Haemorrhoidectomy

Overview

A haemorrhoidectomy is a surgical procedure to remove haemorrhoids (swollen veins in the back passage, also called piles). It is usually done when other treatments have not helped and symptoms are severe, such as persistent bleeding, pain, or a lump that sticks out.

Yes, haemorrhoidectomy is one of the most common surgeries for severe haemorrhoids, but many people with haemorrhoids never need surgery.

Anyone can have haemorrhoids that require surgery, but it is more likely in people whose haemorrhoids do not improve with lifestyle changes, creams, or other procedures like banding.

Symptoms

Common symptoms

• Bleeding from the back passage (usually bright red blood) during or after a bowel movement.
• Itching or irritation around the anus.
• Pain or discomfort, especially when sitting.
• A lump or swelling near the anus that may stick out (prolapse) and need to be pushed back in.

Symptoms in children

• Haemorrhoids are not common in children, but if they occur, symptoms can include bleeding, pain, and a lump. Most cases are mild and do not need surgery.

Symptoms in older adults

• Symptoms are similar, but older adults may have more bleeding or prolapse due to weaker tissues. They may also have other health conditions that affect surgery decisions.

Causes

Main causes

• Straining during bowel movements, often because of constipation or passing hard stools.
• Increased pressure in the veins around the anus due to long periods of sitting, heavy lifting, or pregnancy.

Risk factors

• Chronic constipation or diarrhoea.
• Pregnancy and childbirth.
• Being overweight or obese.
• Aging (tissues become weaker).
• Family history of haemorrhoids.

When to see a doctor

See a doctor urgently if:

• Bleeding that is heavy, sudden, or accompanied by dizziness.
• Severe pain that does not go away with over‑the‑counter relief.
• Signs of infection: redness, swelling, or fever.

Book a routine appointment if:

• You have rectal bleeding, even if it is small or comes and goes.
• You feel a lump near the anus.
• Symptoms like itching or pain affect your daily life or do not improve with self‑care.

Diagnosis

A doctor will ask about your symptoms and examine your back passage. They may use a gloved finger to feel for lumps or perform an internal examination with a short tube called an anoscope or sigmoidoscope.

Tests that may be done

• Visual examination of the anal area.
• Digital rectal exam (the doctor inserts a lubricated finger inside the back passage).
• Proctoscopy or sigmoidoscopy (a small camera tube to look inside the lower bowel).

What to expect at your appointment

The exam is quick and may be slightly uncomfortable but not painful. You may be asked to lie on your side. Your doctor will explain the results and discuss whether haemorrhoidectomy or another treatment is right for you.

Treatment

Treatment for haemorrhoids starts with lifestyle changes and over‑the‑counter remedies. If these do not help, your doctor may suggest procedures like rubber band ligation or injection therapy. Haemorrhoidectomy is a surgical option for severe or complicated haemorrhoids.

Self-care at home

• Eat a high‑fibre diet with plenty of fruits, vegetables, and whole grains.
• Drink plenty of water (6–8 glasses a day).
• Avoid straining on the toilet – go when you feel the urge.
• Take warm baths (sitz baths) to soothe the area.
• Use soft, moist toilet paper or baby wipes instead of dry paper.

Medical treatments

Your doctor may recommend creams, ointments, or suppositories to reduce pain and swelling. Over‑the‑counter pain relievers can help, but always check with a pharmacist or doctor. Never take medicines containing codeine for more than a few days without advice.

When is surgery considered?

Surgery (haemorrhoidectomy) is usually considered when haemorrhoids are large, have not responded to other treatments, or cause complications such as a blood clot (thrombosis) or prolapse that cannot be pushed back. It is also an option if you have significant bleeding that leads to anaemia.

Living with this condition

After a haemorrhoidectomy, you will need to rest for a few days. You can usually return to light activities after 1–2 weeks, but avoid heavy lifting or strenuous exercise for at least 4 weeks. Pain and discomfort are normal – your surgical team will advise on pain relief. Soak in a warm bath several times a day to help with healing and cleaning.

Lifestyle tips

• Keep your bowel movements soft with a high‑fibre diet and plenty of water.
• Avoid sitting for long periods – get up and walk every hour.
• Use a cushion or doughnut ring to sit more comfortably.
• Avoid straining or holding your breath during bowel movements.

Diet and exercise

Eat plenty of fibre (aim for 30g per day from foods like oats, beans, lentils, and vegetables). Drink lots of water. Gentle walking is good for recovery, but avoid heavy lifting and vigorous exercise for at least 4 weeks after surgery.

Mental health and emotional wellbeing

Surgery and recovery can be stressful. You may feel anxious about pain, bowel movements, or the outcome. It is normal to feel frustrated or low. Talk to your doctor or a nurse if you are struggling – they can offer advice and reassurance.

Prevention

You can reduce your risk of developing severe haemorrhoids by eating a high‑fibre diet, drinking plenty of fluids, staying active, and avoiding long periods of sitting or straining on the toilet. If you already have haemorrhoids, these steps can help prevent them from getting worse.

Complications

If left untreated

• Chronic anaemia due to ongoing blood loss.
• Thrombosis (a blood clot inside the haemorrhoid) causing severe pain.
• Prolapsed haemorrhoids that cannot be pushed back, leading to pain and risk of tissue death (strangulation).

Long-term outlook

For most people, haemorrhoidectomy provides long‑term relief from symptoms. The surgery has a high success rate, and serious complications are rare. With proper aftercare, you can expect a full recovery and a significant improvement in quality of life.

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