Most hemorrhoids do not require surgery. It is usually considered only for severe hemorrhoids.
Surgery may be done if other treatments (including home treatment) have failed. Surgery is also considered when symptoms become so bothersome that your lifestyle is affected or when hemorrhoids create a medical emergency, such as uncontrolled bleeding or blood and pus at the anus along with severe rectal pain.
External hemorrhoids usually are not removed with surgery (hemorrhoidectomy) except if they are very large and uncomfortable or if you are having surgery on the anal area for another reason, such as internal hemorrhoids or a tear (anal fissure). If a blood clot develops in the external hemorrhoid, the clot may need to be removed to relieve pain.
Surgical removal of hemorrhoids (hemorrhoidectomy) is a last resort for treating small internal hemorrhoids.
Hemorrhoidectomy is considered the most successful way to treat large internal hemorrhoids, especially those that are still a problem after treatments that cut off blood flow to hemorrhoids (fixative procedures) have been tried.
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What to think about
Sometimes, increased pressure on external hemorrhoids causes them to get irritated and to clot. This causes a lump (thrombosed, or clotted, hemorrhoid) to form. You may suffer from severe pain at the site of a clotted hemorrhoid.
A procedure to relieve the pain can be done in a doctor's office or outpatient clinic. The doctor applies local anesthesia and then makes a small incision where the lump has occurred to remove the clot and reduce pressure and pain. The procedure works best if it is done soon after the clot has formed.
If the pain is tolerable, you may choose to wait to see a doctor. The pain usually goes away in a few days. After 4 or 5 days, the pain from cutting and draining the hemorrhoid is usually worse than the pain from the clot.