Is Hemorrhoidectomy Worth the Pain? Comparing Long-Term Relief, Recovery and Recurrence With Other Piles Treatments

Medicine Made Simple Summary

Hemorrhoidectomy removes problematic hemorrhoidal tissue and can provide durable relief, especially for large or advanced piles. Its main disadvantage is a more painful and longer recovery compared with treatments such as rubber band ligation. Banding is less invasive and allows faster return to daily activities, but some patients may need repeat treatment and recurrence can be higher, particularly in Grade 3 disease. The right choice depends on hemorrhoid grade, prolapse, external disease, symptoms and previous treatment response. Surgery may offer greater long-term control when hemorrhoids are advanced or repeatedly return.

Introduction

If you have piles that keep coming back, you may eventually reach a difficult decision.

Should you continue with medicines and lifestyle changes?

Should you try rubber band ligation?

Should you consider laser or another minimally invasive procedure?

Or should you undergo hemorrhoidectomy and get rid of the problematic hemorrhoidal tissue altogether?

One of the biggest concerns is pain.

Patients often hear that hemorrhoidectomy can be painful and wonder whether the short-term discomfort is really worth it when less-invasive treatments are available.

The answer is not the same for everyone.

For early or moderate hemorrhoids, surgery may be more treatment than you actually need. For large, prolapsed or repeatedly recurring hemorrhoids, however, a more definitive procedure may provide better long-term control.

Recent evidence comparing treatments for Grade 3 hemorrhoids illustrates this trade-off clearly. A 2025 randomized trial found that hemorrhoidectomy had substantially lower recurrence than rubber band ligation at 12 months, but patients experienced more pain during the first week and took longer to return to work.

So the real question is not simply, “Does hemorrhoidectomy hurt?”

It is:

“Is the short-term pain and recovery worth the possibility of more durable relief for my particular piles?”

What Is Hemorrhoidectomy?

Hemorrhoidectomy is a surgical procedure that removes problematic hemorrhoidal tissue.

Hemorrhoids are normal structures containing blood vessels and supporting tissue around the anus and lower rectum. They become a problem when they enlarge, bleed, prolapse or cause persistent symptoms.

The procedure is generally considered for patients with larger or more advanced hemorrhoids, particularly when there is significant prolapse, an external component or failure of less-invasive treatments.

Unlike rubber band ligation, hemorrhoidectomy does not simply shrink the hemorrhoid.

It removes the problematic tissue.

That is one reason it can provide durable symptom control, but it is also why recovery is generally more demanding. 

Why Do Some People Need More Than One Treatment?

Not every hemorrhoid behaves in the same way.

A small Grade 1 hemorrhoid may respond to fibre, fluids and better bowel habits.

A Grade 2 hemorrhoid may respond to rubber band ligation if lifestyle measures are not enough.

A Grade 3 hemorrhoid may require repeated office procedures or surgery depending on its size, prolapse and other features.

Grade 4 hemorrhoids remain permanently prolapsed and are much more likely to require surgical treatment.

This means that comparing treatments without considering hemorrhoid grade can be misleading.

A procedure that works very well for a small internal hemorrhoid may not provide the same result for a large, prolapsed hemorrhoid.

What Is Rubber Band Ligation?

Rubber band ligation, commonly called banding, is an office-based procedure used mainly for internal hemorrhoids.

During the procedure, the doctor places a small elastic band around the base of the hemorrhoid.

The band cuts off its blood supply.

The treated tissue gradually shrinks and eventually falls away.

The area then heals with scar tissue, which can help reduce further prolapse.

The procedure is relatively quick and usually does not require the recovery associated with a major operation.

This is one of its biggest advantages. 

Why Do Patients Choose Banding?

The main attraction is convenience.

There is no large surgical wound.

Recovery is generally much faster than after hemorrhoidectomy.

Pain is usually less severe and patients can often return to work and normal activities sooner.

For appropriately selected Grade 1 and Grade 2 internal hemorrhoids, banding can be an effective treatment.

It may also be used in selected Grade 3 disease.

Long-term studies have shown that rubber band ligation can provide meaningful symptom relief for many patients with internal hemorrhoids, although some patients require repeat treatment. 

This makes banding an attractive option when avoiding surgery is a priority.

What Is the Disadvantage of Banding?

The main limitation is that it may not provide the same level of long-term control as hemorrhoidectomy for more advanced disease.

Some patients need more than one banding session.

