Haemorrhoids are swollen blood vessels and supporting tissues around the anus and lower rectum. Many cases improve with dietary changes, medicines, or minimally invasive procedures, but some persistent or advanced cases may require surgery. A surgical treatment for haemorrhoids includes several procedures, and the most appropriate option depends on the haemorrhoid’s size, location, symptoms, and severity.

What Are Haemorrhoids?

Haemorrhoids are normal blood vessels and supporting tissues in the anal canal. They become problematic when these tissues become enlarged, swollen, or displaced. They may occur internally inside the rectum or externally under the skin around the anus.

Common symptoms include:

  • Bright red bleeding during or after bowel movements.
  • A lump or swelling around the anus.
  • Itching or irritation.
  • Pain or discomfort, particularly with external haemorrhoids or complications.
  • Tissue protruding through the anus during bowel movements.
  • Difficulty keeping the area clean after passing stool.

Haemorrhoids can be associated with constipation, straining during bowel movements, prolonged sitting on the toilet, pregnancy, and other factors that increase pressure around the rectum.

Why Is Surgical Treatment for Haemorrhoids Important?

Not everyone with haemorrhoids requires surgery. Treatment is generally selected according to symptom severity and how the haemorrhoids respond to less invasive measures.

Surgery may be considered when:

  • Haemorrhoids continue to cause significant symptoms despite conservative treatment.
  • Internal haemorrhoids repeatedly prolapse.
  • Bleeding continues or recurs after appropriate treatment.
  • Haemorrhoids are large or advanced.
  • Office-based procedures have not provided adequate improvement.
  • Symptoms significantly interfere with daily activities or quality of life.

Persistent rectal bleeding should not automatically be attributed to haemorrhoids. Other conditions can cause similar symptoms, so appropriate medical assessment is important.

Who Should Consider It?

The decision to undergo surgical treatment for haemorrhoids is usually based on the severity and type of haemorrhoids rather than symptoms alone.

Surgery may be considered for people with:

  • Large or advanced internal haemorrhoids.
  • Haemorrhoids that prolapse significantly.
  • Recurrent symptoms after non-surgical treatment.
  • Persistent bleeding associated with confirmed haemorrhoids.
  • Combined internal and external haemorrhoids.
  • Symptoms that remain troublesome despite appropriate lifestyle measures and medication.

The grade of internal haemorrhoids may also influence treatment selection. Grade I haemorrhoids remain inside the anus, while Grade II prolapse during bowel movements but return spontaneously. Grade III require manual replacement, and Grade IV remain prolapsed.

Who Should Seek Medical Advice First?

A healthcare professional should assess symptoms before deciding whether surgery is appropriate. This is particularly important when symptoms are new, severe, or different from previous episodes.

Additional assessment may be appropriate if you:

  • Have unexplained or persistent rectal bleeding.
  • Have a significant change in bowel habits.
  • Experience unexplained weight loss.
  • Have a family history of colorectal cancer or bowel disease.
  • Develop severe or rapidly worsening anal pain.
  • Take medicines that affect blood clotting.
  • Have other significant medical conditions.
  • Have previously undergone colorectal or anal surgery.

The aim is to confirm the diagnosis and determine whether haemorrhoids are actually responsible for the symptoms.

What Treatment or Management Options Are Available?

Treatment usually progresses from less invasive approaches to procedures or surgery when necessary.

Lifestyle and Conservative Treatment

Increasing dietary fibre, drinking adequate fluids, avoiding excessive straining, and responding promptly to the urge to pass stool can help reduce pressure on the anal tissues. Stool-softening measures may also be recommended when constipation contributes to symptoms.

Medication

Depending on symptoms, healthcare professionals may recommend topical treatments or medicines to relieve discomfort, itching, inflammation, or constipation. These generally manage symptoms rather than physically removing haemorrhoidal tissue.

Minimally Invasive Procedures

Some internal haemorrhoids can be treated with procedures such as rubber band ligation, where a small band is placed around the base of the haemorrhoid to restrict its blood supply. Other options include injection treatments or infrared coagulation in selected cases.

Surgical Procedures

Surgery may be considered when haemorrhoids are large, advanced, recurrent, or unsuitable for less invasive treatment.

Common surgical approaches include:

  • Haemorrhoidectomy.
  • Stapled haemorrhoidopexy.
  • Haemorrhoidal artery ligation.
  • Other techniques selected according to the individual clinical situation.

How Should You Prepare?

Preparation depends on the procedure being considered and whether it is performed under local, regional, or general anaesthesia.

