complications.
The primary advantage of surgical removal is that it’s definitive. Hemorrhoids removed this way generally don’t come back.
What to Expect During Recovery
Recovery from excisional hemorrhoidectomy is notoriously uncomfortable. Pain levels are rated moderate to severe on clinical pain scales, and the worst moment for most people is the first bowel movement after surgery. Pain typically improves after three days and continues to decrease over the following two weeks.
The average recovery time is two to four weeks, though the full range runs from two to eight weeks. Most people report the pain is gone by the two-week mark. Returning to strenuous exercise or manual labor may take six to eight weeks. Your doctor will provide a combination of oral and topical pain medications, and starting them before the pain kicks in makes a real difference.
Recovery from office-based procedures is far easier. Rubber band ligation, for example, involves minimal discomfort and no downtime. This is one reason guidelines prefer these approaches when they’re appropriate for the grade of hemorrhoid.
Thrombosed Hemorrhoids and Urgent Care
A thrombosed external hemorrhoid, where a blood clot forms inside a hemorrhoid near the skin surface, is a special case. It causes sudden, severe pain and a firm, tender lump. If you seek care within 72 hours of symptoms starting, a doctor can excise the clot under local anesthesia, often in the office. After 72 hours, the clot becomes incorporated into the surrounding tissue, making removal less effective. At that point, non-surgical management with pain relief and sitz baths is usually recommended, since symptoms naturally peak around 72 hours and then gradually improve.
If the thrombosis is large or the tissue shows signs of necrosis, excision under general anesthesia may be needed regardless of timing. Strangulated internal hemorrhoids, where blood supply is completely cut off, also require urgent surgical intervention.
Your First Specialist Visit
When you’re referred to a colorectal surgeon, the first appointment typically includes a physical examination of the anal area and possibly a flexible sigmoidoscopy, a quick look at the lower colon and rectum using a thin, flexible tube with a camera. The procedure takes about 5 to 10 minutes and doesn’t require sedation. Some offices may ask you to do a bowel preparation beforehand, so check when you schedule.
The surgeon will determine the grade of your hemorrhoids, rule out other conditions that can mimic hemorrhoid symptoms, and recommend the least invasive treatment that’s appropriate. Many people walk in expecting surgery and leave with a plan for an office procedure instead.