Hemorrhoidectomy Step by Step: Anesthesia, Removing the Hemorrhoid and the Dressing After

She had already tried everything she was supposed to. More fiber. A footstool by the toilet. Warm baths that turned the bathroom into a sauna. Two rounds of banding in the clinic. And still, every few weeks, the bleeding and the aching lump came back, and she found herself standing at work because sitting hurt. When her surgeon finally said the word hemorrhoidectomy, her first question was not about the operation at all. It was, “What happens to me while I’m asleep, and what will it look like when I wake up?”

That is a fair thing to want to know. The hemorrhoidectomy procedure has a reputation, some of it earned, some of it inherited from an era of tight packing and long hospital stays. Much of what circulates online is either vague or alarming.

This explainer walks through the operation the way a surgeon would if there were an extra twenty minutes in the consultation: the anesthesia choices, exactly how the tissue is removed, why the dressing matters less than people fear, and what the first bowel movement is really like.

What actually happens in a hemorrhoidectomy procedure?

Hemorrhoids are cushions of blood vessels and connective tissue that everyone has inside the anal canal; they only become a problem when they swell, slide down or bleed. A hemorrhoidectomy is the operation that cuts those enlarged cushions out. Mayo Clinic notes that about three in four adults will have troublesome hemorrhoids at some point, yet only a small fraction ever reach an operating room, because most respond to fiber, fluids and office treatments.

The operation itself is shorter than most people imagine. You are positioned lying on your back with your legs supported, or occasionally on your side or front, depending on the surgeon’s training. Once the anesthesia is working, the surgeon gently opens the anus with a small instrument called a retractor, which simply holds the tissue apart so the hemorrhoids can be seen.

Each hemorrhoid is lifted, its feeding blood vessel is tied off or sealed, and the swollen tissue is cut away. The surgeon is careful to leave healthy bridges of skin and lining between the wounds. That detail sounds minor, but it is what stops the anal canal from healing into a tight ring later on.

Then comes a fork in the road. In the closed technique, the wounds are stitched with dissolving sutures. In the open technique, they are left to heal from the base upward, like a graze. Both are standard, and both are described by MedlinePlus and Cleveland Clinic as accepted approaches.

Finally, a soft dressing is placed against the anus, you are taken to recovery, and in most cases you go home later the same day. The whole sequence, from first incision to dressing, typically takes well under an hour.

Who is a hemorrhoidectomy usually for, and who is asked to wait?

Surgeons grade internal hemorrhoids from I to IV. Grade I bleed but stay inside. Grade II slide out during a bowel movement and go back on their own. Grade III come out and have to be pushed back with a finger. Grade IV stay out permanently. Mayo Clinic and Cleveland Clinic both describe excision as the option generally reserved for large grade III and grade IV hemorrhoids, for mixed internal and external hemorrhoids, and for people whose symptoms keep returning after rubber band ligation or other office procedures.

Two other groups sometimes head to surgery sooner. One is a person with a thrombosed external hemorrhoid, meaning a clot has formed inside it, when the pain is severe and the clot is fresh. The other is someone with heavy, recurrent bleeding that is affecting their blood count.

Who is usually asked to wait, or steered elsewhere? People with small, low-grade hemorrhoids, because fiber and banding carry far less discomfort and often work. Pregnant patients, because hemorrhoids frequently settle after delivery and surgery is generally deferred. Anyone whose bleeding has not yet been fully evaluated, since the NHS and Mayo Clinic stress that rectal bleeding should never be assumed to be hemorrhoids until a clinician has looked, especially over the age of 45 or with a family history of bowel cancer.

Certain medical situations also change the calculation: inflammatory bowel disease affecting the anus, poorly controlled diabetes, blood-thinning medicines that would need adjusting, or a weakened immune system. None of these is an automatic no. They are reasons for a longer conversation, and the decision rests with the surgeon and the wider treating team who know your history.

Is a hemorrhoidectomy considered major surgery?

People ask this for a practical reason: they want to know how frightened to be. The honest answer sits in the middle. Technically, a hemorrhoidectomy is classified as a minor to intermediate procedure. It does not enter the abdominal cavity, it does not involve major blood vessels, and MedlinePlus describes it as an operation after which most people go home the same day.