Before treatment, your healthcare team may:

  • Review your medical history.
  • Ask about previous operations and treatments.
  • Check your current medications.
  • Ask about allergies.
  • Discuss any medicines that affect blood clotting.
  • Explain whether fasting is required.
  • Provide instructions about bowel preparation if necessary.

Do not stop prescription medicines, particularly blood-thinning medication, unless instructed by your healthcare team.

It can also be useful to ask about the expected recovery period, pain management, wound care, bowel movements, and when normal activities can be resumed.

What Happens During the Procedure or Treatment?

The procedure depends on the type and severity of the haemorrhoids.

Haemorrhoidectomy

The haemorrhoid is surgically removed under appropriate anaesthesia. Recovery may involve discomfort, particularly during bowel movements, along with advice on pain relief, hygiene, and bowel habits.

Stapled Haemorrhoidopexy

A stapling device repositions prolapsed internal haemorrhoidal tissue and reduces its blood supply. It is generally used for selected internal haemorrhoids.

Haemorrhoidal Artery Ligation

The arteries supplying the haemorrhoids are identified and tied off to reduce blood flow. Prolapsed tissue may also be repositioned.

Benefits, Risks, and Possible Side Effects

Different procedures have different advantages and limitations. The appropriate choice depends on the haemorrhoid characteristics and the patient’s overall health.

Potential benefits include:

  • Reduction in haemorrhoid-related bleeding.
  • Reduction in prolapse.
  • Relief from persistent irritation or discomfort.
  • Improvement in symptoms that have not responded adequately to conservative treatment.

Possible risks vary according to the procedure and can include:

  • Pain or discomfort.
  • Bleeding.
  • Difficulty passing stool temporarily.
  • Urinary difficulties.
  • Infection.
  • Recurrence of haemorrhoids.
  • Narrowing of the anal canal, although this is uncommon.
  • Problems with continence, which are uncommon but can occur with certain complications.

Recovery also varies. Some procedures allow a relatively quicker return to normal activities, while traditional haemorrhoidectomy may require a longer recovery because tissue is directly removed.

What Our Colorectal Surgeon Says

The decision to undergo surgery depends on the haemorrhoids’ grade, location, and severity of symptoms, alongside the patient’s quality of life and response to previous treatments. During consultation, we confirm that haemorrhoids are indeed the cause and evaluate whether conservative or minimally invasive options remain viable. If surgery is required, we select an evidence-based procedure tailored to the individual, discussing expected recovery and potential risks to ensure the most appropriate outcome.

Putting This Into Practice

  • Avoid prolonged straining during bowel movements.
  • Increase dietary fibre gradually and maintain adequate fluid intake.
  • Avoid spending excessive time on the toilet.
  • Follow prescribed treatment and bowel-management advice.
  • Keep track of persistent bleeding, pain, or prolapse.
  • Discuss recurring symptoms with a healthcare professional.

When to Seek Professional Help

  • Rectal bleeding continues or repeatedly returns.
  • Haemorrhoids frequently protrude during bowel movements.
  • Severe or persistent anal pain develops.
  • A painful lump suddenly appears around the anus.
  • Symptoms interfere with normal daily activities.
  • Symptoms do not improve despite appropriate conservative treatment.

Frequently Asked Questions

Is surgery always necessary for haemorrhoids?

Surgery is not always necessary. Many cases are managed with dietary changes, medication, or minimally invasive procedures. It is typically reserved for advanced, recurrent, or severely symptomatic haemorrhoids that haven’t responded to other treatments.

What is the most common type of surgical treatment for haemorrhoids?

Haemorrhoidectomy is a standard surgical treatment for advanced cases. Other options include haemorrhoidal artery ligation and stapled haemorrhoidopexy. The choice depends on the haemorrhoid’s size, grade, and location.

Is surgical treatment for haemorrhoids painful?

Post-operative discomfort is expected, especially with tissue removal. Pain levels vary by technique, and your healthcare team will provide management advice. Less invasive approaches may result in less pain but have different clinical limitations.

How long does it take to recover after haemorrhoid surgery?

Recovery time depends on the procedure and individual healing. Minimally invasive treatments allow a faster return to daily activities, while a full haemorrhoidectomy requires more time for wound care and recovery.

Can haemorrhoids come back after surgery?

Yes, recurrence is possible. While surgery removes problematic tissue, it does not eliminate underlying factors like straining or constipation. Maintaining healthy bowel habits is essential to reducing the risk of return.

Next Steps

Surgical treatment for haemorrhoids varies according to their type, size, grade, and symptoms. Less invasive options may be sufficient, while surgery may be considered for persistent, recurrent, or advanced cases. Proper assessment is important to confirm the cause of symptoms and determine the most appropriate treatment.