Surgery is chosen when haemorrhoids are high-grade or do not respond to conservative treatment. It includes classic haemorrhoidectomy and non-excisional techniques (ligation, fixation), with a choice individualised to the grade and symptoms.
What does it involve?
It covers a spectrum of techniques for symptomatic haemorrhoids that have not responded to conservative treatment. The choice depends on the grade and symptoms, aiming for durable relief with the least possible discomfort.
Haemorrhoids are normal vascular "cushions" of the anus; surgery treats their pathological enlargement/prolapse, not merely a symptom.
When is it needed?
It is indicated for recurrent bleeding, prolapse (grade III–IV), thrombosis or persistent symptoms despite stool regulation and local measures. Lower-grade haemorrhoids are often managed in the office (e.g. banding).
Another cause of bleeding is always excluded (especially in patients with risk factors) before attributing it to haemorrhoids.
Preparation
A proctological assessment precedes surgery for grading and to exclude coexisting pathology. Stool-regulation advice is given and the appropriate technique/anaesthesia is chosen.
How it's done
Options escalate: rubber-band ligation for lower grades (no excision); Doppler-guided techniques (HAL/THD) that ligate the feeding arteries with less post-operative pain; and excisional haemorrhoidectomy (Milligan–Morgan/Ferguson) for large, grade III–IV haemorrhoids, offering the most definitive result.
The choice is individualised to grade, symptoms and patient priorities, balancing definitiveness against post-operative pain.
Band ligation
A non-excisional technique for selected grades — quick, with minimal discomfort.
Haemorrhoidectomy
The classic excision for advanced disease — a definitive result, with a few days' recovery.
Fixation techniques
Methods that reduce prolapse with less post-operative pain in selected cases.
Recovery
Non-excisional techniques recover quickly. After excisional haemorrhoidectomy, post-operative pain is significant in the first days and is managed with analgesia, sitz baths, stool regulation and local care.
Return to activities is gradual; full healing takes a few weeks.
Risks & outcomes
Possible: pain, bleeding, urinary retention (especially after excisional surgery) and, less often, stenosis or continence disturbance — minimised by correct technique and preserving adequate mucosal bridges.
"Success" means durable resolution of bleeding/prolapse with preserved normal anal function.
Frequently asked questions
Do I definitely need surgery?
Not always. Many haemorrhoids are treated conservatively or with gentle office techniques. Surgery is chosen for advanced disease or when other measures fail.
Is a haemorrhoidectomy very painful?
There is discomfort for a few days, controlled with analgesia, local care and soft stools. Non-excisional techniques cause even less pain.
Will I need to stay in hospital?
Many techniques are done as day cases with return home the same day.
Can they come back?
With the right technique and better habits (fibre, hydration, avoiding straining) recurrence is less likely.