Haemorrhoid removal (haemorrhoidectomy)

An operation to cut away large or troublesome piles (haemorrhoids), usually considered only when simpler treatments have not worked.

✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review

In short

It is an operation to cut away large or persistent piles, usually after simpler treatments have failed.
It is the most effective way to stop piles returning, but also the most painful to recover from.
Most people go home the same day, but pain and some bleeding can last a couple of weeks or more.
Heavy bleeding, severe pain, fever or being unable to pass urine after surgery needs prompt review.

A plain-English summary. The detail — including risks and recovery — is below.

At a glance

TypeSurgical operation

AnaestheticUsually general anaesthetic; sometimes spinal

How long it takesUsually about 30 minutes

Hospital stayUsually day case

Time off workAbout 1–3 weeks; can be longer because of pain

When you'll see resultsPiles removed; healing and pain settle over a few weeks

On the NHS?Available on the NHS by criteria, usually after simpler treatments

A general guide. Your surgeon will give you advice for your situation.

Best fit

Removes large or persistent piles that have not responded to other treatments.

Pause if

Your piles are small or mild and likely to respond to diet changes, creams or banding.

Main recovery point

Pain is usually at its worst. Take regular pain relief, use stool softeners, and try warm baths to ease discomfort. Some bleeding is normal.

Good aftercare

A clear pain-relief plan, including stool softeners and dietary advice, with realistic expectations about discomfort.

First few days

Pain is usually at its worst. Take regular pain relief, use stool softeners, and try warm baths to ease...

First 1–2 weeks

Pain eases gradually, especially after the first few bowel movements. Many people need time off work because...

Weeks 2–4

Wounds continue to heal and discomfort settles. Bleeding or spotting may continue for several weeks as the area...

Up to about 6 weeks

Most people have healed and returned to normal activity. Keeping stools soft and avoiding straining helps protect...

Medical line illustration of lower rectum and anal canal treatment anatomy for Haemorrhoid removal. — Illustration only - not a diagnosis, medical advice or a promise of result. Your anatomy and treatment plan may differ. Vuemedics does not publish before-and-after photos.

What is haemorrhoid removal (haemorrhoidectomy)?

Haemorrhoids (piles) are swollen blood vessels in and around the back passage (anus). They can cause bleeding, itching, discomfort and lumps. Most piles improve with diet changes, creams, or clinic treatments such as banding.

Haemorrhoid removal (haemorrhoidectomy) is an operation to cut away large or persistent piles, usually under general anaesthetic and often as a day case. It is generally considered only when simpler treatments have not worked, or for large piles that hang down.

This is the most effective surgery for stopping piles coming back, but it is also the most painful option, with a healing area in a sensitive place. Other surgical options, such as stapling or tying off the blood supply, may cause less pain but can have a higher chance of piles returning.

Surgery treats the piles you have now. It does not change the habits, such as straining or constipation, that can cause new piles, so these still matter afterwards.

Types & techniques

There isn't one single operation. The right approach depends on you — which is something to discuss with your surgeon.

Conventional haemorrhoidectomy

The piles are cut away, usually leaving small open wounds to heal naturally. The most effective at preventing return, but the most painful to recover from.

Stapled haemorrhoidopexy

A circular stapling device lifts and reduces the blood supply to the piles. Often less painful early on, but piles and prolapse can return more often.

Haemorrhoidal artery ligation (HALO/THD)

Stitches tie off the arteries feeding the piles, sometimes with a lift of the tissue. Usually less painful, with a higher chance of needing further treatment.

Rubber band ligation (banding)

A clinic, non-surgical treatment where a band is placed on the pile to make it drop off. Often tried before surgery for smaller piles.

Other clinic treatments

Injections (sclerotherapy), infrared or electrical treatments can shrink smaller piles, usually before surgery is considered.

Cutting away versus stapling or artery ligation

Point	Cut away	Stapled / HALO
Early pain	More	Often less
Chance of return	Lowest	Higher
Best for	Large external piles	Internal piles/prolapse
Recovery	Longer, painful wounds	Often quicker early on

Cutting the piles away is the most durable but most painful option. Stapling and artery ligation can mean less early pain but a higher chance of piles returning. The right choice depends on your piles and preferences.

Preparing for your surgery

See the surgeon, who will examine the piles and confirm that surgery is the right step after simpler treatments.
Tell the team about all medicines, especially blood thinners, and any health conditions.
Follow fasting instructions for the day of surgery.
You may be asked to use a small enema to empty the back passage before surgery.
Plan plenty of pain relief, stool softeners and a high-fibre diet for afterwards.
Arrange a lift home and someone to help in the first day or two.
Plan time off work, allowing for pain when sitting and going to the toilet.

