Most haemorrhoid symptoms can be managed without surgery, often with changes to diet, fluid intake, and toilet habits. Some patients also benefit from simpler procedures such as rubber band ligation or injection sclerotherapy.

When haemorrhoids are large, prolapsed, painful, or when these measures no longer help, a haemorrhoidectomy may be recommended. This is an operation to remove the haemorrhoidal tissue, usually performed under a general anaesthetic.

You may require an enema before surgery.

• Local anaesthetic nerve blocks are used at the time of surgery to reduce pain immediately afterwards.

• Most people experience significant discomfort for 1–2 weeks, especially when opening their bowels.

• Pain gradually improves, and most patients are back to work and normal activities within 4–6 weeks, although complete wound healing can take that long.

A caudal injection is a type of regional anaesthetic very similar to an epidural. It involves placing local anaesthetic near the nerves at the base of the spine, which numbs the area after surgery.

• It is considered the gold standard for pain relief after haemorrhoidectomy, often giving excellent comfort compared with standard tablets alone.

• Because the area is numb, a urinary catheter is required, and you will usually need to stay in hospital overnight for monitoring.

• The numbness wears off gradually, and you will then move on to oral pain relief (tablets).

This option is not suitable for everyone, but if it is available and appropriate for you, it can make the early recovery period much more comfortable.

• Local anaesthetic nerve blocks are used at the time of surgery to reduce pain immediately afterwards.

• Most people experience significant discomfort for 1–2 weeks, especially when opening their bowels.

• Pain gradually improves, and most patients are back to work and normal activities within 4–6 weeks, although complete wound healing can take that long.

You will go home with a set plan to keep you comfortable and support your recovery:

• Anti-inflammatory pain relief (NSAID): taken regularly for 7 days to reduce pain and swelling.

• Movicol (laxative): to soften stools and prevent straining.

• Metronidazole (antibiotic): prescribed for 7 days to reduce infection risk.

⚠️ Metronidazole can sometimes cause abdominal cramps or colicky pain. If this becomes problematic, you can stop taking it — but continue with the other medicines.

You may also receive additional pain relief prescriptions if needed, tailored to your health and the type of operation performed.

• Take regular warm salt baths (sitz baths) for comfort and hygiene.

• Avoid firm wiping; use moist wipes or pads instead.

• Wear perianal pads to keep the area clean.

• Follow your medicine plan for pain relief and stool softening.

• Increase fibre and fluids in your diet to avoid constipation.

Contact your surgeon, GP, or the hospital if you develop:

• Sudden worsening pain not relieved by medicines

• Persistent bleeding or heavy bleeding from the wound

• Fever or signs of infection

• Difficulty passing urine or stools

Haemorrhoidectomy is an effective treatment for severe haemorrhoids, but it does come with a recovery period of discomfort. With good wound care, stool softening, and the prescribed medicines, most patients return to normal activities within 4–6 weeks.