Hemorrhoid Surgery: When a Minor Procedure Brings Major Relief

It is one of the last major taboo topics in our society: anal discomfort. Yet millions of people suffer from enlarged hemorrhoids. Burning, itching, oozing, and bleeding make everyday life a torment. Many people affected put off seeing a doctor out of embarrassment—often for years. But when ointments and sitz baths no longer provide relief, hemorrhoid surgery is often the only way to achieve lasting relief.

Everyone has them—but when do they become a problem?

Hemorrhoids are not a disease in and of themselves, but rather important vascular cushions that, together with the sphincter muscle, seal the rectum. Only when blood pools inside them and they enlarge is the condition referred to as hemorrhoidal disease. Doctors classify this into four stages:

• Stages 1 & 2: Mild enlargements that can often still be effectively treated with dietary changes, sclerotherapy, or rubber band ligation.

• Grade 3: The hemorrhoids protrude during bowel movements but retract (sometimes manually).

• Grade 4: The vascular cushions remain permanently outside the anus and can no longer be pushed back in.

By stage 3 at the latest, proctologists often recommend surgery, as conservative methods reach their limits at this stage and quality of life is severely impaired.

Traditional or Modern: Surgical Methods

Modern proctology offers various procedures that are tailored to the individual patient. The goal is always the same: to remove or resect the excess tissue and restore the natural anatomy.

1. Traditional hemorrhoidectomy (e.g., according to the Milligan-Morgan method): In this procedure, the enlarged hemorrhoids are surgically excised. The wound is usually left open to promote better healing (secondary wound healing). This procedure is considered very thorough and has a low recurrence rate, but it requires a slightly longer healing period.

2. Stapler method (according to Longo): A modern, often less painful procedure. Using a special stapler, a strip of mucosa above the hemorrhoids is removed, and the prolapsed tissue is essentially “lifted”—that is, pulled back up to its original position. Since there are fewer pain nerves in the surgical area, postoperative pain is often less severe.

3. Minimally invasive procedures (e.g., laser or HAL-RAR): In newer methods, the feeding arteries are located using ultrasound and selectively ligated (HAL), or the tissue is gathered and tied off (RAR). Laser procedures are also used to shrink the hemorrhoids from the inside. These methods are particularly gentle on the sensitive anal mucosa.

After Surgery: Patience Pays Off

Fear of pain after surgery is usually greater than the reality, thanks to modern pain management approaches. Nevertheless, healing in this sensitive area of the body requires time and discipline. Soft stools are crucial for successful healing. A high-fiber diet (psyllium husks, plenty of vegetables) and adequate fluid intake are essential. Hygiene also plays a role: After a bowel movement, the area should be gently rinsed with lukewarm water—avoid using moist toilet paper or harsh soaps.

Conclusion: An Improvement in Quality of Life

Those who bring themselves to undergo surgery often regret only one thing: not having done it sooner. Success rates are high, and the liberating feeling of being able to sit, ride a bike, or exercise pain-free again far outweighs the inconveniences of the short recovery period. An open conversation with a specialist (proctologist) is the first step toward ending this silent suffering.