First there are the non-invasive procedures such as latex banding or coagulation therapy. Latex banding involves placing a tight latex band around the pile, causing the pile to shrivel up and fall off. This is a relatively safe procedure, but it can take up to a week to complete the process, during which time the pain could get quite intense. Latex banding can only be used on piles of a certain size, as it's not suitable for piles that are too small to get a good lock on nor for piles too large to get the latex band around.

Another non-invasive procedure is cauterization therapy, which can be performed by laser, medication, or freezing. In this instance, the effect of the procedure is to cut off blood flow into the pile at the source. All of these therapies are potentially quite painful, but carry less possibility of long term damage than full incisive surgery.

Coagulation therapy, which also causes the complete stoppage of blood to the pile, is also an option. This is less effective than most, but also carries less risk and potential trauma, so it is frequently used for the elderly or for those who might not recover well.

The first invasive surgical procedure involves stapling the piles back up into the anal canal while excising as much pile tissue as possible. This procedure carries much less risk of trauma and permanent damage than hemorrhoidectomy, but does have a higher recurrence rate. People who take this option are about 3% more likely to experience a return of their piles. In addition, the surgeon needs to be specifically trained in this procedure for optimal results.

Hemorrhoidal arterial ligation is another alternative to full hemorrhoidectomy. In this procedure, the doctor finds the blood vessels feeding the artery, and closes it right above those vessels' entry into the pile. It is also less traumatic than a full hemorrhoidectomy, and boasts a 93% success rate in stopping piles from returning.

Then there is hemorrhoidectomy, which involves the total removal of the pile and surrounding tissue by either a scalpel or laser.

Neither has been proven in clinical studies to work better than the other, and while laser surgery might reduce the chance of scalpel-borne infection, it can also cause deep tissue burns if the surgeon isn't sufficiently skilled. A hemorrhoidectomy does carry the highest chance of permanent pile removal. However, it also carries the highest chance of extremely bad side effects such as lifelong incontinence and permanent nerve damage. These side effects are fortunately extremely rare, but you should be aware of them. In addition, hemorrhoidectomy has the longest recovery time and usually a long period of pain and inflammation.

Knowing the risks is an important part of deciding whether surgery is right for you. Only you, with your doctor's assistance, can decide on the pile surgery right for you.