Where it earns respect is in the recovery. The anus is one of the most richly nerve-supplied areas of the body, and wounds there are in constant motion and contact with stool. So the operation is small, but the healing is not trivial. Cleveland Clinic frames it as day surgery with a recovery that takes real patience.

Preparation reflects that middle status. You will usually be asked to:

• Stop eating and drinking for a set number of hours beforehand, because the anesthesia team needs an empty stomach.
• Tell the team about every medicine and supplement you take, particularly anything that thins the blood, so they can advise whether it should be paused. That decision belongs to your prescribing clinician, not to you or to this article.
• Sometimes use an enema or a bowel-clearing preparation the evening before, so the surgeon has a clear view and the first post-operative stool is delayed slightly.
• Arrange for an adult to drive you home and stay with you the first night.

The pre-operative assessment also checks your general health, and if you have heart or lung conditions, the anesthesia plan may be adapted. None of this makes the operation “major” in the surgical sense, but it does mean it is planned like real surgery rather than a quick office visit.

Anesthesia for a hemorrhoidectomy: what your options usually are

Anesthesia simply means the medicines that keep you free from pain and, depending on the type, asleep during the operation. MedlinePlus lists three approaches for hemorrhoid surgery, and the anesthesiologist chooses among them based on your health, the surgeon’s preference and your own wishes.

General anesthesia puts you fully to sleep. You breathe through a mask or a soft tube in the airway, and you have no awareness of the procedure. It is common for excisional hemorrhoidectomy because it relaxes the anal muscles completely and lets the surgeon work without hurry. The trade-offs are a slightly groggy afternoon and, for some people, nausea.

Spinal anesthesia numbs you from roughly the waist down through a single injection into the fluid around the spinal nerves in the lower back. You may be given light sedation so you doze. Advantages include less nausea and quicker alertness afterward. A known downside, noted in the NIH’s StatPearls chapter on hemorrhoidectomy, is a higher chance of temporary difficulty passing urine in the hours after surgery, because the same nerves that are numbed also serve the bladder.

Local anesthesia with sedation means the surgeon injects numbing medicine directly around the anus while you are made sleepy but not fully unconscious. It suits smaller excisions and some external hemorrhoids.

Whichever route is chosen, surgeons very often add a local anesthetic block around the anus at the end, even under a general. This buys several hours of relative comfort while you wake up and travel home. Many teams also inject the area to reduce bleeding. You can ask beforehand which combination your team plans to use and why; it is a reasonable question, not a challenge.

Removing the hemorrhoid: what the surgeon does, step by step

Once you are anesthetized, the sequence is remarkably consistent from one operating room to the next. Here is what happens, in order, in an excisional hemorrhoidectomy.

First, the surgeon examines the anal canal properly, something that is hard to do fully when a patient is awake and tensing. The three classic positions where hemorrhoids sit are confirmed, and any that are too small to warrant removal are left alone.

Second, the largest hemorrhoid is grasped with a fine clamp and drawn gently downward. This exposes its base and the pedicle, the stalk of tissue carrying its blood supply.

Third, the surgeon makes a narrow, elliptical incision in the skin at the outer edge of the hemorrhoid. The shape matters: a slim ellipse heals into a neat line, while a wide one can distort the anal opening.

Fourth, the hemorrhoid is dissected off the underlying internal anal sphincter, the ring of involuntary muscle that keeps the anus closed at rest. Protecting this muscle is the single most important technical goal, because it is what preserves continence.

Fifth, the pedicle is tied with a suture or sealed with an energy device, and the hemorrhoid is cut free. The same steps are repeated for each remaining hemorrhoid, always leaving a bridge of intact lining between wounds.

Sixth, the wounds are either stitched (closed technique) or left open. Bleeding points are checked twice, once with the retractor in place and once after it is removed, since pressure can hide a small bleed.

The specimen is sent to pathology, not because cancer is expected, but because routine examination of removed tissue is standard practice. Then the dressing goes on.

Open, closed, stapled or banding? Hemorrhoidectomy vs rubber band ligation in one table

Not every “hemorrhoid surgery” is the same operation, and the differences shape both the day of surgery and the weeks after. The table below summarizes the main approaches described by Mayo Clinic, Cleveland Clinic and the NIH’s StatPearls chapter. It is a guide to the conversation, not a recommendation; the right choice depends on grade, anatomy and your surgeon’s experience.

