Background <p>Post-hemorrhoidectomy urinary symptoms are common, with an incidence reaching 50% in some studies. Pudendal nerve block was used to alleviate pain and urinary symptoms after perineal surgeries. This study explored the effect of trans-perineal pudendal nerve block on the patient experience after hemorrhoidectomy, regarding urinary symptoms and analgesic requirements.</p> Methods <p>This study included 66 patients randomly allocated into two equal groups. In group P, ultrasound-guided pudendal nerve block was applied after induction of anesthesia and lithotomy position, while no block was applied in group C.</p> Results <p>The incidence of postoperative dysuria was significantly lower in group P (14% in group P, 40% in group C, <i>p</i> 0.028). Also, the mean numerical rating scale score and the frequency of analgesia requirements on the first day after surgery were significantly lower in group P (1.7 ± 1 vs. 0.5 ± 0.8, p 0.00, 3.8 ± 0.31 vs. 2.7 ± 0.59, p 0.00 consecutively).</p> Conclusions <p>Ultrasound-guided trans-perineal pudendal nerve block resulted in a better patient experience after hemorrhoidectomy, regarding urinary symptoms and analgesic requirements, without any noted complications.</p>