Written and medically reviewed by: Assoc. Prof. Cengiz Dibekoğlu, MD, General SurgeryLast updated:
Hemorrhoids
Conservative care, office procedures, and excisional surgery
Bleeding is common — but not every bleed is “just hemorrhoids.”
Internal and external hemorrhoids cause bleeding, prolapse, itching, and discomfort. Care is stepwise: dietary measures and office procedures first; excisional hemorrhoidectomy when conservative care fails for advanced symptomatic disease. Energy devices such as LigaSure assist excisional hemorrhoidectomy — they are not a separate treatment paradigm. Stapled hemorrhoidopexy is not a routine first-line surgical option for every patient. Bright rectal bleeding with anemia or change in bowel habit still needs proper examination and often colonoscopy.
Educational schematic. Some structures may be simplified or emphasized for clarity; not an exact anatomical depiction.
© Cengiz Dibekoğlu — illustrative; not for unauthorized use
Figure summary
- Labeled on this figure: Internal hemorrhoid · External hemorrhoid · Dentate line.
- Related figures on this page: Symptoms, Treatment, LigaSure, Overview.
Figure labels (English)
- Internal hemorrhoid
- External hemorrhoid
- Dentate line
Educational figures
Tap a figure to enlarge. These English illustrations mirror the Turkish hub gallery for this condition.
Symptoms Educational schematic. Some structures may be simplified or emphasized for clarity; not an exact anatomical depiction.
© Cengiz Dibekoğlu — illustrative; not for unauthorized use
Treatment Educational schematic. Some structures may be simplified or emphasized for clarity; not an exact anatomical depiction.
© Cengiz Dibekoğlu — illustrative; not for unauthorized use
LigaSure Educational schematic. Some structures may be simplified or emphasized for clarity; not an exact anatomical depiction.
© Cengiz Dibekoğlu — illustrative; not for unauthorized use
Overview Educational schematic. Some structures may be simplified or emphasized for clarity; not an exact anatomical depiction.
© Cengiz Dibekoğlu — illustrative; not for unauthorized use
Grade-based care
Not every hemorrhoid needs surgery.
Exclude other causes
Colonoscopy may be needed depending on age and red flags.
Surgery options
Excisional hemorrhoidectomy when indicated — not every technique carries the same evidence profile.
Recovery discipline
Pain control and stool softness are central after excision.
What to know
- Key note inside
Red flags beyond hemorrhoids
Heavy bleeding, anemia, weight loss, or change in bowel habit need broader evaluation — do not self-diagnose forever.
Conservative and office care
Fiber, fluids, toilet habits, and selected office procedures help many grades I–II and some grade III symptoms.
When surgery is discussed
Excisional hemorrhoidectomy for symptomatic advanced disease failing conservative and office care — not for every visible cushion.
Excisional hemorrhoidectomy
Open or closed excision remains the standard durable operation for advanced symptomatic grades.
Energy-device-assisted excision
LigaSure and similar devices are used within excisional hemorrhoidectomy to seal vessels — tools, not a separate paradigm.
- Key note inside
Stapled hemorrhoidopexy — selected only
Not recommended as a routine first-line surgical option for every patient; discussed only in selected internal-prolapse patterns.
Postoperative reality
Pain peaks in the first days; soft stools and scheduled analgesia matter more than heroic early return to heavy lifting.
What happens next
What patients notice — and which warning signs need urgent care
- 1
Hemorrhoid Symptoms
What patients notice — and which warning signs need urgent care
Read this chapter - 2
Hemorrhoid Diagnosis
Exam, anoscopy, and when colonoscopy is required
Read this chapter - 3
Hemorrhoid Treatment
How treatment options are matched to risk, stage, and goals
Read this chapter - 4
Hemorrhoid Surgery Methods
Excisional hemorrhoidectomy, office procedures, and selected stapled use
Read this chapter - 5
LigaSure Hemorrhoidectomy
Energy-device-assisted excisional hemorrhoidectomy
Read this chapter - 6
After Hemorrhoid Surgery
Pain control, soft stools, and when to call
Read this chapter - 7
Hemorrhoid Recurrence
Honest rates by method and how to protect results
Read this chapter
Patient education videos
From Dr. Dibekoğlu’s official YouTube channel.
Rectal cancer can be mistaken for hemorrhoids
Evidence
Scientific sources
Show sources · 2ASCRS clinical practice guidance for hemorrhoid staging and treatment pathways.
Evidence
Scientific sources
- 1. ASCRS clinical practice guideline — hemorrhoidsASCRS · Guideline libraryOpen source →
- 2. ASCRS clinical practice guidelines libraryAmerican Society of Colon & Rectal Surgeons (ASCRS) · Guideline libraryOpen source →
Last reviewed: 21 August 2026. Links go to publisher pages.
Appointment / info
Describe bleeding pattern, prolapse, and prior treatments clearly — and bring colonoscopy reports if already done.
This page is for education. It is not medical advice and does not replace a visit with your physician.
Medical editor: Assoc. Prof. Cengiz Dibekoğlu, MD · English patient-education hub.