What Size Hemorrhoids Need Surgery?

Hemorrhoids, also known as piles, are small lumps around and inside the anus. They can cause discomfort, pain and even bleeding.

Most small hemorrhoids go away on their own after a while but what size hemorrhoids need surgery? If your hemorrhoids don’t show any signs of prolapse, then it is likely that they disappear without treatment.

In this guide, we take a closer look at different hemorrhoid sizes and various types of hemorrhoid surgery.

Table of Contents

What Size Hemorrhoids Need Surgery?

Hemorrhoids are divided into four different grades. Grade 3 and grade 4 hemorrhoids usually require surgery because they are a larger size.

These two grades can cause severe pain, bleeding and even prolapse which means that surgery is necessary.

On the other hand, grade 1 and grade 2 hemorrhoids either don’t result in prolapse or they go away on their own. These smaller hemorrhoids don’t typically swell up or bleed.

If you notice that your hemorrhoids are causing pain and they are bleeding, then your doctor may recommend surgery.

What Is a Grade 3 Hemorrhoid?

A hemorrhoid grade 3 is a large, internal hemorrhoid that protrudes through the anus. It does not return to its original position, so the patient needs to push it back in.

This continual prolapse can lead to other health conditions, such as a permanent prolapse. This is the reason why healthcare professionals typically recommend surgery for this grade of hemorrhoid.

What Is a Grade 4 Hemorrhoid?

Hemorrhoids with a grade 4 are internal hemorrhoids that cause a continual prolapse where the patient cannot push it back inside the anus.

Prolapsed hemorrhoids can only be corrected with surgery.

How Do You Know If Your Hemorrhoid Needs Surgery?

The majority of hemorrhoids are small enough that they don’t require surgery. However, if you notice that your hemorrhoids bleed a lot or they feel painful, then surgery can be a quick way to remove them.

Here are the common symptoms of grade 3 and grade 4 hemorrhoids that may need surgical intervention.


As hemorrhoids are swollen veins that are swollen and inflamed, the tissue in the affected area is irritated and itchy.

The itching is uncomfortable. However, you may be able to treat your hemorrhoids at home by:

  • Drinking a lot of water and eating a high-fiber diet
  • Avoiding strained bowel movements
  • Apply an anti-itch cream for a week
  • Avoid lifting or straining the hemorrhoid area
  • Put ice on the irritated area for ten minutes

These hemorrhoid home remedies can reduce the swelling, irritation, and itching around the anus. It may also reduce the size of the hemorrhoid.


Another common symptom of hemorrhoids is bleeding. The bright red blood usually only appears when you use the bathroom.

It is important to keep in mind that small amounts of blood are not an immediate sign that your hemorrhoid requires surgery.

Some bleeding hemorrhoids may clear on their own. However, if you notice heavy bleeding after each visit to the bathroom, then your doctor may recommend a medical procedure.


Together with the itchiness, your hemorrhoids may also feel painful because of the inflamed tissue inside the anus. 

You might also be tempted to press on the affected area or scratch it. However, this can irritate the hemorrhoid and result in more pain.

You can treat the pain with over-the-counter painkillers or hemorrhoid creams. If the pain doesn’t go away, then it is best to speak to your doctor about potential surgery.

Prolonged Symptoms

Most hemorrhoids clear up with effective home remedies within a few weeks. If a patient’s symptoms don’t improve after a month, then a doctor can suggest surgery.

Depending on your symptoms, there are a number of different procedures that can be performed. Not all of them involve anesthesia.

Protruding Tissue

While hemorrhoids are usually internal, sometimes they can also stick out of the anal opening. Healthcare professionals call this a prolapse.

A doctor can find out from the level of prolapse, how far a hemorrhoid has progressed. The larger hemorrhoids cause permanent prolapse that can only be rectified with surgical intervention.

Both grade 3 and 4 hemorrhoids can prolapse which is a sign that you will likely need more than home remedies.

Recurring Hemorrhoids

If you had hemorrhoids in the past, then you can change your diet and lifestyle to prevent continued outbreaks.

Hemorrhoid prevention typically includes drinking a lot of water, reducing the time that you are sitting, and eating plenty of fiber.

If you still experience hemorrhoid flare-ups, then you can speak to your doctor about treating them with hemorrhoidectomy.

Types of Hemorrhoid Surgery

Hemorrhoid surgery is a common procedure that is done either without anesthesia or with local anesthesia.

There are a variety of techniques that a surgeon can use to remove the hemorrhoid and correct the prolapse.


Banding is one of the most common office procedures for grade 3 internal hemorrhoids. This technique is also known as rubber band ligation.

The surgeon places a tight band around the bottom of the hemorrhoid to remove the blood supply. This procedure may need to be done two or more times to fully remove the hemorrhoid.

This hemorrhoid procedure is not painful but you might feel discomfort or a slight pressure in the affected area.

However, banding is not recommended for people who take blood thinners because the bleeding risk is relatively high.

Coagulation Therapy

Coagulation therapy or photocoagulation is typically used for internal hemorrhoids with grades 1, 2, or 3.

This office hemorrhoid treatment uses extreme cold, heat, or infrared light to shrink the hemorrhoid. Similar to banding, it is usually painless but can cause mild cramping.

Hemorrhoidal Artery Ligation

Similar to banding and photocoagulation, hemorrhoidal artery ligation (HAL) is a type of hemorrhoid surgery that doesn’t require anesthesia. It is commonly used to remove grade 2 or 3 hemorrhoids.

With this treatment, the surgeon locates and closes the specific blood vessels that cause the hemorrhoid. This method is equally effective as hemorrhoidectomy but it involves less post-operative pain.


Hemorrhoidectomy is the traditional hemorrhoid removal technique for grade 3 and 4 hemorrhoids, including large external hemorrhoids or hemorrhoids with prolapse.

This procedure requires a spinal block, sedation, or anesthesia which means that you won’t feel any pain when the doctor removes the hemorrhoid by cutting it out.

Hemorrhoidectomy only takes a few hours and you can return home after a brief observation period in a recovery room.

As hemorrhoidectomy is an invasive procedure, the post-operative pain can last up to one week. There is also a greater risk of infection.


Also known as stapling, hemorrhoidopexy is a same-day surgery with local or general anesthesia. This hemorrhoid treatment targets hemorrhoids with grade 3 or 4 and prolapsed tissue.

During hemorrhoidopexy, a surgeon applies a staple to fix the prolapsed hemorrhoid in its place. He also cuts the blood supply to the hemorrhoid, so it will shrink and return inside the anus.

This procedure is less painful than hemorrhoidectomy and patients typically take less recovery time. However, there is a greater risk of prolapse recurrence.

Final Thoughts

What size hemorrhoids need surgery also depends on other symptoms you may have, such as bleeding, pain, or swelling around the affected area.


Content on the DrHouse website is written by our medical content team and reviewed by qualified MDs, PhDs, NPs, and PharmDs. We follow strict content creation guidelines to ensure accurate medical information. However, this content is for informational purposes only and not a substitute for professional medical advice, diagnosis, or treatment. For more information read our medical disclaimer.

Always consult with your physician or other qualified health providers about medical concerns. Never disregard professional medical advice or delay seeking it based on what you read on this website.

If you are experiencing high fever (>103F/39.4C), shortness of breath, difficulty breathing, chest pain, heart palpitations, abnormal bruising, abnormal bleeding, extreme fatigue, dizziness, new weakness or paralysis, difficulty with speech, confusion, extreme pain in any body part, or inability to remain hydrated or keep down fluids or feel you may have any other life-threatening condition, please go to the emergency department or call 911 immediately.



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