What Is a Hemorrhoidectomy and What Should You Expect?

Most people with hemorrhoids never need surgery. Dietary changes resolve mild cases; in-office procedures like rubber band ligation handle moderate ones. But for severe, large, or persistently symptomatic hemorrhoids that haven't responded to other treatments, a hemorrhoidectomy is the most effective and durable solution available.

A hemorrhoidectomy is a surgical procedure to remove hemorrhoidal tissue. It's most often recommended for Grade III or IV internal hemorrhoids, large external hemorrhoids, or cases where multiple hemorrhoids need to be addressed comprehensively.

During the procedure, the surgeon removes the swollen tissue and either closes the wound with sutures or leaves it open to heal — the technique depends on the specific situation and the surgeon's approach. The procedure is typically performed under general or spinal anesthesia and takes about 30 to 45 minutes. Most patients go home the same day.

Hemorrhoidectomy is generally recommended when hemorrhoids are Grade III or IV; when office procedures have already been tried and failed; when multiple large hemorrhoids are present; or when mixed internal and external hemorrhoids need to be addressed together. Your colorectal surgeon will go over whether surgery is the appropriate next step for your specific case.

Week 1 is the hardest. Pain is typically at its peak, and the first bowel movement — usually within 2 to 3 days — is what most patients are most anxious about. Staying ahead of pain with prescribed medication, doing sitz baths multiple times a day, and keeping stools soft with stool softeners and a high-fiber diet make this week manageable. Most patients can move around the house but aren't ready for much more.

Weeks 2 and 3 bring real improvement. Pain decreases noticeably, bowel movements become less difficult, and many patients with desk jobs return to work during this period. Physical activity restrictions (no heavy lifting, no strenuous exercise) typically apply for 3 to 4 weeks.

Full internal healing takes 4 to 6 weeks. You'll feel substantially better before you're fully healed, which is why follow-up appointments matter.

Pain management and follow-up access to your surgeon make or break the recovery experience. At CR Surgery OC, Dr. Chung checks in with patients frequently after surgery — because the recovery period is where attentive care matters most. A surgeon who is accessible and responsive during recovery is not a luxury — it's the standard of care.

How many hemorrhoidectomies do you perform per year? What is your approach to post-operative pain management? When will I have my first follow-up appointment? What signs should prompt me to call you during recovery? A surgeon who answers these questions directly and has a clear plan is a surgeon you can trust.