Piles Removal Surgery: When Is It Needed?

Living with persistent bleeding, pain or prolapsed piles can make everyday activities and bowel movements increasingly uncomfortable. While piles, also known as haemorrhoids, often improve with lifestyle changes, medication or minimally invasive procedures, these measures may not provide lasting relief for everyone. Larger or more advanced piles may require surgery to relieve symptoms and improve quality of life.

Understanding when piles removal is recommended and what surgery involves can help you make informed decisions about your care.

When Is Piles Removal Recommended?

Not all piles require surgery. The most suitable treatment depends on the severity of your symptoms, the grade of the piles and how they respond to previous treatment.

Piles removal may be recommended if you have:

• Third- or fourth-degree piles
• Persistent or recurrent bleeding
• Prolapsed piles that cannot be easily pushed back
• Pain or discomfort that affects your daily activities
• Recurrent thrombosed external piles
• Second-degree piles that have not responded to treatments such as rubber band ligation

Your colorectal surgeon will assess your condition and discuss whether surgery is the most appropriate option based on your symptoms and examination findings.

What Types of Piles Surgery Are Available?

Several surgical techniques are available for treating piles. The most appropriate procedure depends on the type, size and severity of the haemorrhoids.

Conventional Haemorrhoidectomy

Conventional haemorrhoidectomy involves removing the enlarged haemorrhoidal tissue through surgical excision. It is widely regarded as the most effective treatment for permanently removing large or advanced piles and is commonly recommended for third- and fourth-degree haemorrhoids.

Although recovery is generally longer than with minimally invasive procedures, it offers durable symptom relief and a lower risk of recurrence for appropriately selected patients.

Stapled Haemorrhoidectomy

Stapled haemorrhoidectomy is primarily used to treat prolapsed internal piles. During the procedure, the prolapsed tissue is repositioned back into the anal canal before a circular stapling device removes excess tissue and secures the remaining tissue in place.

Compared with conventional haemorrhoidectomy, this technique is generally associated with less postoperative pain. However, it may not be suitable for all types of piles.

Laser Haemorrhoidectomy

Laser haemorrhoidectomy uses a laser to remove haemorrhoidal tissue in a manner similar to conventional surgery. Despite common misconceptions, current evidence does not show that laser piles surgery provides superior outcomes or significantly less postoperative pain compared with standard surgical techniques.

Your colorectal surgeon will advise whether this approach is appropriate based on your condition.

What Happens Before Piles Surgery?

Before surgery, your colorectal surgeon will perform a thorough assessment to confirm that surgery is the most suitable treatment.

This usually includes:

• Reviewing your symptoms and medical history
• Performing a physical examination
• Conducting investigations such as anoscopy or sigmoidoscopy where appropriate
• Discussing the recommended procedure, expected recovery and potential risks
• Reviewing your medications, including blood-thinning medication if applicable

You will also receive instructions on preparing for surgery, including fasting requirements and any temporary medication adjustments.

What Is Recovery Like After Piles Removal?

Recovery varies depending on the procedure performed and the extent of the surgery. Most patients can return home on the same day or after a short hospital stay, depending on their individual circumstances.

During the recovery period, it is normal to experience:

• Mild to moderate discomfort
• Minor bleeding during bowel movements
• Temporary swelling around the surgical site

Your surgeon may recommend pain relief, stool softeners and a high-fibre diet to make bowel movements more comfortable while healing takes place. Most people gradually return to their normal activities over the following weeks, although strenuous exercise and heavy lifting should be avoided until advised otherwise by your surgeon.

What Are the Benefits of Piles Surgery?

For patients with advanced or persistent piles, surgery can provide long-term relief when other treatments have not been successful.

Potential benefits include:

• Relief from persistent bleeding and discomfort
• Removal of prolapsed haemorrhoids
• Improved comfort during bowel movements
• Reduced risk of recurrent symptoms
• Better quality of life for patients with severe disease

While surgery offers effective symptom relief, maintaining healthy bowel habits remains important to reduce the risk of new haemorrhoids developing in the future.

Timely Treatment Can Help Restore Comfort

Persistent or advanced piles can affect your comfort, confidence and quality of life, particularly when symptoms continue despite conservative treatment. Knowing when surgery is appropriate allows you to explore the available treatment options before symptoms become more severe.

At Ho Kok Sun Colorectal, a colorectal clinic in Singapore, every patient receives a comprehensive evaluation to determine whether piles surgery is appropriate. Care is led by Dr Ho Kok Sun, with treatment recommendations tailored to your symptoms, examination findings and the severity of your condition. If piles continue to interfere with your daily life despite conservative treatment, arrange a consultation to discuss your options and the most appropriate next steps.

Frequently Asked Questions (FAQs) About Piles Removal Surgery