What happens

On the day, you will meet the surgeon and anaesthetist to confirm the plan and consent. The operation is usually done under general anaesthetic, although a spinal anaesthetic is sometimes used.

In a conventional haemorrhoidectomy, the surgeon cuts away the piles, usually leaving small wounds open to heal. In stapled surgery, a device lifts and reduces the blood supply to internal piles. In artery ligation, stitches tie off the arteries feeding the piles.

The operation usually takes about 30 minutes. Most people go home the same day once they are comfortable and have passed urine. The first few days, and the first bowel movements, are often the most uncomfortable part.

Is this operation right for me?

A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.

May not be suitable if…

Your piles are small or mild and likely to respond to diet changes, creams or banding.
You have a bleeding or clotting problem, or take blood thinners that cannot be safely managed.
You have a condition such as inflammatory bowel disease affecting the back passage, where surgery needs specialist care.
Your symptoms may be from another cause, such as a fissure or, rarely, a more serious bowel problem that needs checking first.

Delay surgery if…

You have an active infection around the back passage.
Blood-thinning medicines need adjusting before surgery.
You have new or unexplained bleeding or bowel changes that should be investigated first.
You cannot arrange transport home or help in the first day or two.

Alternatives to discuss

Diet changes, more fibre and fluids, and treating constipation.
Creams or ointments for symptom relief.
Clinic treatments such as rubber band ligation, injections or infrared treatment.
Less painful operations such as stapling or artery ligation, accepting a higher chance of return.

Before you decide

Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.

What matters most to me?

Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.

What are all my options?

Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.

What would make me pause?

Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.

What happens if I do nothing today?

For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.

Anaesthetic choices

The safest option depends on the operation, your health, the facility and your surgeon/anaesthetist. Ask what is planned and why.

General anaesthetic

Most common; you are fully asleep during the operation.

Spinal anaesthetic

Sometimes used, numbing the lower body while you stay awake; can raise the chance of early difficulty passing urine.

Local anaesthetic

May be added for pain relief after surgery, or used for some smaller procedures.

Benefits

Removes large or persistent piles that have not responded to other treatments.
Cutting the piles away is the most effective way to stop them coming back.
Can stop ongoing bleeding, discomfort and the bother of piles hanging down.
May improve hygiene and itching where large piles made this difficult.

Risks & complications

More common

Significant pain for the first one to two weeks, often worse when opening your bowels
Bleeding or spotting, especially with early bowel movements
Difficulty passing urine in the first day or so
Swelling, discomfort and a feeling of needing to open your bowels

Less common

Bleeding that is heavier or happens a week or two later as wounds heal
Wound infection
Difficulty controlling wind or, less often, leakage of stool that is usually temporary
Piles or symptoms coming back, more so after stapling or artery ligation

Rare but serious

Narrowing of the back passage (anal stenosis) that may need treatment
Longer-lasting problems with bowel control
A connection or tear forming (fistula or fissure) needing further treatment
Serious complications after stapled surgery, which are uncommon but important

The main trade-off is pain versus durability: cutting the piles away works best but hurts most, while stapling and artery ligation hurt less but can recur more. Difficulty passing urine early on is common, and longer-lasting bowel-control problems, though uncommon, matter a lot. Ask your surgeon which operation they recommend, the chance of return, and how they will help with pain.

Published figures to discuss

How well surgery works, and the chance of complications, depends on the type of operation, the size of the piles and individual healing. Cutting the piles away is the most durable but most painful, while stapling and artery ligation are less painful but recur more often. The figures below are broad ranges from systematic reviews and surgical sources, not promises for any individual.

