Haemorrhoids are swollen blood vessels in and around the anus that can cause bleeding, itching, pain, or a lump. Many cases improve with dietary changes, medication, and office-based procedures. However, some haemorrhoids become persistent, recurrent, or significantly prolapsed and may require an operation. Understanding when haemorrhoids surgery is recommended can help patients recognise when further assessment may be appropriate.
What Are Haemorrhoids?
Haemorrhoids are normal blood vessels and supporting tissue in the anal canal. Problems occur when these tissues become enlarged, swollen, or displaced. They can develop internally inside the anal canal or externally beneath the skin around the anus.
Common symptoms include:
- Bright red bleeding during or after bowel movements
- Itching or irritation around the anus
- A lump or swelling near the anus
- Pain, particularly with thrombosed external haemorrhoids
- Tissue protruding from the anus during bowel movements
- Difficulty keeping the area clean
Constipation, repeated straining, prolonged sitting on the toilet, pregnancy, and other factors that increase pressure around the anal veins may contribute to haemorrhoidal symptoms.
Why Is It Important?
Haemorrhoids are common and often manageable without surgery. However, persistent symptoms should be assessed because rectal bleeding is not always caused by haemorrhoids. Conditions affecting the bowel or anus can produce similar symptoms.
Appropriate assessment may help:
- Confirm that haemorrhoids are responsible for the symptoms.
- Determine whether they are internal, external, or both.
- Establish the severity of prolapse or bleeding.
- Identify whether conservative or office-based treatment is still appropriate.
- Determine whether surgery should be considered.
The goal is to choose treatment according to the severity of symptoms rather than assuming that every haemorrhoid requires an operation.
Who Should Consider Haemorrhoids Surgery?
Surgery is generally considered when haemorrhoids cause significant or persistent symptoms and less invasive treatments have not provided sufficient relief. The decision depends on the type and severity of haemorrhoids, previous treatments, and the effect of symptoms on daily life.
You may be advised to discuss surgery if you:
- Have large or advanced haemorrhoids.
- Have internal haemorrhoids that repeatedly prolapse.
- Need to manually push prolapsed tissue back into the anus.
- Have persistent bleeding despite appropriate treatment.
- Experience recurrent symptoms after office-based procedures.
- Have symptoms that significantly interfere with work or daily activities.
A colorectal surgeon can assess whether surgery is appropriate or whether another treatment may be more suitable.
Who Should Seek Medical Advice First?
Before deciding on haemorrhoids surgery, a medical assessment is important. Rectal bleeding, anal pain, and changes in bowel habits can have causes other than haemorrhoids.
Tell your doctor if you:
- Have persistent or unexplained rectal bleeding.
- Notice a change in bowel habits.
- Have unexplained weight loss.
- Have black or tarry stools.
- Take blood-thinning medication.
- Have a personal or family history of colorectal cancer or bowel disease.
- Develop severe or rapidly worsening anal pain.
Additional examination or investigations may be recommended depending on your age, symptoms, medical history, and examination findings.
What Treatment or Management Options Are Available?
Surgery is not usually the first treatment for uncomplicated haemorrhoids. Management may progress from conservative measures to office-based procedures and, when appropriate, surgery.
Common options include:
- Dietary changes: Increasing fibre and maintaining adequate fluid intake can help soften stools and reduce straining.
- Lifestyle changes: Avoiding prolonged toilet sitting and maintaining regular physical activity may support healthier bowel habits.
- Medication: Topical treatments or pain-relieving medicines may temporarily reduce symptoms in selected patients.
- Rubber band ligation: A small band is placed around an internal haemorrhoid to restrict its blood supply, causing the treated tissue to shrink.
- Other office procedures: Sclerotherapy or infrared coagulation may be considered for selected internal haemorrhoids.
- Surgery: Procedures such as haemorrhoidectomy may be considered for larger, prolapsing, or persistent haemorrhoids.
The appropriate option depends on the individual diagnosis and severity of symptoms.
How Should You Prepare?
If surgery is recommended, your healthcare team will explain the preparation required. This may include a review of your medical history, medications, allergies, and previous treatments.
Before the procedure, you may need to:
- Tell your doctor about all medications and supplements.
- Discuss blood-thinning medication before surgery.
- Complete any recommended blood tests or other assessments.
- Follow instructions about eating and drinking before anaesthesia.
- Arrange transportation home if you are having day surgery.
- Plan for assistance with daily activities during the early recovery period.
Ask your surgeon what restrictions to expect after surgery, including when you can return to work, exercise, and normal bowel habits.
What Happens During Haemorrhoids Surgery?
The exact procedure depends on the type and severity of the haemorrhoids. Haemorrhoidectomy involves removing problematic haemorrhoidal tissue and may be performed under general or regional anaesthesia, depending on the circumstances.
The process generally involves:
- Preoperative assessment and confirmation of the treatment plan.
- Administration of the appropriate anaesthesia.
- Identification and treatment or removal of the affected haemorrhoidal tissue.
- Monitoring for bleeding before completing the procedure.
- Recovery from anaesthesia in a monitored area.
