Hemorrhoids can be surgically removed while you are sedated and pain-free (local or spinal anesthesia) or deep asleep and pain-free (general anesthesia ). After the hemorrhoid is removed, gauze packing is inserted to reduce bleeding.

Smaller hemorrhoids may not require surgery. Treatments for small hemorrhoids may involve a chemical injection to reduce swelling or rubber band ligation to cut off the blood supply to the hemorrhoid. These procedures can often be done as an outpatient or office procedure with minimal or no anesthesia.

Hemorrhoid removal may be recommended when nonsurgical treatment (fiber -rich diet, laxatives, stool softener, suppositories, medications, warm baths) has not provided adequate relief from:

• Persistent itching
• Anal bleeding
• Pain
• Blood clots (thrombosis of the hemorrhoids)
• Infection

Risks for any anesthesia are:

• Reactions to medications
• Problems breathing

• Bleeding
• Infection

The outcome is usually very good in the majority of cases. Preventive measures such as adherence to a high fiber diet, and avoiding constipation must be taken to prevent recurrence.

The patient may experience considerable pain after surgery as the anus tightens and relaxes. Medications to relieve pain may be used. To avoid straining, stool softeners will be used. Avoid any straining during bowel movement or urination. Soaking in a warm bath can bring additional comfort. Expect complete recovery in about 2 weeks.

Feldman M, Friedman LS, Sleisenger MH, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 8th ed. Philadelphia, Pa: WB Saunders; 2006.

Rakel P, ed. Conn's Current Therapy 2007. 59th ed. Philadelphia, Pa: WB Saunders; 2007.