At what point would you recommend the removal of hemorrhoids?

Indication 4 surgery: Most hemorrhoid patients resolve with medical therapy. If your symptoms persist, beyond a 4 to 6 week trial of bowel regimen and local care, then ask for surgical referral. Take friend to help with risk/benefit analysis. Rectal surgery can benefit, recovery is challenging in this sensitive area. Be well.

Quality of life: Hemorrhoids should be removed surgically when medical management has failed and symptoms are greatly affecting your quality of life.

Few absolutes: The strongest indications for hemorrhoidectomy include thrombosed hemorrhoids which can be associated with severe pain, and hemorrhoidal bleeding bad enough to produce anemia. Other indications include grade iii - IV (prolapsed) hemorrhoids that can make hygiene difficult or rarely cause significant constipation. Patient preference is important to consider as well.