- Discharge or overnight observation depending on the procedure and individual circumstances.
After surgery, bowel movements may initially be uncomfortable. Pain relief, adequate fluids, and appropriate dietary measures can support recovery.
Benefits, Risks, and Possible Side Effects
The potential benefit of haemorrhoids surgery is treatment of haemorrhoids that are causing persistent symptoms or have not responded adequately to less invasive approaches.
Potential benefits include:
- Reduction in bleeding from treated haemorrhoids.
- Treatment of significant prolapse.
- Relief from persistent irritation or discomfort.
- Improved ability to carry out daily activities.
Possible risks and side effects include:
- Pain or discomfort, particularly during bowel movements.
- Bleeding.
- Infection.
- Temporary difficulty passing urine.
- Changes in bowel habits during recovery.
- Anal narrowing or other complications, although these are uncommon.
- Recurrence of haemorrhoids.
Recovery varies between individuals and depends on the surgical technique used. Your colorectal surgeon should explain the expected recovery period and specific risks before treatment.
Cost or Availability
Haemorrhoid treatment is available in specialist colorectal and surgical settings. The total cost of surgery can vary according to the procedure, hospital or day-surgery facility, surgeon’s fees, anaesthesia, and postoperative care.
Before proceeding, ask whether the quoted estimate includes:
- Surgeon’s fees
- Anaesthetist’s fees
- Facility or operating theatre charges
- Medications
- Follow-up appointments
- Additional investigations or procedures
Patients in Singapore can also ask their healthcare provider whether MediSave or insurance coverage may apply to the planned procedure and what out-of-pocket expenses may remain.
What Our Colorectal Surgeons Say
Patients often ask whether persistent haemorrhoids automatically mean surgery is necessary. The answer depends on the severity of the haemorrhoids, the symptoms they cause, and how they have responded to previous treatment. During consultation, we assess the patient’s symptoms and perform an appropriate examination before discussing management options. Conservative treatment or office-based procedures may be sufficient for some patients. When surgery is considered, we explain the intended procedure, potential risks, expected recovery, and available alternatives so that patients can make an informed decision based on their individual circumstances.
Putting This Into Practice
- Increase dietary fibre gradually and drink adequate fluids.
- Avoid prolonged sitting or straining on the toilet.
- Follow prescribed treatment as directed.
- Keep track of persistent bleeding or recurring symptoms.
- Attend follow-up appointments when recommended.
- Discuss surgery if symptoms remain troublesome despite appropriate treatment.
When to Seek Professional Help
Seek medical advice if you:
- Have persistent or recurrent rectal bleeding.
- Develop severe or worsening anal pain.
- Have haemorrhoids that repeatedly protrude.
- Continue to have symptoms despite conservative treatment.
- Develop changes in bowel habits or unexplained weight loss.
- Experience significant symptoms that interfere with daily activities.
Frequently Asked Questions
When is haemorrhoids surgery recommended?
Haemorrhoids surgery may be recommended when haemorrhoids are large, repeatedly prolapse, cause persistent bleeding or discomfort, or do not respond adequately to conservative and office-based treatments. The decision depends on the individual’s symptoms and examination findings. Surgery is not automatically required simply because haemorrhoids are present.
Can haemorrhoids go away without surgery?
Yes. Many haemorrhoids can be managed without surgery through dietary changes, adequate fibre and fluids, improved bowel habits, medication, or office-based procedures. Surgery is generally reserved for selected patients with persistent, recurrent, or more advanced disease. The appropriate treatment depends on the type and severity of the haemorrhoids.
Is haemorrhoids surgery painful?
Some pain or discomfort is expected during recovery, particularly when passing stools. The level of discomfort varies depending on the surgical procedure and individual factors. Your doctor can recommend appropriate pain management and provide advice about bowel habits during recovery. Severe or worsening pain should be reported to the medical team.
How long does it take to recover from haemorrhoids surgery?
Recovery varies depending on the procedure and individual healing. Some people can gradually resume light activities within days, while more complete recovery may take several weeks. Your surgeon will provide specific guidance about work, exercise, driving, bowel movements, wound care, and follow-up based on the operation performed.
Can haemorrhoids come back after surgery?
Yes, haemorrhoids can recur after treatment. Surgery addresses the haemorrhoidal tissue causing the current problem but does not eliminate factors such as constipation, straining, or prolonged toilet sitting. Maintaining healthy bowel habits and following your doctor’s recommendations may help reduce the likelihood of future symptoms.
Next Steps
Most haemorrhoids do not require surgery, particularly when symptoms respond to dietary changes, medication, or office-based treatment. However, persistent bleeding, recurrent prolapse, significant discomfort, or symptoms that interfere with daily activities may warrant further assessment. Haemorrhoids surgery is one treatment option for selected patients, and the appropriate approach depends on the severity and type of haemorrhoids. If your symptoms continue despite conservative treatment, or if you are concerned about rectal bleeding or other bowel changes, consult a colorectal surgeon. A proper assessment can help determine whether surgery or a less invasive treatment is appropriate for you.