Approach	What is done	Anesthesia typically used	Usually offered for	Key trade-offs
Rubber band ligation	A tiny band cuts off blood flow so the internal hemorrhoid shrinks and falls off	None; done awake in clinic	Grade I to III internal hemorrhoids	Least pain and downtime; may need repeating; not for external hemorrhoids
Open excisional hemorrhoidectomy	Hemorrhoid cut out, wounds left open to heal	General or spinal	Large grade III and IV, mixed or thrombosed	Longest track record; wounds ooze for weeks; low recurrence
Closed excisional hemorrhoidectomy	Hemorrhoid cut out, wounds stitched	General or spinal	Same as open	Slightly faster skin healing; stitches can loosen; similar pain
Stapled hemorrhoidopexy	A circular stapler removes a ring of lining above the hemorrhoids and lifts them back into place	General or spinal	Circumferential internal prolapse	Less early pain; Mayo Clinic notes higher risk of recurrence and rectal prolapse than excision
Doppler-guided artery ligation	Feeding arteries located by ultrasound and tied off	General, spinal or local	Grade II to III internal hemorrhoids	Less pain; less evidence for long-term durability

Two patterns are worth noticing. First, the less tissue removed, the less it hurts and the more likely the problem is to return. Second, only excision deals convincingly with external hemorrhoids and skin tags. Your surgeon may combine methods, for example excising one large external component while banding smaller internal ones.

The dressing after hemorrhoidectomy: what is packed, what is left open

This is the part of the operation people worry about most, often because a relative remembers hospital stays decades ago when the anal canal was tightly packed with gauze that had to be pulled out the next morning. That practice has largely gone. Current teaching, reflected in the NIH’s StatPearls review, favors either no internal packing at all or a small, soft piece of absorbent material placed just inside the anus, with a pad taped or held against the outside.

Why the change? Tight packing did not reduce bleeding meaningfully, but it did increase pain and the chance of urinary retention, because a full, stretched anal canal irritates the same nerves that control the bladder. So the modern dressing is modest: a light, non-stick layer over the wounds, then a thick gauze pad, then either mesh underwear or tape to hold it.

Some surgeons apply a medicated ointment to the wounds before the dressing, chosen to relax the sphincter muscle or to numb the area. Whether that is used, and what it contains, is entirely the surgeon’s decision, and you should not add anything to the wound yourself without asking.

At home, the pad will show spotting of blood and a clear or yellowish fluid for several days, more if your wounds were left open. Cleveland Clinic describes this oozing as expected. Most teams tell patients to remove the outer pad after the first bowel movement or the first warm bath, whichever comes first, and thereafter to simply wear a clean pad or liner, changed whenever it feels damp.

If a small internal piece was placed, it usually slides out on its own with the first bowel movement. You do not need to hunt for it, and you should not try to pull it out.

Is hemorrhoidectomy one of the most painful surgeries? Hemorrhoidectomy pain, honestly

It hurts. Anyone who tells you otherwise is either lucky or selling something. The anal canal below a landmark called the dentate line is skin, not gut lining, and skin there has the same dense pain nerves as your fingertips. Cut it, then ask it to stretch around a bowel movement twenty hours later, and you have a wound that few other operations can match for raw, immediate discomfort.

The NIH’s StatPearls chapter describes post-operative pain as the most common complaint after excisional hemorrhoidectomy and the main reason patients delay surgery. Compared with abdominal operations, the pain is more localized and does not come with the deep, whole-body soreness of a large incision, but it peaks sharply, especially with the first few bowel movements and when sitting.

The typical shape is this: the local anesthetic wears off the first evening; days one through three are the hardest; the first bowel movement is the single worst moment for many people; then, day by day, the intensity ratchets down. By the end of the second week most people describe soreness rather than pain, though a burning sensation with stool can linger while the wounds fully close.

What helps is well established and non-controversial:

• Warm sitz baths, which Mayo Clinic describes as soaking the area for 10 to 15 minutes two or three times a day and after bowel movements.
• Keeping stool soft from day one, so nothing hard passes over the wounds.
• Taking the pain medicines your team prescribed, on the schedule they set, rather than waiting until it is unbearable.
• Lying on your side rather than sitting for long stretches in the first days.

