Hemorrhoids: When They Need Surgery and What to Expect

By Dr. Rashna Ginwalla, Clearwater Advanced Surgical Associates, LLC

Hemorrhoids are one of the most common conditions I treat — and also one of the most embarrassing for patients to bring up. If you've been putting off talking to a surgeon because the subject feels awkward, I want to say upfront: you're not alone, and there's nothing unusual about your situation. Hemorrhoids affect roughly three out of four adults at some point in their lives.

Most hemorrhoids respond to simple measures. The ones that end up in my office are the ones that haven't.

What hemorrhoids are

Hemorrhoids are swollen veins in and around the rectum and anus. Internal hemorrhoids form inside the rectum; external hemorrhoids form under the skin around the anal opening. Both types can become painful, bleed, prolapse (protrude through the opening), or cause itching and discomfort that makes daily life genuinely miserable.

They tend to develop from increased pressure in the lower rectum — chronic straining during bowel movements, prolonged sitting, pregnancy, or simply the wear of time. A low-fiber diet is one of the most common contributing factors.

When surgery makes sense

The first line of treatment for hemorrhoids is almost always non- surgical: more fiber, more water, sitz baths, and over-the-counter relief. Many hemorrhoids improve significantly with these changes. If they don't — or if they've reached a point where they're bleeding significantly, prolapsing regularly, or causing constant discomfort — it's time to talk about a procedural option.

Rubber band ligation is the most common office procedure I perform for internal hemorrhoids. I place a small rubber band around the base of the hemorrhoid, cutting off its blood supply. The hemorrhoid shrinks and falls off within five to ten days. The procedure takes only a few minutes and is done without anesthesia, though you may feel a dull pressure or ache for a day or two afterward. Multiple hemorrhoids are treated in separate sessions, spaced about four to six weeks apart.

Hemorrhoidectomy — surgical removal — is reserved for larger or more complicated hemorrhoids that don't respond to banding, or for external hemorrhoids that are causing significant symptoms. This is a more involved procedure done under anesthesia, and the recovery is more significant. I'll be straightforward about that. Hemorrhoidectomy is one of the more uncomfortable surgical recoveries, but the relief it provides is durable, and for patients with severe disease, it's the right answer.

What recovery from hemorrhoidectomy looks like

I'll be honest with you because I think you deserve the full picture before making a decision.

Pain. Hemorrhoidectomy recovery is genuinely painful, particularly in the first one to two weeks, and worst during bowel movements. This is manageable — we'll prescribe appropriate pain medication, and there are techniques (sitz baths, topical numbing cream before bowel movements) that make a real difference — but I won't tell you it's a breeze.

Bowel movements. The first bowel movement after surgery will be uncomfortable. The most important thing I can tell you is: don't avoid it. Delaying makes the stool harder and the pain worse. Start stool softeners the day of surgery and keep taking them. Aim for 25 to 35 grams of fiber a day and drink plenty of water — at least eight to ten glasses. Your diet does the work here.

Sitz baths. Soaking in a few inches of warm water for fifteen to twenty minutes, several times a day (especially after bowel movements) is the single most effective comfort measure. It reduces swelling, relaxes the muscles, and makes healing more comfortable.

Returning to normal life. Most patients with desk jobs are back at work in one to two weeks. If your work involves physical activity or heavy lifting, plan on three to six weeks. Full activity clearance comes at your follow-up once I've confirmed healing is on track.

Rubber band ligation recovery is much gentler: a day or two of dull aching, some spotting when the hemorrhoid falls off around day five to ten, and you're generally back to normal within a week.

When should you come see me?

If you've been dealing with hemorrhoids that don't improve with diet and lifestyle changes, or if you're experiencing regular bleeding, prolapse, or significant discomfort, it's worth a conversation. There's no commitment in coming in — sometimes the right answer is more conservative management, and sometimes a procedure is clearly the better path. Either way, you'll leave with a clear plan.

Call the office at (208) 985-6179, or request an appointment through the patient portal.

This page is a summary. After your consultation, I'll provide you with a detailed packet covering pre-operative preparation, the day of surgery, and post-operative care.