The goal of hemorrhoid surgery is to remove the enlarged hemorrhoid tissue and relieve rectal pain, itching and bleeding. But surgery is not your only option. Hemorrhoid treatments include lifestyle changes, minimally invasive procedures, and surgery. Use the following information as a guide in making the decision to have hemorrhoid removal surgery. Nonsurgical Hemorrhoid Removal In most cases, doctors recommend lifestyle modifications to treat small hemorrhoids. These include eating more fiber, taking a fiber supplement, drinking plenty of fluids, and exercising regularly. Your doctor can also prescribe topical medicine to help with symptoms. Hemorrhoids on the inside of the anus are internal hemorrhoids and those on the outside of the anus are called external hemorrhoids. Internal hemorrhoids may not be painful, but they can bleed and also slip out of position. External hemorrhoids often look like purple lumps and are more likely to be painful. Minimally invasive treatments are available to treat internal hemorrhoids. They include: Rubber band ligation: A very snug rubber band is placed around the base of the hemorrhoid to cut off its blood supply. The hemorrhoid painlessly shrivels up. Sclerotherapy: A chemical solution is injected into the hemorrhoid causing it to shrink. Infared photocoagulation: Infared radiation from a special light is applied to the hemorrhoidal tissue. Heat from the light destroys the tissue and it eventually sheds off. Hemorrhoid Removal Surgery Hemorrhoid removal surgery, also known as hemorrhoidectomy, treats large hemorrhoids causing significant pain or bleeding. During a traditional hemorrhoidectomy, a narrow incision is made around the hemorrhoids to cut out the swollen tissue. Your doctor closes the wound with dissolvable stitches. A newer procedure called stapled hemorrhoidopexy may be an option for you. During stapled hemorrhoidopexy, a circular stapling device is used to lift and staple the swollen hemorrhoidal tissue back into place in the anal canal. Compared to traditional hemorrhoidectomy, recovery after stapled hemorrhoidopexy is usually easier, but hemorrhoids are more likely to return. This procedure is not a good option for large external hemorrhoids. Ask your doctor about all of your treatment options. Consider getting a second opinion before deciding on surgery. When to Consider Hemorrhoid Removal Surgery Your doctor may decide that you are a good candidate for hemorrhoid removal surgery if: You have combined internal and external hemorrhoids. You have grade 3 or 4 prolapsed internal hemorrhoids. Prolapse means that the hemorrhoids are dropping, or slipping 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 have additional anorectal conditions that require surgery. 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 treatments. Who Is NOT a Good Candidate for Hemorrhoid Removal Surgery? You may not be a good candidate if: You have small hemorrhoids. Lifestyle and dietary changes can alleviate your symptoms. You are pregnant. You take certain medicines, such as blood thinners, that increase your risk of bleeding. You have a severe illness or infection. What to Expect A general surgeon, a colon and rectal surgeon, or proctologist will perform your hemorrhoid removal surgery in a hospital or outpatient surgery center. You will have a nerve block or general anesthesia. Most people go home the day of surgery but you may have to stay in the hospital for one night. Recovery time varies depending on the procedure, type of anesthesia, your general health, age, and other factors. Full recovery may take 2 to 4 weeks. During recovery, avoid lifting, pulling, and strenuous activity. You may need help around the house for a few days following surgery. Avoid straining during bowel movements or when urinating. Eat a high-fiber diet, drink 8 to 10 glasses of liquid a day, and take stool softeners to avoid constipation, as your doctor recommends.