Your team may prescribe a combination of medicine classes, sometimes including a topical ointment that relaxes the sphincter. What, how much and for how long are decisions for the prescribing clinician.

Hemorrhoidectomy recovery time: what the days and weeks usually look like

Recovery is less a straight line than a set of stages, and knowing which stage you are in takes some of the fear out of it. The ranges below are the typical ones described by MedlinePlus and Cleveland Clinic; your own course may be shorter or longer, and only your surgeon can say whether it is on track.

Day of surgery. You wake in recovery, are checked for bleeding and for the ability to pass urine, and usually go home the same day. Expect grogginess, a numb, heavy feeling around the anus, and pad spotting.

Days one to three. Pain peaks. Swelling around the wounds is normal and can feel like the hemorrhoids are still there; they are not. You will be encouraged to walk around the house, drink fluids, eat fiber and take a first warm bath. The first bowel movement usually lands in this window.

Days four to seven. Bathroom trips remain uncomfortable but predictable. Oozing on the pad settles to a steady, small amount. Many people who work at a desk begin to consider short periods of remote work, with a cushion.

Week two. A common surprise: a small fresh bleed around days seven to fourteen, when the scab covering the tied-off vessel separates. StatPearls notes this delayed bleeding is usually minor, but heavy bleeding at any point is a call-your-team event.

Weeks three to six. Open wounds are closing over, itch as they heal, and daily life largely normalizes. MedlinePlus describes most people returning to usual activities within about two to three weeks, with complete wound healing taking somewhat longer.

Bed rest, for the record, is not prescribed. Resting is fine; lying in bed for days is not, because it slows healing and raises the small risk of blood clots in the legs. Gentle movement from day one is the standard advice.

How can you poop after hemorrhoid surgery? The first bowel movement after hemorrhoidectomy

Every surgeon hears this question, usually asked with a nervous laugh. The fear is rational. The first bowel movement after hemorrhoidectomy passes directly over fresh wounds. The goal of everything you do in the first days is to make that stool soft, formed and unhurried.

The mechanics that help are simple. Fiber holds water in the stool so it stays soft; Mayo Clinic recommends 20 to 30 grams a day for people with hemorrhoids, from food or a supplement, and your team may suggest starting a bulk-forming fiber the day of surgery. Fluids give the fiber something to hold. Stool softeners, a class of medicine that draws water into stool, are commonly prescribed for the first week or two; whether you take one, and which, is the prescribing clinician’s call.

When the urge comes, do not fight it and do not force it. Sit with your knees a little higher than your hips, using a footstool if you have one. Breathe out slowly as you go rather than holding your breath and straining. Many people find the first movement is over faster than they feared, followed by a sharp burn that eases within twenty minutes.

Afterward, skip dry toilet paper. Rinse with a handheld shower, a squeeze bottle of warm water or a shallow warm bath, then pat dry with a soft cloth. The warm bath does double duty: it cleans the wound and relaxes the sphincter, which is why so many people plan their first bath and first bowel movement together.

Two warnings. Call your team if you have not had a bowel movement by the third day, because impacted hard stool is far more painful to pass than soft stool on day one. And do not take laxatives beyond what your team advised in an effort to “get it over with”; loose, frequent stools irritate the wounds too.

Risks and complications of the hemorrhoidectomy procedure, in neutral terms

Every operation carries risk, and a good consent conversation names them plainly. The list below draws on MedlinePlus, Cleveland Clinic and the NIH’s StatPearls review. Frequencies are described in words rather than percentages, because published rates vary widely between studies and surgical techniques.

Common and usually short-lived:

• Pain, discussed above, which is expected rather than a complication.
• Difficulty passing urine in the first day, more likely after spinal anesthesia or with heavy fluids during surgery. It usually resolves; occasionally a temporary catheter is needed.
• Minor bleeding, both immediately and around the second week when scabs separate.
• Temporary difficulty controlling gas or minor leakage of mucus while swelling settles.

Uncommon but important:

• Heavy bleeding requiring a return to the operating room.
• Infection or an abscess, which StatPearls notes is surprisingly uncommon given the location, but needs prompt treatment.
• Fecal impaction, a hard mass of stool that cannot be passed, usually because pain led to avoiding the toilet.