Others experience recurrence and require additional treatment.

A long-term cohort study of Grade 3 hemorrhoids found that a single banding procedure was effective in 51.6% of patients, while a single hemorrhoidectomy was effective in 95.9%. More than one-third of patients in the banding group required a second session.

This does not mean that banding is a poor treatment.

It means that the trade-off can be different.

You may have less pain and a faster recovery, but you may need another procedure later.

What Does the Evidence Say About Recurrence?

Recurrence is one of the most important differences between treatment options.

A 2025 randomized trial involving patients with symptomatic Grade 3 hemorrhoids compared rubber band ligation with hemorrhoidectomy. At 12 months, recurrence was reported in 47.5% of patients treated with banding compared with 6.1% after hemorrhoidectomy. 

However, this study had a relatively small sample size and was stopped early because of funding limitations.

That means the results are important but should not be interpreted as a guarantee that every patient undergoing banding will have recurrence or that every patient undergoing hemorrhoidectomy will remain symptom-free.

Other studies have also found that repeated banding can achieve good long-term results in many patients.

A long-term study following patients treated with rubber band ligation found that 69% were asymptomatic at 10 to 17 years, while 28% had residual symptoms and 3% required further surgery.

The important lesson is that recurrence depends on the treatment, the grade and anatomy of the hemorrhoids, and the individual patient.

What Is the Biggest Advantage of Hemorrhoidectomy?

The biggest advantage is durability.

When problematic hemorrhoidal tissue is surgically removed, there is less remaining tissue available to prolapse in the same way.

This can make hemorrhoidectomy particularly useful for patients with large, advanced or repeatedly symptomatic hemorrhoids.

In Grade 3 disease, studies have found that hemorrhoidectomy can provide more definitive control than a single session of banding. 

For patients who have already undergone several banding sessions, repeatedly treating the same problem may become frustrating.

In such situations, a surgeon may recommend hemorrhoidectomy because the expected long-term benefit may justify the more difficult recovery.

What Is the Biggest Disadvantage of Hemorrhoidectomy?

Pain.

There is no reason to hide this from patients.

Hemorrhoidectomy is generally more painful during the early recovery period than less-invasive procedures such as rubber band ligation.

In the 2025 randomized trial of Grade 3 hemorrhoids, pain during the first week was significantly higher after hemorrhoidectomy than after banding. Patients who underwent hemorrhoidectomy also took longer to return to work. (PubMed Central (PMC))

The pain is mainly related to the surgical wound and the fact that the area is involved in bowel movements.

The first few bowel movements can be particularly uncomfortable.

However, the pain is temporary.

For most patients, it gradually improves as the wound heals.

How Long Does Hemorrhoidectomy Recovery Take?

Recovery varies between individuals.

The first several days are usually the most uncomfortable.

Bowel movements can cause pain, burning or pressure.

Some bleeding or discharge can occur during healing.

Many patients begin feeling significantly better over the first couple of weeks, although full recovery can take longer.

The American Society of Colon and Rectal Surgeons notes that patients may need around two to four weeks before returning fully to their usual level of activity. 

This is considerably longer than the recovery expected after many office-based procedures.

Therefore, if you have an important event, work commitment or travel planned, discuss the timing with your surgeon before scheduling surgery.

What About Returning to Work?

This is another important difference.

Patients undergoing banding generally return to work much sooner.

In the 2025 randomized trial, the median time to return to work was one day after rubber band ligation compared with nine days after hemorrhoidectomy. 

These numbers should not be treated as a guarantee.

Your recovery depends on the type of work you do, the extent of treatment and your individual response.

Someone working from home may return earlier than someone whose job involves prolonged sitting, driving, lifting or physical activity.

The key point is that hemorrhoidectomy usually requires more planning around work and daily activities.

Is the Pain Worth It?

This is where the answer becomes personal.

If you have mild Grade 2 hemorrhoids that respond well to banding, there may be little reason to accept the recovery associated with hemorrhoidectomy.

But imagine a different situation.

You have large Grade 3 hemorrhoids.

They prolapse every time you pass stool.

You need to push them back inside.

You have already undergone banding twice.

The symptoms keep returning.

You are constantly planning your day around your bowel movements.

In this situation, another short outpatient procedure may not provide the long-term solution you want.

The temporary pain of hemorrhoidectomy may be a reasonable trade-off for a greater chance of durable symptom control.

What About Grade 1 and Grade 2 Piles?

