Hemorrhoid surgery is performed with the patient under anesthesia. In most cases, a general or spinal anesthetic is used. General anesthetics cause a patient to lose consciousness and sensation by an injection of medication or breathing a medicinal gas. Spinal anesthetics cause a patient to lose sensation of pain by injecting a medication into the area around the spinal cord. Some patients may be able to tolerate a local anesthetic combined with sedation. This causes a loss of sensation in only a specific region of the body. When spinal anesthetics or local anesthetics are used, the patient remains conscious during the procedure.

During hemorrhoid surgery, an anoscope is used to view the hemorrhoid and surrounding tissue. An anoscope is a short, rigid tube that is inserted into the anus. Once the surgeon can see the base of the hemorrhoid, its blood supply is tied off with surgical stitches (sutures). The hemorrhoidal tissue is removed, or excised, and some of the surrounding tissue is usually removed as well. The surgeon takes care to avoid damaging the anal sphincter. The actual removal of tissue may be done with a scalpel, scissors, cautery (uses an instrument that relies on heat or electricity to cut tissue) or laser.

The edges of the anal or rectal lining (rectal mucosa) around the excised tissue may be left open, closed or partially closed. This is a matter of physician preference. Results and post-surgical pain are similar whether the lining is left open or closed.