Hemorrhoids: Understanding Symptoms and Surgical Treatment Options

May 1, 2024

Hemorrhoids, also known as piles, are swollen veins located in the lower part of the rectum and anus, somewhat akin to varicose veins. They can develop internally within the rectum or externally under the skin around the anus. While they’re a common and often non-serious condition, understanding the symptoms and knowing when surgical intervention is necessary is key to effective management and relief.

Symptoms of Hemorrhoids

The symptoms of hemorrhoids vary depending on whether they are internal or external:

  • Internal Hemorrhoids typically don’t cause discomfort since they form in an area of the rectum that lacks nerve endings. However, straining or irritation during bowel movements can lead to painless bleeding, noticeable as bright red blood on toilet paper or in the toilet bowl. In some cases, internal hemorrhoids can prolapse, meaning they extend beyond the anus, causing potential pain, discomfort, and irritation.
  • External Hemorrhoids can lead to itching, irritation, or pain around the anus, especially when sitting. Thrombosed external hemorrhoids, which occur when blood pools and clots in an external hemorrhoid, can cause significant pain and swelling.

When Surgery Becomes Necessary

While many hemorrhoid cases can be managed with lifestyle modifications and over-the-counter treatments, certain situations may necessitate surgical intervention:

  • Severe Discomfort: Persistent pain or discomfort that doesn’t improve with non-surgical treatments may require surgery.
  • Large Hemorrhoids: Large internal or external hemorrhoids that cause significant symptoms or bleeding might be best treated surgically.
  • Thrombosed External Hemorrhoids: If a thrombosed hemorrhoid is extremely painful, surgical removal within the first 72 hours of symptom onset can provide rapid relief.
  • Prolapsed Internal Hemorrhoids: Internal hemorrhoids that prolapse and cannot be retracted or that frequently prolapse may require surgical removal.

Surgical Treatment Options

Several surgical procedures are available for treating hemorrhoids, each with its indications and recovery processes:

  • Hemorrhoidectomy: This involves the complete removal of the hemorrhoid and is considered the most effective method for severe or recurring hemorrhoids. The procedure can be performed under local, regional, or general anesthesia. Recovery involves managing pain and may require a few weeks for complete healing.
  • Stapled Hemorrhoidopexy: Also known as a stapled hemorrhoidectomy, this procedure involves resecting a band of tissue above the hemorrhoid to cut off its blood supply, causing it to shrink and reattach to the rectal wall. It’s generally less painful than a traditional hemorrhoidectomy and has a quicker recovery time but may not be suitable for external hemorrhoids.
  • Rubber Band Ligation: A minimally invasive procedure for internal hemorrhoids where a rubber band is placed around the base of the hemorrhoid, cutting off its blood supply. The hemorrhoid then withers and falls off. This procedure is often done in an office setting.
  • Infrared Coagulation: A less invasive treatment that uses infrared light to cause scar tissue, which cuts off the blood supply to the hemorrhoid, causing it to shrink. This method is suitable for smaller internal hemorrhoids.

Post-Surgical Care and Recovery

Proper post-surgical care is crucial to ensure a smooth and speedy recovery after hemorrhoid surgery. This includes following a high-fiber diet to prevent constipation and reduce straining during bowel movements, staying hydrated by drinking plenty of water, and using stool softeners if necessary. Patients are also advised to avoid heavy lifting and rigorous physical activity for a few weeks post-surgery to avoid putting extra pressure on the healing areas. Pain management, typically through prescribed or over-the-counter pain relievers, plays a key role in recovery, especially after procedures like hemorrhoidectomy that might result in significant discomfort. It’s important for patients to follow their surgeon’s specific instructions and attend follow-up appointments to monitor healing and address any concerns during the recovery phase.

Recommendations for Effective Recovery Post-Surgery

After undergoing hemorrhoid surgery, it’s crucial for patients to follow a tailored care plan to ensure a smooth and speedy recovery. Key recommendations typically include maintaining a high-fiber diet to soften stools and prevent straining during bowel movements, staying hydrated, and engaging in moderate physical activity to promote blood flow. Pain management, often through prescribed medications or over-the-counter pain relievers, plays a vital role in post-surgical care. Additionally, patients are advised to avoid heavy lifting and to take sitz baths to soothe the surgical area, reduce inflammation, and keep the area clean, facilitating faster healing and reducing the risk of infection.


Hemorrhoids, while often uncomfortable and distressing, are typically manageable with the right approach. For those with severe symptoms, surgical interventions offer effective relief. Understanding the symptoms and available treatment options, including when surgery is appropriate, is crucial for those suffering from hemorrhoids. Consulting with a healthcare provider is essential to determine the most suitable treatment based on individual needs and the severity of symptoms.