At what point should hemorrhoids be removed?

Not the first choice: When one has persistent bleeding/discomfort in the rectal area despite maximal conservative treatment - fiber supplement/laxative, rectal preparations (anusol hc), constipation control etc.

Hemorrhoids: Hemorrhoids should be treated first with fiber, fluids, and miralax (polyethylene glycol). Most symptoms should respond to a healthy diet and regular meals and these supplements. Intervention beyond this should be based on frequency, severity and impact on daily activity of hemorrhoid related symptoms. Keeping a journal of symptoms and diet and bowel function is quite useful.

When symptomatic: Only surgery when have bleeding pain or difficulty with keeping clean. With surgery can be a 3 to 6 week recovery from pain and discomfort.