Management and Treatment of Hemorrhoidal Disease

Hemorrhoidal disease is a prevalent anorectal disorder characterised by symptomatic enlargement and distal displacement of the normal anal cushions, manifesting with bleeding, prolapse, pain and pruritus. Initial management prioritises lifestyle and dietary modification to ensure soft, regular stools and minimise straining. Pharmacological therapies—including venotonic agents, anti-inflammatory topical preparations and stool softeners—aim to reduce vascular congestion and alleviate discomfort. For persistent or recurrent symptoms, outpatient procedures such as rubber band ligation, sclerotherapy and infrared coagulation offer minimally invasive alternatives with rapid recovery. In higher-grade or refractory cases, Doppler-guided dearterialisation and stapled haemorrhoidopexy have been developed to limit tissue excision and postoperative pain, while traditional excisional haemorrhoidectomy remains the definitive intervention for extensive prolapse or complex disease. Advances in laser haemorrhoidoplasty and refined surgical adjuncts have demonstrated improved patient satisfaction and shortened convalescence. Optimal care requires individualised selection of modalities based on disease grade, symptom severity and patient preference, with an integrated approach to maintain long-term quality of life and reduce recurrence.

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Management and Treatment of Hemorrhoidal Disease publication trend

The graph below shows the total number of articles in management and treatment of hemorrhoidal disease across all publications each year (not limited to Nature Index journals).

Technical terms

Rubber band ligation (RBL): Outpatient procedure where elastic bands are applied to the haemorrhoidal base to induce ischaemic necrosis and sloughing.

Mucopexy: Surgical suspension of prolapsed mucosa by suturing the redundant tissue back into its anatomical position.

Doppler-guided dearterialisation: Technique using Doppler ultrasound to locate and ligate terminal haemorrhoidal arteries, reducing arterial inflow.

Stapled haemorrhoidopexy: Circular stapling device excises a ring of rectal mucosa above the haemorrhoids, repositioning cushions and interrupting blood supply.

References

1. Consensus statement of the Italian society of colorectal surgery (SICCR): management and treatment of hemorrhoidal disease. Techniques in Coloproctology (2020).
2. Comparison of stapled haemorrhoidopexy with traditional excisional surgery for haemorrhoidal disease (eTHoS): a pragmatic, multicentre, randomised controlled trial. The Lancet (2016).
3. Transanal hemorrhoidal dearterialization (THD) for hemorrhoidal disease: a single-center study on 1000 consecutive cases and a review of the literature. Techniques in Coloproctology (2017).
4. Non-excisional laser therapies for hemorrhoidal disease: a systematic review of the literature. Lasers in Medical Science (2020).
5. Strategies to Reduce Post-Hemorrhoidectomy Pain: A Systematic Review. Medicina (2022).