Rare and longer-term:

• Anal stenosis, a narrowing of the anal canal from scarring, most likely if too much lining was removed. This is why surgeons preserve skin bridges.
• Lasting fecal incontinence, if the sphincter muscle is injured. It is rare in experienced hands but is the most serious functional risk.
• An anal fissure or a fistula forming at a wound site.
• Recurrence of hemorrhoids, which is lower after excision than after stapling or banding but never zero.

The alternatives, from watchful waiting with fiber through banding, sclerotherapy and stapling, each carry their own trade-offs, mostly in the direction of less pain and more recurrence. Weighing them for your situation is the surgeon’s job, done together with you.

What people often get wrong about hemorrhoid surgery

Some myths about the hemorrhoidectomy procedure are harmless. Others lead people to delay care or to sabotage their own recovery. Here are the ones surgeons correct most often.

“They pack you full of gauze and rip it out the next day.” As covered above, tight packing has largely been abandoned because it worsens pain and urinary retention without preventing bleeding. Modern dressings are light and external, or a small piece that passes on its own.

“You need a week of bed rest.” No mainstream guidance recommends bed rest. MedlinePlus and Cleveland Clinic describe gentle walking from the first day, with rest as needed. Immobility slows bowel function and healing.

“Hemorrhoids are removed so they can never come back.” The specific cushions that were excised do not regrow, but hemorrhoidal tissue elsewhere in the canal can enlarge over years, particularly if constipation and straining continue. Surgery treats the problem; it does not exempt you from fiber.

“Bleeding after surgery means something went wrong.” Light spotting is expected for days, and a small bleed around the second week is a well-described event as scabs separate. What matters is volume: soaking pads, passing clots or feeling faint are different and need a call.

“Any rectal bleeding is just hemorrhoids.” This is the myth with the highest stakes. The NHS and Mayo Clinic both emphasize that bleeding must be evaluated by a clinician, because bowel cancer and inflammatory bowel disease can bleed in exactly the same way.

“Laser or stapled surgery is painless.” Less painful in the early days for some techniques, yes; painless, no. And Mayo Clinic notes stapling carries a higher chance of recurrence than excision, so the trade is comfort now for durability later.

“If the first bowel movement hurts, hold it.” Holding leads to harder stool and worse pain. Soft and early beats hard and late.

Questions to ask your care team before a hemorrhoidectomy

A surgical consultation moves quickly, and it is easy to leave with the big questions unasked. Writing them down helps. These are the ones colorectal surgeons say they are glad to be asked, grouped by the phase they concern.

About the decision:

• What grade are my hemorrhoids, and why is excision better for me than banding or another office procedure?
• Have all other possible causes of my bleeding been ruled out, and do I need a colonoscopy first?
• What is likely to happen if I choose to wait?

About the operation:

• Will you use the open or closed technique, and what shapes that choice for me?
• What anesthesia do you plan, and will a local block be added at the end?
• Roughly how many hemorrhoids do you expect to remove?

About medicines:

• Which of my current medicines or supplements should be paused, and who decides that?
• What will you prescribe for pain and for stool softening, and who do I call if it is not working?

About the dressing and wound care:

• Will anything be placed inside the anus, and what should I do when it comes out?
• How should I clean the area after bowel movements, and should I apply anything?

About recovery:

• When can I drive, sit for long periods, exercise and return to my specific job?
• What bleeding is normal and what is not?
• When is my follow-up, and how do I reach the team after hours?

You are not obliged to ask all of these. Even three or four, answered clearly, will change how the first week feels.

When to call your doctor after a hemorrhoidectomy

Most recoveries are uncomfortable but uncomplicated. A small number are not, and the difference between a minor problem and a serious one is often how quickly you pick up the phone. MedlinePlus and Cleveland Clinic list the following as reasons to contact your surgical team promptly or, if you cannot reach them, to seek urgent care.

Call the same day if you have:

• Bleeding that soaks through a pad in an hour, keeps coming with every bowel movement in large amounts, or includes clots larger than a coin.
• Inability to pass urine for more than six to eight hours after getting home, or a painfully full bladder.
• No bowel movement by the third day despite the measures your team advised.
• Pain that is escalating after day three instead of easing, or that no longer responds to the prescribed medicines.
• A fever, chills, or spreading redness and swelling around the anus.
• Foul-smelling discharge or pus from the wound.