For early-stage disease, hemorrhoidectomy is generally not the first option.

Grade 1 hemorrhoids do not prolapse outside the anus.

Grade 2 hemorrhoids prolapse during bowel movements but return inside on their own.

Many patients with these grades can be treated with fibre, fluids, constipation management and appropriate office-based procedures.

Rubber band ligation is particularly useful for symptomatic internal hemorrhoids that have not responded adequately to conservative treatment.

The goal is to avoid unnecessary surgery when a simpler treatment can provide adequate relief. 

What About Grade 3 Piles?

Grade 3 hemorrhoids require more careful decision-making.

These hemorrhoids come out during bowel movements and need to be pushed back manually.

Some patients respond well to banding.

Others have large or advanced prolapse and eventually require surgery.

Recent evidence suggests that hemorrhoidectomy may provide better long-term symptom control and lower recurrence for Grade 3 disease, while banding offers less pain and faster recovery.

This is an excellent example of why treatment should be individualized.

There is no universally correct answer.

What About Grade 4 Piles?

Grade 4 hemorrhoids remain outside and cannot be pushed back inside.

This is advanced disease.

Because the tissue remains permanently prolapsed, simple dietary changes or repeated topical medicines are unlikely to correct the underlying structural problem.

Surgical treatment is much more likely to be recommended.

If you have Grade 4 piles, the question is generally less about whether you need treatment and more about which surgical approach is most appropriate. 

What About Laser Treatment?

Laser treatment has become popular because it is often promoted as a less painful alternative to conventional hemorrhoid surgery.

However, “laser piles treatment” can refer to different techniques.

Some procedures use laser energy to shrink hemorrhoidal tissue or reduce its blood supply rather than removing the tissue in the same way as an excisional hemorrhoidectomy.

The advantages and limitations depend on the exact technique, the hemorrhoid grade and the surgeon's experience.

Patients should therefore avoid choosing a treatment simply because it contains the word “laser.”

Ask your surgeon what exact procedure is being performed and why it is suitable for your hemorrhoids.

The goal should be appropriate treatment, not simply the newest technology.

What About Hemorrhoidal Artery Ligation?

Another option for selected patients is hemorrhoidal artery ligation.

This procedure identifies and ties off blood vessels supplying the hemorrhoids, often using Doppler guidance.

It aims to reduce blood flow and prolapse without removing the hemorrhoidal tissue.

Evidence from the HubBLe randomized trial found that recurrence at one year was lower after hemorrhoidal artery ligation than after a single session of rubber band ligation, but the artery-ligation procedure caused more early pain and often required more resources. When repeat banding was considered, the difference in recurrence became less clear. 

This illustrates an important principle.

A treatment with a lower recurrence rate after one procedure may not necessarily be the best choice once repeat procedures, cost, recovery and patient preference are considered.

What About Stapled Hemorrhoidopexy?

Stapled hemorrhoidopexy is another surgical technique that relocates prolapsed hemorrhoidal tissue rather than removing the hemorrhoids in the same way as conventional excisional hemorrhoidectomy.

It can offer advantages such as less early postoperative pain in selected patients.

However, long-term recurrence is an important consideration.

A 2026 systematic review of randomized trials found a higher overall recurrence risk after stapled hemorrhoidopexy compared with conventional hemorrhoidectomy, particularly recurrence related to prolapse, although the evidence remains subject to limitations. 

This is why the surgeon needs to consider both immediate recovery and long-term durability when choosing the operation.

What Matters More: Recovery or Recurrence?

There is no universal answer.

Some patients value a quick return to work above everything else.

For them, an office procedure may be preferable even if there is a possibility of repeat treatment.

Other patients are tired of repeated episodes and want the greatest likelihood of long-term control from a single procedure.

For them, a more definitive operation may be attractive.

Your priorities matter.

A good treatment decision should consider your medical condition as well as your lifestyle.

Is a Second Banding Procedure a Problem?

Not necessarily.

Needing another banding session does not mean the treatment failed.

Some patients require more than one session because there are multiple hemorrhoidal columns or because symptoms persist.

For some patients, this is a reasonable trade-off.

They may prefer two short procedures with minimal recovery over one operation followed by a longer recovery.

The important question is whether repeated treatment continues to provide meaningful relief.

When Does Hemorrhoidectomy Become More Attractive?

Hemorrhoidectomy may become a stronger option when several factors are present.