Figure	Reported range	How to interpret it	Source / confidence
Bleeding after surgery	Post-procedure haemorrhage is often reported around 1–2% in larger series; delayed bleeding reports range about 0.9–10%	Most bleeding is minor, but heavier bleeding can occasionally need treatment.	Risk factors of delayed hemorrhage after LigaSure hemorrhoidectomy — PMCpmc.ncbi.nlm.nih.govPublished figure
Difficulty passing urine (urinary retention)	Reported roughly 1 in 20, with a wide range across studies, and more likely after spinal anaesthetic	Usually temporary; occasionally needs a catheter.	Risk factors of delayed hemorrhage after LigaSure hemorrhoidectomy — PMCpmc.ncbi.nlm.nih.govPublished figure
Narrowing of the back passage (anal stenosis)	Uncommon; reported around 1% up to a few per cent depending on technique	May need stretching or further treatment.	Risk factors of delayed hemorrhage after LigaSure hemorrhoidectomy — PMCpmc.ncbi.nlm.nih.govPublished figure
Problems controlling wind or stool	Uncommon; minor incontinence reported in low single figures, often temporary	Longer-lasting problems are less common but important to discuss.	Guide sourcesClinical context
Symptoms coming back	Lowest after excisional haemorrhoidectomy; stapled haemorrhoidopexy has higher long-term recurrence in systematic reviews	New piles can still form, so habits afterwards matter. Artery ligation is less painful for some patients but may trade that for higher recurrence.	Guide sourcesClinical context

These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.

Recovery — what to expect, and when

Recovery is often more uncomfortable than people expect. Most people are home the same day, but pain and some bleeding can last a couple of weeks, with the first bowel movements being the hardest part.

First few days

Pain is usually at its worst. Take regular pain relief, use stool softeners, and try warm baths to ease discomfort. Some bleeding is normal.

First 1–2 weeks

Pain eases gradually, especially after the first few bowel movements. Many people need time off work because sitting and toileting are uncomfortable.

Weeks 2–4

Wounds continue to heal and discomfort settles. Bleeding or spotting may continue for several weeks as the area heals.

Up to about 6 weeks

Most people have healed and returned to normal activity. Keeping stools soft and avoiding straining helps protect the result.

What's normal — and not a worry

Pain when sitting and when opening your bowels, easing over a couple of weeks
Spotting or light bleeding, sometimes for several weeks
A feeling of fullness or of needing to open your bowels
Mild swelling around the back passage

Aftercare

Take regular pain relief as advised; the first days and first bowel movements are the hardest.
Use prescribed or recommended stool softeners and eat plenty of fibre to keep stools soft.
Drink plenty of fluids and avoid straining on the toilet.
Try warm baths to ease discomfort and keep the area clean.
Use any prescribed creams or laxatives as directed.
Build up gentle activity, but avoid heavy lifting early on.
Keep follow-up advice and contact the team about heavy bleeding or severe pain.

Before-surgery checklist

Pain relief bought or prescribed
Stool softeners or laxatives obtained
High-fibre foods stocked at home
Lift home and help for the first day or two arranged
Time off work booked, allowing for toileting discomfort
Clinic and out-of-hours contact numbers saved

Scars and how they heal

Conventional surgery usually leaves small open wounds around the back passage that heal naturally over a few weeks; these are not usually visible scars in everyday life. Stapled and artery-ligation procedures leave internal wounds. Some swelling and skin tags can remain after healing.

⚠ Get urgent help if…

Heavy bleeding, passing large clots, or bleeding that soaks pads and does not stop
Severe or worsening pain not controlled by your pain relief
Being unable to pass urine despite needing to
A high temperature, feeling shivery or generally very unwell
Increasing redness, swelling or smelly discharge from the area
New or worsening problems controlling wind or stool

Who to contact: your surgeon or clinic first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.

General guidance — it doesn't replace the specific advice your surgeon gives you.

Results & realistic expectations

A good result clears the troublesome piles and stops the bleeding and discomfort, with the healed area settling over a few weeks. Cutting the piles away is the most reliable way to stop them returning.

The trade-off is a painful recovery, and other operations that hurt less can let piles return more often. Surgery does not change habits like straining and constipation, so keeping stools soft and avoiding straining remains important to protect the result.

How long it lasts

Cutting the piles away gives the most durable result, with a low chance of the same piles returning, though new piles can still form over time. Stapling and artery ligation are less painful but have a higher chance of symptoms coming back. A high-fibre diet, good fluid intake and avoiding straining help keep symptoms away long term.

Combining with other procedures

Sometimes more than one pile is treated at the same operation, or a small skin tag is removed alongside. Surgeons usually avoid removing too much tissue at once because of the risk of narrowing the back passage. Any added treatment should be explained so you can weigh it up.

Follow-up & long-term care

Many people are given advice and discharged, with a clinic review if needed to check healing or if symptoms persist. Report heavy bleeding, severe pain, or new problems controlling your bowels promptly. If symptoms return later, further assessment can look at other treatment options.

