A hemorrhoidectomy is a surgical procedure that removes hemorrhoids by cutting them out. It’s the most effective treatment for severe hemorrhoids, with the lowest recurrence rate of any surgical option, but it’s also the most painful to recover from. The procedure is typically reserved for advanced cases that haven’t responded to less invasive treatments like rubber band ligation or medicated creams.
When a Hemorrhoidectomy Is Needed
Not all hemorrhoids require surgery. Internal hemorrhoids are graded on a four-point scale based on how much tissue pushes out (prolapses) from the anal canal. Grade I hemorrhoids bulge slightly but stay inside. Grade II hemorrhoids push out during straining but slide back in on their own. Grade III hemorrhoids push out and need to be manually pushed back in. Grade IV hemorrhoids are permanently prolapsed and can’t be pushed back in at all.
Hemorrhoidectomy is reserved for grade III and IV hemorrhoids, specifically when conservative treatments have already failed. Your doctor will typically try office-based procedures first, such as rubber band ligation (placing a small band around the hemorrhoid to cut off blood flow), sclerotherapy (injecting a solution to shrink the tissue), or infrared coagulation. Surgery becomes the next step if those approaches don’t work or if the hemorrhoids are too advanced to respond to them.
There are also situations where surgery is needed more urgently: when internal hemorrhoids become trapped and swollen (incarcerated), when there’s a large external component bulging alongside the internal hemorrhoids, or when hemorrhoids are causing significant bleeding in someone with a blood-clotting disorder.
How the Surgery Works
The two main techniques are the open method and the closed method. In the open approach, the surgeon clamps the hemorrhoid tissue, ties off the blood vessels feeding it with dissolvable stitches, and removes the tissue. The wound is then left open to heal on its own. In the closed approach, the wound is stitched shut after removal. Both are performed under anesthesia, and most people go home the same day.
A third option, called stapled hemorrhoidopexy, works differently. Instead of cutting out the hemorrhoids, a circular stapling device lifts the prolapsed tissue back into its normal position and cuts off its blood supply. This approach causes less pain in the first few weeks after surgery, but it comes with a significant tradeoff: higher recurrence rates over time.
Excisional Surgery vs. Stapled Hemorrhoidopexy
A large randomized trial of 777 patients compared traditional excisional hemorrhoidectomy to stapled hemorrhoidopexy over two years. The stapled group reported less pain and used fewer painkillers in the first three weeks, but return to normal activity at six weeks was similar between both groups. By 12 and 24 months, the differences clearly favored excisional surgery.
At two years, 25% of patients in the excisional surgery group experienced some form of recurrence, compared to 42% in the stapled group. Prolapse-related recurrence was more than three times as likely after stapling. The excisional surgery group also reported better overall quality of life, fewer ongoing symptoms, and better bowel control over the full 24-month follow-up. Serious complication rates were similar between both groups, at roughly 7 to 9%.
Because of these outcomes, traditional excisional hemorrhoidectomy remains the standard for severe hemorrhoids when long-term results matter most.
What Recovery Looks Like
Recovery takes two to four weeks on average, and the first few days are the hardest part. The most significant pain typically occurs with your first bowel movement after surgery. Pain generally begins improving after three days and continues to get better over the following two weeks. Most people say the pain is gone by the two-week mark.
Returning to desk work is usually possible within one to two weeks, depending on your comfort level. Strenuous exercise and manual labor typically need to wait six to eight weeks.
Managing Pain and Healing at Home
Sitz baths are one of the most important parts of recovery. Sitting in three to five inches of warm water for 10 to 20 minutes helps reduce pain from local muscle spasms and supports healing. Plan on doing this at least three to four times a day, plus after every bowel movement, for the first several days.
Keeping your stools soft is critical. Hard stools put pressure on the surgical site and make bowel movements significantly more painful. A stool softener like docusate sodium (at least two doses per day) is standard, especially if you’re taking opioid pain medication, which can cause constipation. Aim for 20 to 35 grams of fiber daily and at least eight cups of water. High-fiber foods, a fiber supplement, and consistent hydration work together to keep things moving without straining.
Possible Complications
Urinary retention is the most common complication after any anorectal surgery, affecting about 15% of patients on average, though rates vary widely from 3 to 50% depending on the study and the type of anesthesia used. This is usually temporary and resolves within a day or two, sometimes requiring a catheter in the short term.
Clinically significant bleeding occurs in roughly 2% of excisional hemorrhoidectomy patients, with reported rates ranging from 0.3 to 6%. Stapled procedures carry a slightly higher bleeding risk, up to about 10%.
Anal stenosis, a narrowing of the anal canal from scar tissue, happens in 1 to 7.5% of cases. This is more of a concern when a large amount of tissue is removed. Mild stenosis can often be managed with dilation, while severe cases may need additional surgery.
Long-Term Effectiveness
Excisional hemorrhoidectomy has the best long-term track record of any hemorrhoid procedure. A meta-analysis of 17 randomized trials covering more than 2,000 patients found that traditional excisional surgery had a 25% recurrence rate at two years, compared to roughly 42% for stapled hemorrhoidopexy. The excisional approach was particularly superior at preventing prolapse from returning.
While a one-in-four chance of some recurrence may sound high, many of those recurrences are minor, such as occasional bleeding that can be managed without another surgery. For most people with severe hemorrhoids, a hemorrhoidectomy provides lasting relief from the symptoms that brought them to surgery in the first place.