Hemorrhoid surgery is performed using one of two types of anesthesia: general anesthesia or spinal anesthesia, which is also known as regional anesthesia. Once you are in the operating room, the anesthesia provider, who may be a nurse or a physician, will give the medication to ensure that the you feel no pain. You may be awake but feeling no pain if you elect spinal anesthesia, or asleep if you choose a general anesthetic.
Once the anesthesia medications are given, the procedure begins. The surgeon will identify the hemorrhoid, and, if necessary, pull it down through the anus so it can be operated upon. Once the surgeon has access to the tissue, it will be "tied off" with suture to prevent bleeding. This is best described as a small tourniquet that cuts off the blood flow to the hemorrhoid. The hemorrhoid is then cut away from the other tissue.
There are multiple techniques that may be used to remove the hemorrhoid, including a scalpel, a laser, or electrocautery. Once the hemorrhoid tissue is removed, it may be sewn closed or left open to heal on its own, depending upon your surgeon's preference. This technique may be repeated if there is more than one hemorrhoid present.
Once the procedure to remove the hemorrhoid is completed, but you are still under anesthesia, you will be given a local anesthetic, which will numb the surgical area for 8-12 hours. This medication will significantly improve your pain level during the first few hours of your recovery.
You may stay in the hospital overnight, or you may be able to return home once you wake from anesthesia completely. You may experience some difficulty urinating after surgery. Some difficulty is expected, but a complete inability to urinate should be considered an emergency and treatment should be sought.