Harvard Women's Health Watch

Ask the doctor: Do I need hemorrhoid surgery?

Q. I have bleeding hemorrhoids, and my doctor recommends surgery. How do I know if this is really necessary?

A. The symptoms of itching, rectal pain, and bleeding of hemorrhoids can be very uncomfortable. Yet surgery is rarely the first treatment. Most hemorrhoids can be managed with conservative measures. Try boosting the fiber and fluid in your diet and getting regular exercise to stimulate bowel function. If possible, move your bowels whenever you feel the urge. Use a wet cloth or wipe and pat dry after a bowel movement to avoid irritating inflamed skin. Sit in a warm-water sitz bath to ease discomfort. Over-the-counter hemorrhoid products, including witch-hazel wipes (Tucks) and analgesic creams, can provide temporary relief.

If these steps do not work for you, or if a hemorrhoid has prolapsed (protruded), you may need a procedure. Two minimally invasive techniques—rubber-band ligation and laser, infrared, or bipolar coagulation—shrink internal hemorrhoids. They do not require anesthesia, but it can take two to four procedures to get rid of hemorrhoids. If you have hemorrhoids that are persistently painful, that protrude, or that return after minimally invasive procedures, you probably need surgery. Although hemorrhoidectomy requires general anesthesia and you'll need pain medication afterward, it cures roughly 95% of cases and has a very low complication rate.

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