They remove hemorrhoids in a few different ways, depending on how big, painful, and stubborn they are. In many cases, doctors don’t “cut them out” right away; they start with less invasive procedures done in the office, and surgery is usually a last step if other options fail.

1. Office procedures (no big surgery)

These are usually for internal hemorrhoids (inside the rectum), especially grades 1–3.

Rubber band ligation (most common)

  • The doctor inserts a small scope into the rectum so they can see the hemorrhoid.
  • A tiny device places a tight rubber band at the base of the internal hemorrhoid.
  • The band cuts off blood supply, so the hemorrhoid shrivels, dies, and falls off in a few days when you go to the bathroom.
  • You might feel pressure or mild pain for a day or two, but it’s usually quick and done without full anesthesia.

Sclerotherapy (injection treatment)

  • A chemical solution is injected into or around the hemorrhoid.
  • This irritates the blood vessel lining and makes it scar and shrink, reducing bleeding and size.
  • It’s used for smaller internal hemorrhoids or for people who can’t have banding.

Infrared / heat / coagulation techniques

  • A probe delivers heat, laser, or infrared light directly to the hemorrhoid tissue.
  • The heat seals blood vessels and causes the hemorrhoid to shrink over time.
  • Done in short sessions; you go home the same day.

2. Minor procedures for external hemorrhoids

These focus mostly on painful clots in external hemorrhoids.

Thrombectomy (for a clot in an external hemorrhoid)

  • If a big, painful lump appears suddenly around the anus (a thrombosed hemorrhoid), and you get seen within about 72 hours, the doctor can numb the area with a local anesthetic.
  • They make a small cut over the clot, remove the trapped blood, and sometimes trim the overlying skin.
  • Pain relief is often very fast, though the area can be sore for several days.

3. Surgical removal (hemorrhoidectomy)

This is the classic “they cut them out” operation and is usually for large, very symptomatic, or prolapsing hemorrhoids, or when other treatments have failed.

How a hemorrhoidectomy works

  • It’s done in an operating room under spinal, regional, or general anesthesia, so you’re numb or asleep.
  • The surgeon gently pulls the hemorrhoidal tissue away from the anal canal.
  • Using a scalpel, scissors, electrocautery, or a laser, they cut out the hemorrhoid “bundles” at their base, taking care to protect the muscle that controls the anus.
  • The wounds may be closed with dissolvable stitches (closed hemorrhoidectomy) or sometimes left partially open to drain (open hemorrhoidectomy).
  • Usually, all main hemorrhoid columns are treated in one session.

What it feels like afterward

  • This surgery is effective, but recovery is known to be quite painful for 1–2 weeks because the area is very sensitive and you still have to pass stool.
  • Doctors often recommend:
    • Strong pain medicine for a few days
    • Stool softeners and fiber so you don’t strain
    • Sitz baths (soaking the area in warm water) several times a day
  • Most people can get back to light activities in 1–2 weeks, but it may take longer before everything feels fully normal.

4. Stapled hemorrhoidopexy (“stapling”)

This is another operating-room procedure mainly for internal hemorrhoids that prolapse (bulge out).

  • A circular stapling device is placed just inside the rectum.
  • It removes a ring of tissue above the hemorrhoids and staples the remaining tissue.
  • This pulls the hemorrhoids back up inside and reduces blood flow to them, so they shrink.
  • Pain is often less than traditional hemorrhoidectomy because the staples are placed higher up, where there are fewer pain nerves.
  • Not usually used for large external hemorrhoids.

5. Newer / specialized methods (like laser or artery ligation)

Some centers use more modern tools that still follow the same basic idea: cut off blood supply and shrink or remove the tissue.

  • Laser hemorrhoid surgery : A focused laser beam shrinks or removes hemorrhoid tissue and seals blood vessels at the same time. Often marketed as having less bleeding and faster recovery, though availability and cost vary.
  • Hemorrhoidal artery ligation (HAL / THD) : The surgeon uses a special ultrasound probe to find the arteries feeding the hemorrhoids and ties them off with stitches. Sometimes they also “lift” the tissue back inside. Pain may be milder than a full excision in some people.

6. When do they actually remove hemorrhoids?

Doctors usually move to removal (banding, laser, surgery, etc.) when:

  • You have repeated bleeding or prolapse that doesn’t improve with diet, fiber, ointments, and lifestyle changes.
  • You have severe pain, especially from thrombosed external hemorrhoids.
  • The hemorrhoids are large, come out frequently, or have been graded as higher-stage internal hemorrhoids.
  • Complications appear (like anemia from chronic bleeding).

Example path:

  1. Start with fiber, fluids, stool softeners, and creams.
  2. If internal hemorrhoids keep bleeding or prolapsing → office procedures (rubber band ligation, sclerotherapy, coagulation).
  3. If those fail or hemorrhoids are very large/prolapsing → surgery (hemorrhoidectomy or stapled/laser methods).

7. Safety, risks, and what you should know

Even though “removal” sounds scary, these are very common procedures and usually safe in the hands of an experienced colorectal or general surgeon. Possible risks (especially with full surgery) include:

  • Pain for days to weeks
  • Bleeding after surgery
  • Difficulty urinating the first day or so
  • Infection or delayed wound healing
  • Rarely, narrowing of the anal canal (stricture) or issues with control if the muscle is injured

Most of these risks are uncommon when the surgery is done properly and you follow post-op instructions closely.

8. If you’re thinking about treatment

  • Get evaluated by a doctor (ideally a colorectal specialist) to confirm it’s really hemorrhoids and not something else causing bleeding or pain.
  • Ask which grade/type of hemorrhoids you have; that determines which removal options make sense.
  • Bring up your priorities: quickest recovery vs. lowest chance of recurrence vs. avoiding general anesthesia.
  • Never try to cut, pop, or band hemorrhoids at home; that can lead to heavy bleeding or infection.

TL;DR:

  • Small or internal hemorrhoids are often removed or shrunk in the office with bands, injections, or heat.
  • Large, prolapsing, or stubborn hemorrhoids may need surgery, where the surgeon cuts out the hemorrhoid tissue or uses a stapler/laser to remove and reposition it.
  • The goal in every method is to stop blood flow to the swollen veins so they shrink or disappear, while protecting the muscles that control the anus.

If you tell me your situation (internal vs external, symptoms, or what your doctor suggested), I can walk you through what that specific procedure is like step by step.