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A proctoplasty may also be performed. This procedure extends the removal of tissue higher into the anus so that redundant or prolapsing anal lining is also removed. Postoperative pain is a major problem with hemorrhoidectomy, and potent pain medications (narcotics) are usually required. This surgery does not remove the hemorrhoids, but rather the expanded hemorrhoidal supporting tissue that has allowed the hemorrhoids to slip downward. This procedure involves several steps: A circular, hollow tube is inserted into the anal canal and a suture (a long thread) is placed through it and woven circumferentially within the anal canal above the internal hemorrhoids.