Do Hemorrhoids Always Need Surgery?
Hemorrhoids can be uncomfortable, worrying, and sometimes embarrassing to talk about. The good news is that many people improve without surgery, especially when symptoms are assessed early and treated in the right way.
Haemorrhoids, also spelled hemorrhoids, are common. They can affect adults of all ages and often flare up during periods of constipation, straining, pregnancy, heavy lifting, or prolonged sitting. While some cases need specialist treatment, surgery is not always the first step.
This article is general information only and does not replace personalised medical advice.
What are hemorrhoids?
Haemorrhoids are swollen blood vessels in or around the anus and lower rectum. They are similar to varicose veins, but in a different part of the body.
They may be:
Internal
Located inside the rectum. These may cause bleeding or a feeling of tissue coming out during bowel motions.
External
Located under the skin around the anus. These can cause pain, swelling, itching, or a tender lump.
Haemorrhoids can develop when pressure builds up in the lower rectum. Common triggers include:
Straining during bowel motions
Chronic constipation or diarrhoea
Sitting on the toilet for long periods
Low-fibre diet
Pregnancy and childbirth
Heavy lifting
Age-related weakening of supporting tissues
Bright red bleeding, itching, discomfort, and a lump near the anus are common symptoms. Still, rectal bleeding should never be assumed to be from haemorrhoids without proper assessment.
Do all hemorrhoids require surgery?
No. Most haemorrhoids do not need surgery.
In many cases, symptoms improve with bowel habit changes, simple treatments, and time. The aim is to reduce pressure, soften stools, and allow irritated tissue to settle.
The right treatment depends on:
The type of haemorrhoids
Severity of symptoms
How long symptoms have been present
Whether bleeding, prolapse, or severe pain is occurring
How much symptoms affect daily life
A specialist can also check whether symptoms are truly due to haemorrhoids or another condition, such as an anal fissure, inflammation, polyps, or bowel disease.
Non-surgical treatment options
Increase fibre intake
Fibre helps soften stools and makes bowel motions easier to pass. This can reduce straining, one of the main causes of haemorrhoid flare-ups.
Good fibre sources include:
Fruits such as apples, pears, berries, and oranges
Vegetables
Wholegrain bread, oats, brown rice, and bran
Legumes such as lentils, beans, and chickpeas
Fibre supplements, if advised by a doctor
It is best to increase fibre gradually. A sudden jump can cause bloating or gas.
Stay well hydrated
Fibre works best when paired with enough fluid. Drinking water during the day can help prevent hard stools and reduce constipation.
People who exercise, work outdoors, or live in warmer Australian climates may need extra fluids. Alcohol and too much caffeine can contribute to dehydration in some people.
Make helpful lifestyle changes
Small daily changes can make a real difference. Try to:
Avoid straining on the toilet
Go when the urge appears, rather than delaying
Limit time sitting on the toilet
Stay physically active
Avoid long periods of sitting when possible
Use a footstool to support a better toilet posture
Warm baths may also ease discomfort during a flare-up.
Use over-the-counter treatments carefully
Pharmacy treatments can help with short-term symptoms such as itching, swelling, or irritation. These may include creams, ointments, suppositories, or wipes.
They can be useful, but they should not replace assessment if bleeding continues, pain is severe, or symptoms keep returning. Some products are not intended for long-term use, so follow instructions or ask a pharmacist or doctor.
Consider office-based procedures
Some internal haemorrhoids can be treated without an operation in hospital. One common option is rubber band ligation.
During this procedure, a small rubber band is placed around the base of an internal haemorrhoid. This cuts off its blood supply, causing it to shrink and fall away over several days. It is usually done in a clinic setting and does not involve cutting the skin.
Rubber band ligation is not suitable for every case, but it can be effective for selected internal haemorrhoids.
When might surgery be recommended?
Surgery may be recommended when haemorrhoids are large, severe, recurrent, or not responding to other treatments.
It may also be considered when there is:
Significant prolapse that does not stay inside
Ongoing bleeding after other causes have been excluded
Severe pain from external haemorrhoids or clots
Repeated flare-ups affecting work, sleep, or daily comfort
Failed non-surgical or office-based treatment
Surgical options vary depending on the diagnosis. Dr. Zeev Duieb will explain which approach is most suitable, what it involves, and what recovery is likely to look like.
Signs it is time to see a specialist
Book a medical review if you notice:
Rectal bleeding, especially if it keeps happening
A lump that does not settle
Pain that is severe or worsening
Symptoms lasting more than a week or two despite treatment
Leakage, mucus, or difficulty cleaning
A change in bowel habits
Unexplained weight loss or fatigue
These symptoms do not always mean something serious, but they should be checked. Early assessment can reduce worry and help avoid ongoing discomfort.
What to expect during a surgical consultation
A consultation for haemorrhoids is usually straightforward and respectful. Many patients feel anxious beforehand, but the aim is to understand the problem and offer practical options.
Dr. Zeev Duieb will usually ask about:
Symptoms and how long they have been present
Bleeding, pain, itching, or prolapse
Bowel habits and constipation
Past treatments
Medical history and medications
Family history of bowel conditions, if relevant
An examination may be recommended. This is done with privacy, explanation, and care. In some cases, further tests may be advised to rule out other causes of bleeding or bowel symptoms.
You should leave the consultation with a clear understanding of the likely diagnosis and the treatment choices available.
Recovery after treatment
Recovery depends on the treatment used.
With lifestyle measures and pharmacy treatments, symptoms may improve over days to weeks, especially if constipation is addressed.
After rubber band ligation, some people feel mild pressure or discomfort for a short time. Normal activities can often resume quickly, although advice may vary.
After surgery, recovery may take longer. Some discomfort is expected, particularly with bowel motions early on. Pain relief, stool softeners, hydration, and careful wound care can help. Your surgeon will provide instructions on activity, hygiene, diet, and follow-up.
The goal of treatment is not only to manage the current flare-up, but also to reduce the chance of symptoms returning.
Frequently asked questions
Can haemorrhoids go away on their own?
Mild haemorrhoids can improve with fibre, fluids, avoiding straining, and time. Persistent or recurrent symptoms should be assessed.
Is rectal bleeding always from haemorrhoids?
No. Haemorrhoids are a common cause of bright red bleeding, but other conditions can also cause bleeding. A proper diagnosis matters.
Is rubber band ligation painful?
Most people feel pressure rather than sharp pain. Some discomfort or aching can occur afterward, but it is usually manageable.
How do I know if I need surgery?
Surgery is usually considered when symptoms are severe, recurrent, or not improving with other treatments. A specialist assessment is the best way to decide.
Will haemorrhoids come back after treatment?
They can recur, especially if constipation or straining continues. Long-term bowel habits play an important role in prevention.
Take the next step
Haemorrhoids are common, treatable, and often manageable without surgery. Still, persistent symptoms should not be ignored, especially bleeding, worsening pain, or problems that affect your quality of life.
If haemorrhoids continue to trouble you, book a consultation with Dr. Zeev Duieb, General Surgeon in Melbourne, to discuss the most appropriate treatment options for your symptoms and circumstances.
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