When hemorrhoids are treated early, surgery is usually not necessary. Unfortunately, many people feel embarrassed and postpone seeing a doctor, which often makes surgical treatment the only option to relieve their sometimes severe discomfort. Each year, about 50,000 hemorrhoid surgeries are performed in Germany.
On this page, you can find more information and connect with qualified physicians for hemorrhoid surgery.
Doctors classify hemorrhoids into four stages.
In the first and second stages, the enlarged hemorrhoidal cushions around the rectal lining are not visible externally. When hemorrhoidal tissue protrudes through the anus during straining, it usually retracts on its own shortly afterwards.
In the early stages, the following may help:
In mild cases, hemorrhoids can be treated with procedures such as sclerotherapy, rubber band ligation, or modern laser therapies. The laser precisely seals the enlarged hemorrhoids with minimal tissue damage, stopping bleeding and relieving symptoms. If this is not sufficient, surgical hemorrhoidectomy becomes necessary.
Sclerotherapy: A special solution is injected into the hemorrhoidal tissue to reduce blood flow. The hemorrhoids then shrink, easing symptoms.
Rubber band ligation: A small device places a rubber band around the hemorrhoid. This cuts off blood supply, causing the tissue to die and fall off within a few days.
Laser method: Enlarged hemorrhoids are precisely sealed, which stops bleeding and reduces discomfort.
Hemorrhoids in the third stage protrude
and no longer retract on their own.
Hemorrhoids can be located inside the rectum or externally © Henrie | AdobeStock
In the fourth stage, the enlarged hemorrhoids can no longer be manually pushed back into the rectum. At this stage, a rectal prolapse (prolapse of the rectal lining through the anus) is present.
Patients in the third and fourth stages often experience pronounced symptoms such as:
In advanced stages, surgical removal (hemorrhoidectomy) is unavoidable and the only curative option. Pain relief is typically achieved with surgery.
For removal of enlarged hemorrhoids, various effective procedures are available. The operation is performed under general or local anesthesia and usually requires inpatient care; outpatient hemorrhoid surgery is uncommon.
Below are the most common hemorrhoidectomy techniques.
This classic procedure is widely used. Individual hemorrhoids are pulled out and surgically excised. The wound in the anal canal is left open, which is why the procedure is also called an “open hemorrhoidectomy.”
The Milligan-Morgan operation is especially suited for prolapsed hemorrhoids in the third and fourth stages.
The Ferguson technique is a modification of the Milligan-Morgan procedure and is commonly performed in the United States. The steps are the same, but at the end, the surgeon closes the wound with a longitudinal suture.
This is also known as a closed hemorrhoidectomy. The advantage is quicker pain relief after surgery. However, there is some risk of scarring in the anal canal.
The Parks procedure is used for extensive fourth-degree hemorrhoids. A Y-shaped incision is made in the anal mucosa. The underlying tissue is removed, supplying blood vessels are ligated, and the wound edges are sutured in a T-shape.
The Parks hemorrhoidectomy offers several advantages:
This complex, reconstructive procedure is performed for the most severe fourth-degree hemorrhoids. After a U-shaped incision, a skin flap is folded aside, the hemorrhoidal tissue is excised, and the supplying and draining blood vessels are ligated. The mucosal flap is then repositioned and sutured. The result: rapid healing, minimal pain, and preservation of the sensitive skin in the anal region.
Patients generally experience little pain after this procedure. Healing is quick, and the sensitive skin of the anal canal is preserved.
The stapled technique is a relatively newer method, mainly used for third-degree hemorrhoids. Unlike traditional surgery, no tissue is excised. Instead, the prolapsed hemorrhoids are repositioned to their normal anatomical location in the anal canal using a special stapling device above the hemorrhoids.
Because the procedure is performed in an area without pain-sensitive nerves, postoperative pain is minimal or absent.
Overall, the risk of complications after hemorrhoid surgery is very low. With all surgical techniques, there is some risk of postoperative bleeding. Therefore, patients usually remain in the hospital for about three days.
Men may experience urinary retention. In rare cases, the following may occur:
Anal stenosis (narrowing of the anal canal) is also very rare and usually due to scar formation. In the first weeks after surgery, patients frequently report increased urgency to defecate.
Following hemorrhoidectomy, several measures support recovery and reduce pain. Especially with open wounds in the rectal and anal area, careful aftercare is crucial.
Gentle hygiene promotes healing. The anus should be rinsed with lukewarm water after each bowel movement. Afterwards, the wound should be covered with a cloth or gauze pad.
Zinc ointment protects the skin and aids healing. To allow sufficient air circulation, synthetic underwear should be avoided. Cotton underwear is best, as it is breathable and absorbs moisture.
After surgery, stool should be kept soft through a high-fiber diet and adequate fluid intake. This prevents pain during bowel movements. Overly loose stools, however, can soil the wound and cause discomfort.
Patients should not take laxatives during the recovery period.
After hemorrhoid surgery, the typical recovery period before returning to work is 1–4 weeks, depending on the surgical method and the type of work. Recovery may be shorter for sedentary jobs and longer for physically demanding work. The exact duration depends on pain levels and wound healing, as advised by the physician.
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