Haemorrhoidectomy

A haemorrhoidectomy is a surgical operation to remove haemorrhoids — the swollen, enlarged veins in and around your back passage (your anus and lower rectum). It is performed under a general anaesthetic, which means you will be fully asleep throughout and will not feel, hear, or be aware of anything during the procedure.

A technique called the Milligan-Morgan or Parks approach is used — these are the well-established, reliable methods for this type of surgery. In plain terms, the haemorrhoidal tissue is carefully removed at its base through small surgical wounds. Depending on what is found during the operation, these wounds are either left open to heal naturally or partially closed with dissolving stitches. Your body is good at healing this particular area on its own — it happens more reliably than many people expect.

Of the available treatments for haemorrhoids, a haemorrhoidectomy is the most definitive option for long-term relief. It does, however, come with a meaningful recovery period, and we want to be completely honest about what that looks like. Full detail is in the Recovery section below.

A haemorrhoidectomy is usually recommended when other treatments have not been enough. You may be in the right place if:

• You have Grade III or IV internal haemorrhoids — meaning haemorrhoids large enough to slip outside your anus (prolapse) that have not responded to banding or other clinic-based treatments
• You have large external haemorrhoids (on the outside of your anus) causing ongoing pain, swelling, or bleeding despite other treatments
• You have a combination of internal and external haemorrhoids that need to be treated at the same time
• You have acutely thrombosed haemorrhoids — where a blood clot has formed inside a haemorrhoid, causing sudden, severe pain and swelling
• A significant amount of the lining of your bowel (the mucosa) has slipped downwards alongside the haemorrhoids
• You have had ongoing symptoms despite previous non-surgical treatments that simply have not worked well enough

• Durable long-term result — in published series, recurrence after a haemorrhoidectomy is below 10% at five years
• It can treat large or complicated haemorrhoid disease where other approaches have not been enough
• It is the only treatment that can properly address external haemorrhoids (the ones that sit on the outside of your anus) — banding cannot reach these
• Long-term results are good — in published series, lasting relief from bleeding and prolapse is maintained beyond five years in most people
• Usually done as a day procedure, or with a short overnight stay — you will not need a long hospital admission
• The tissue removed is always sent to a pathologist for analysis — this is a routine safety step to make sure there are no rare underlying conditions, and you do not need to do anything for this to happen

• Pain after the operation — this is the most significant side effect of this surgery, and it is important to be upfront with you about that. The area around your anus is very sensitive, and the first few days can be uncomfortable. You will be sent home with a good pain management plan — a combination of simple medications — and most people find it becomes progressively more manageable after the first three or four days. You will not be left to cope on your own.
• Bleeding — a small amount of bleeding in the early post-operative period is normal. Significant bleeding straight after the operation is uncommon (less than 1%). There is a small risk — around 2 to 5% of patients — of a secondary bleed occurring around 7 to 10 days after surgery, when the body is shedding the healing tissue. This can look alarming, but it usually settles on its own. If it happens, call us or go to your nearest emergency department.
• Difficulty passing urine (urinary retention) — some people find it hard to urinate in the first hours after the operation, which is common after any procedure in this area and under general anaesthetic. If this happens, a temporary urinary catheter (a small tube) can be placed to drain your bladder until things settle — usually within a day.
• Narrowing of the anal canal (anal stricture) — in fewer than 2% of cases, some scarring during healing can cause the anal opening to narrow slightly. If this happens, it can be treated with simple stretching (dilatation) procedures.
• Minor leakage or control issues (faecal incontinence) — a small number of patients notice some minor leakage or difficulty controlling wind or stools in the long term. Serious incontinence is rare; minor changes are more common, though most settle over time.
• Wound infection or slow healing — because the wounds in this area are naturally exposed to moisture and bacteria, infection or delayed healing can occasionally occur. This is uncommon, and is treated with antibiotics and wound care if needed.

Full bowel preparation is not needed for a haemorrhoidectomy — typically a phosphate enema is given on the day. If you take blood thinners, diabetes medication, GLP-1 weight-loss injectables, or iron supplements, please flag this when you book — these need specific adjustments before the procedure.

• You will be asked to stop aspirin, anti-inflammatory medications (like ibuprofen or naproxen), and blood thinners as directed — our rooms will give you specific guidance on which medications to pause and when
• Before your operation, you will have a proper conversation about what to expect during recovery — including the pain — so you can plan ahead and are not caught off guard
• You will start taking a stool softener before the procedure, and continue for four weeks afterwards — this is important because keeping your stools soft and easy to pass is one of the best things you can do to make your recovery more comfortable

• You will be admitted to Warringal Private Hospital or Epworth Eastern on the morning of your surgery and given a general anaesthetic — you will be fully asleep throughout and will not be aware of anything. The anaesthetist will speak with you beforehand. You will be positioned carefully on the operating table (either on your back with legs raised, or face-down) — the team manages this entirely while you are asleep.
• Each haemorrhoidal complex is identified and removed at its base — the whole operation typically takes around 30 to 45 minutes.
• The wounds are either left open to heal naturally or partially closed, depending on what is found during the operation — both approaches heal well in this area.
• Before you wake up, a local anaesthetic is injected into the area to give you several hours of numbness — this helps keep you comfortable in the immediate recovery period.
• You will spend a few hours in the day-stay recovery unit before going home. You will be discharged with pain medications and stool softeners, and clear written instructions.
• On the evening of your operation, you can begin warm saltwater sitz baths — simply sitting in a shallow bath or basin of warm water for 10 to 15 minutes. These are soothing and help keep the area clean as it heals.

• Days 1 to 3: This is the most uncomfortable stretch, and we want to be honest with you about that. The area will be sore, and going to the toilet for the first time can feel daunting. Take your pain medication regularly (do not wait until the pain becomes severe), apply nifedipine ointment as directed (this helps relax the sphincter spasm that drives much of the pain), use ice packs for 15 minutes every hour in the first few days, do your sitz baths, keep your stools soft with the medications provided, and rest as much as you can. Having a support person at home during this time is really helpful. Full step-by-step instructions are in the Post-haemorrhoidectomy aftercare guide.
• Days 3 to 7: For most people, the pain starts to ease noticeably from day three or four onwards. You'll be able to move around more comfortably, and light activity around the house is fine and encouraged.
• Around 1 week: Some people — particularly those in desk-based jobs — are able to return to light work around this point, especially if they can work from home. Manual or physically demanding work takes longer. Everyone heals at a different pace, so follow your body's lead.
• 3 to 4 weeks: By this stage, most people are back to normal day-to-day activities, including exercise. The wounds are healing well, and the discomfort has largely resolved for most people. Full healing continues internally for a little longer.
• In the long term, keeping your diet high in fibre and drinking plenty of water is the single most important thing you can do to keep haemorrhoids from coming back. Your body will thank you for it.
• A post-operative review is routinely arranged 2 to 6 weeks after your procedure, with timing depending on the type of operation — this review is provided at no charge. It is a chance to check that everything is healing well and to answer any questions you have.

Questions or concerns after your operation? Please don't sit at home worrying — call our rooms on (03) 9816 3951 and leave a message, which goes directly as a text to Mr Nguyen. You can also text the office mobile on 0499 090 126. We aim to get back to you promptly during business hours — no question is too small.

If you're worried something is seriously wrong: Call 000 immediately or go straight to your nearest emergency department — do not wait for us to call you back. If it's easier, the Austin Hospital Emergency Department is available on (03) 9496 5000. Trust your instincts — if something feels urgent, treat it as urgent.