Sarah Lewis, PharmD

What is a hemorrhoidectomy?

A hemorrhoidectomy is the removal of hemorrhoidal tissue. Hemorrhoidal tissues contain blood vessels that act as cushions by swelling slightly to protect the anal canal during bowel movements.

Anal pressure can cause these tissues to stay swollen. Straining during bowel movements and pregnancy commonly cause too much pressure in the anal canal. Symptoms of hemorrhoids include rectal pain and bleeding.

Internal hemorrhoids occur inside the anal canal. External hemorrhoids occur around the anal opening. A hemorrhoidectomy treats large hemorrhoids that cause pain or bleeding.

A hemorrhoidectomy has risks and potential complications. You may have less invasive treatment options. Consider getting a second opinion about all your treatment choices before having a hemorrhoidectomy. 

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Types of hemorrhoidectomy

The types of hemorrhoidectomy procedures include:

  • Excisional hemorrhoidectomy removes the hemorrhoidal tissue by cutting it. Your surgeon may choose to leave the tissue wound open (open excisional hemorrhoidectomy) or close it with stitches (closed excisional hemorrhoidectomy). Most surgeons prefer the closed technique.

  • Stapled hemorrhoidopexy removes only a portion of the hemorrhoidal tissues. The remaining hemorrhoidal tissues are lifted back up into the anal canal and stapled into place with a special stapling device. This procedure tends to cause less postoperative pain and has a shorter recovery period. It is not effective for large external hemorrhoids, and hemorrhoids tend to recur more often.

Other procedures that may be performed

Your doctor may perform other procedures in addition to a hemorrhoidectomy. This includes a lateral internal sphincterotomy to open or widen the internal sphincter muscle. It is not a common procedure.

Your doctor may perform this procedure if you have high resting internal sphincter pressure. This makes it difficult to push out stool. The goal of this procedure is to reduce pain after surgery during bowel movements.

Why is a hemorrhoidectomy performed? 

Your doctor may recommend a hemorrhoidectomy to treat large hemorrhoids that cause symptoms, such as rectal pain and bleeding. Your doctor may only consider a hemorrhoidectomy for you if other treatment options with less risk of complications are ineffective. Ask your doctor about all of your treatment options and consider getting a second opinion before deciding on a hemorrhoidectomy. 

Your doctor may recommend a hemorrhoidectomy under the following conditions: 

  • You have additional anorectal conditions that require surgery.

  • You have combined internal and external hemorrhoids.

  • You have grade 3 or 4 prolapsed internal hemorrhoids. Prolapse means that the hemorrhoids are falling out of the anus. Grade 3 prolapse occurs with a bowel movement, but you can manually push the hemorrhoid back through your anus. A grade 4 prolapse cannot be put back.

  • You’ve had minimally invasive procedures or other treatments that have not corrected the problem.

  • You have significant amounts of bleeding from your hemorrhoids

  • You have a strangulated internal hemorrhoid. This occurs when the anal sphincter traps the hemorrhoid and cuts off blood supply to the tissue.

  • You have a hemorrhoid with blood clots (thrombosed external hemorrhoid) that recur after less invasive procedures.

Who performs a hemorrhoidectomy?

The following specialists can perform a hemorrhoidectomy:

  • General surgeons specialize in the surgical treatment of a variety of diseases, disorders and conditions.

  • Colon and rectal surgeons are general surgeons with extra training in the surgical treatment of intestinal and rectal conditions.

  • Proctologists specialize in diseases of the anus, rectum and colon using medical and surgical techniques.

How is a hemorrhoidectomy performed

Your hemorrhoidectomy will be performed in a hospital or outpatient surgery setting. 

Your surgeon will insert a retractor into your anus after you have anesthesia. This allows your surgeon to see the hemorrhoids. The hemorrhoids are removed by cutting or stapling. Stitches are placed internally or externally. They are usually ab