Seek emergency care immediately if you have:

• Heavy bleeding with dizziness, fainting, a racing heart or looking pale.
• Severe abdominal pain, a swollen abdomen or repeated vomiting.
• A swollen, painful calf or sudden shortness of breath and chest pain, which can signal a blood clot.

Mention at follow-up, or call sooner if it worries you:

• Difficulty controlling gas or stool that has not improved after the first two weeks.
• Stools that are becoming narrower or harder to pass as the weeks go on, which can suggest scar tissue narrowing the canal.
• A new tear or persistent sharp pain with each bowel movement after the wounds should have healed.

Trust your instinct. If something feels different from the recovery you were told to expect, that alone is a good enough reason to call. Your treating team would rather hear about a false alarm than miss a real one.

Frequently asked questions

Is hemorrhoidectomy one of the most painful surgeries?

It is widely regarded as one of the more painful minor operations, mainly because the anal skin is densely supplied with nerves and the wounds are stretched by every bowel movement. The NIH’s StatPearls chapter identifies pain as the most common complaint. It peaks in the first three days and eases steadily over one to two weeks.

How many days of bed rest do I need after hemorrhoidectomy?

None is prescribed. MedlinePlus and Cleveland Clinic advise gentle walking from the first day, resting when you need to but avoiding prolonged bed rest, which slows bowel function and raises the small risk of leg clots. Most people resume usual activities within about two to three weeks, with your surgeon confirming the timeline.

Is a hemorrhoidectomy considered major surgery?

No. It is classified as minor to intermediate surgery because it does not enter the abdomen or involve major vessels, and it is usually done as day surgery. The recovery, however, is more demanding than the label suggests, with significant pain and several weeks of wound healing, so it is planned and consented like real surgery.

How can you poop after hemorrhoid surgery?

Keep stool soft from day one with fiber, fluids and any softener your team prescribes, then go when the urge comes rather than delaying. Sit with knees raised, breathe out slowly instead of straining, and rinse with warm water afterward rather than wiping. A warm bath before and after relaxes the sphincter and eases the burn.

What is the typical hemorrhoidectomy recovery time?

MedlinePlus describes most people returning to normal activities within about two to three weeks, with complete wound healing taking longer, particularly when wounds are left open. Pain is worst in the first three days, oozing settles over a week or two, and itching as the wounds close can continue into the fourth to sixth week.

What is the first bowel movement after hemorrhoidectomy really like?

For most people it is the single most uncomfortable moment of recovery: a sharp, burning pain that usually fades within about twenty minutes. It typically happens on day one to three. Soft stool makes an enormous difference, which is why teams emphasize fiber and softeners from the day of surgery and ask you to call if nothing has passed by day three.

Hemorrhoidectomy vs rubber band ligation: how do they differ?

Banding is an awake office procedure that shrinks internal hemorrhoids with a tiny band; it hurts little but may need repeating and cannot treat external hemorrhoids. Hemorrhoidectomy removes the tissue under anesthesia, causes considerably more pain and downtime, and is generally reserved for large grade III to IV or mixed hemorrhoids, with lower recurrence.

Will there be packing inside me after the operation?

Usually not in the traditional sense. Most surgeons now place either nothing internally or a small soft absorbent piece just inside the anus, with a pad outside. Any internal piece typically slides out with the first bowel movement or bath. Tight gauze packing has largely been abandoned because it worsens pain and urinary retention.

Why is bleeding common around the second week after hemorrhoidectomy?

When the scab over a tied-off blood vessel separates, usually around days seven to fourteen, a small fresh bleed can occur. The NIH StatPearls review describes this as typically minor. Heavier bleeding, clots, soaking a pad within an hour, or feeling faint are not typical and need an urgent call to your surgical team.

Can hemorrhoids come back after a hemorrhoidectomy?

Yes, although recurrence after excisional surgery is lower than after banding or stapling. The removed cushions do not regrow, but remaining hemorrhoidal tissue can enlarge over years, especially with ongoing constipation and straining. Long-term fiber, fluids and not lingering on the toilet remain the main ways to manage that risk.

References

• MedlinePlus: Hemorrhoid surgery
• NIH StatPearls: Hemorrhoidectomy
• NHS: Piles (haemorrhoids)

This article is for general information only and is not a substitute for professional medical advice. Please consult a qualified doctor about your individual situation.