Eat plenty of fibre and drink enough fluids to keep stools soft.
Avoid straining and prolonged sitting on the toilet.
Treat constipation early to protect the result.
Seek review if bleeding, lumps or discomfort return.

Revision and secondary surgery reality

Piles or prolapse can return, particularly after stapling or artery ligation, and may need further treatment.
Narrowing of the back passage occasionally needs stretching or surgery.
Heavier bleeding as wounds heal sometimes needs review or treatment.
Some people need ongoing measures, such as a high-fibre diet and stool softeners, to control symptoms.

Ask your surgeon for their own revision rate, what counts as a revision, and what is included in the written aftercare policy.

What good aftercare looks like

A clear pain-relief plan, including stool softeners and dietary advice, with realistic expectations about discomfort.
Written warning signs for heavy bleeding, severe pain and inability to pass urine, with a named contact route.
Follow-up to check healing if needed, and advice on preventing constipation.
A route back for assessment if symptoms return or bowel-control problems develop.

What affects the cost

Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:

The type of operation (cutting away, stapling or artery ligation)
Surgeon and anaesthetist fees
Theatre and facility costs
Anaesthetic type
Clinic treatments such as banding tried beforehand
Follow-up appointments

Make sure your written quote includes

The surgeon's and anaesthetist's fees
Theatre and facility costs
Anaesthetic type included
Any device used for stapled surgery
Follow-up appointments and wound advice
The cancellation policy
What happens, and who pays, if there is a complication or piles return

On the NHS? Haemorrhoid surgery is available on the NHS, usually after simpler treatments and by local criteria; private care is used for timing, choice of surgeon or self-pay.

You're entitled to your total cost in writing — including aftercare and any revision — before you decide.

Choosing a surgeon safely

Check your surgeon is on the GMC Specialist Register for this area.
Make sure they practise at a CQC-registered location, and look for membership of bodies like BAAPS or BAPRAS.
You're entitled to a two-stage consent process with time to reflect (a cooling-off period). The surgeon who will operate must consent you — not a salesperson.
Be wary of pressure: time-limited offers, discounts or deposits taken before you've had time to think are red flags, not bargains.
You're entitled to your total cost in writing — including aftercare and any revision — before you decide.

How Vuemedics verifies every consultant →

Questions to ask your medical professional

Take this to your consultation. A good surgeon will welcome every one of these.

Have I tried the simpler treatments that usually come before surgery?
Which operation do you recommend for me, and why?
How will you help me manage the pain afterwards?
What is the chance my piles come back with this operation?
What is the risk of problems controlling wind or stool, or of narrowing?
When can I expect to return to work and normal activity?
Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
Will you be the surgeon who carries out my operation, and who looks after me afterwards?
What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
What does a realistic result look like — and what can this operation not achieve?
What are my options, including waiting, doing nothing for now, or choosing a different approach?
Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
What is the total cost in writing, including any follow-ups, and how much time do I have to decide?

Frequently asked questions

Do I really need surgery for piles?

Often not. Most piles improve with diet changes, creams or clinic treatments such as banding. Surgery is usually only for large or persistent piles that have not responded to these. Discuss whether simpler options have been tried.

How painful is the recovery?

Cutting the piles away is the most painful option, with discomfort for one to two weeks, especially when opening your bowels. Good pain relief and keeping stools soft make a big difference. Less painful operations exist but can recur more often.

How long will I need off work?

Often one to three weeks, partly because sitting and going to the toilet are uncomfortable. Your surgeon can advise based on your job and the operation chosen.

Will the piles come back?

Cutting them away has the lowest chance of return, though new piles can still form. Stapling and artery ligation are less painful but more likely to recur. Avoiding straining and constipation helps.

Is it normal to bleed afterwards?

Some bleeding and spotting is normal for a few weeks as wounds heal. Heavy bleeding, large clots, or bleeding that will not stop is not normal and needs urgent review.

Is it available on the NHS?

Yes, but usually only after simpler treatments have been tried and by local criteria. People may choose private care for timing or choice of surgeon.

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How we made this page

Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →

Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.

Sources & standards: NHS — Piles (haemorrhoids) Guy's and St Thomas' NHS — Piles (haemorrhoids): surgery NICE — Haemorrhoidal artery ligation (IPG342) Hemorrhoidectomy — StatPearls (NCBI Bookshelf) Rubber band ligation versus haemorrhoidectomy: systematic review — PMC Risk factors of delayed hemorrhage after LigaSure hemorrhoidectomy — PMC Stapled hemorrhoidopexy recurrence systematic review — PubMed

Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.

Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.