These can include:

• Large Grade 3 or Grade 4 hemorrhoids.
• Significant prolapse that interferes with daily activities.
• A substantial external hemorrhoidal component.
• Repeated bleeding despite appropriate treatment.
• Persistent symptoms after banding or other office procedures.
• Multiple recurrences that require repeated intervention.
• A strong preference for a more definitive treatment despite the longer recovery.

The decision should follow a clinical examination rather than simply the number of symptoms you have. 

What Can You Do to Reduce Recurrence After Treatment?

Treatment does not replace healthy bowel habits.

Even after successful hemorrhoid treatment, constipation and straining can continue to put pressure on the anal tissues.

A few habits are particularly important.

Eat enough fibre.

Drink adequate fluids.

Treat constipation early.

Avoid prolonged toilet sitting.

Do not repeatedly strain to pass stool.

Stay physically active according to your doctor's advice.

These measures are useful whether you have undergone banding, laser treatment or hemorrhoidectomy.

Can Hemorrhoids Return After Hemorrhoidectomy?

Hemorrhoidectomy is highly effective, but it does not make you permanently immune to hemorrhoids.

The removed hemorrhoidal tissue is unlikely to return in exactly the same form.

However, new hemorrhoidal disease can develop from other tissue.

Long-term bowel habits therefore still matter.

Constipation, straining and prolonged toilet sitting should be addressed even after successful surgery.

The aim is not only to treat today's hemorrhoids but also to reduce the factors that contribute to future problems.

How Should You Make the Decision?

Start with the diagnosis.

Find out your hemorrhoid grade.

Understand whether the disease is internal, external or mixed.

Ask whether there is significant prolapse.

Then consider your previous treatment history.

If you have never tried conservative treatment, surgery may be premature.

If you have Grade 2 disease that responds to banding, there may be little reason to undergo hemorrhoidectomy.

If you have Grade 3 disease with repeated recurrence after banding, surgery may offer better long-term control.

If you have Grade 4 disease, surgical evaluation is usually appropriate.

Finally, consider your priorities.

Do you want the shortest recovery?

Or do you want the greatest likelihood of long-term control from a single procedure?

There is no wrong answer when the decision is made with a clear understanding of the trade-offs.

Questions to Ask Your Surgeon

Before choosing a treatment, ask your surgeon to explain the reasoning behind the recommendation.

Ask what grade your hemorrhoids are and whether there is an external component.

Ask whether banding is appropriate.

If banding has already failed, ask whether another session is worthwhile or whether surgery would provide better long-term control.

If laser treatment has been recommended, ask what exact technique will be used and what outcomes can realistically be expected.

If hemorrhoidectomy is recommended, ask about postoperative pain, recovery time, return to work and the risk of complications.

Most importantly, ask what the doctor would recommend if you were a family member.

The conversation should be about your condition rather than the popularity of a particular procedure.

Final Thoughts

Is hemorrhoidectomy worth the pain?

For some patients, absolutely.

For others, no.

The answer depends on the severity of the hemorrhoids and what you want from treatment.

Rubber band ligation offers an important advantage: it is less invasive, usually less painful and allows a faster return to daily life. However, some patients need repeat procedures and recurrence can be more common, particularly in advanced hemorrhoidal disease. 

Hemorrhoidectomy has the opposite trade-off.

The recovery is more demanding.

The first few days can be painful.

Returning to work and normal activities can take longer.

But for selected patients, particularly those with large, prolapsed or recurrent hemorrhoids, it can provide more durable symptom control.

The decision should therefore not be based on fear of pain or the promise of a quick recovery.

Think about the whole picture.

Short-term recovery versus long-term relief.

One definitive procedure versus the possibility of repeat treatment.

Less pain now versus potentially greater durability later.

If your hemorrhoids are mild, a major operation may be unnecessary.

If your hemorrhoids are advanced or repeatedly returning despite appropriate treatment, avoiding surgery at all costs may simply prolong the problem.

The right treatment is the one that matches your hemorrhoid grade, anatomy, symptoms, previous treatment response and personal priorities.

Call to Action

If you are repeatedly experiencing bleeding, prolapse, discomfort or recurrence after piles treatment, consult an experienced colorectal or general surgeon before choosing your next treatment. A detailed examination can determine whether you are better suited to conservative treatment, banding, another minimally invasive procedure or hemorrhoidectomy. Understanding the expected recovery and long-term benefits of each option can help you make a decision based on evidence rather than fear.