Clin Colon Rectal Surg 2011; 24(1): 005-013
DOI: 10.1055/s-0031-1272818
© Thieme Medical Publishers


Caroline Sanchez1 , Bertram T. Chinn1
  • 1Division of Colon and Rectal Surgery, University of Medicine and Dentistry–Robert Wood Johnson Medical School, Edison, New Jersey
Further Information

Publication History

Publication Date:
23 February 2011 (online)


Hemorrhoid disease is the most common reason patients seek evaluation by a colon and rectal surgeon. The majority of hemorrhoids can be managed nonoperatively with medical management or office-based procedures. The authors review the anatomy, pathophysiology, presentation, and management of hemorrhoids.


  • 1 Johanson J F, Sonnenberg A. The prevalence of hemorrhoids and chronic constipation. An epidemiologic study.  Gastroenterology. 1990;  99 1856-1857
  • 2 Cintron J, Abacarian H. Benign anorectal: hemorrhoids. In: Wolff B G, Fleshman J W, eds. The ASCRS of Colon and Rectal Surgery. New York, NY: Springer-Verlag; 2007: 156-177
  • 3 Smith L E. Hemorrhoids. In: Fazio V, ed. Current Therapy in Colon and Rectal Surgery. St. Louis, MO: Mosby; 2004: 11-18
  • 4 Kluiber R M, Wolff B G. Evaluation of anemia caused by hemorrhoidal bleeding.  Dis Colon Rectum. 1994;  37 (10) 1006-1007
  • 5 Aigner F, Gruber H, Conrad F et al.. Revised morphology and hemodynamics of the anorectal vascular plexus: impact on the course of hemorrhoidal disease.  Int J Colorectal Dis. 2009;  24 (1) 105-113
  • 6 Greenspon J, Williams S B, Young H A, Orkin B A. Thrombosed external hemorrhoids: outcome after conservative or surgical management.  Dis Colon Rectum. 2004;  47 (9) 1493-1498
  • 7 Johanson J F, Rimm A. Optimal nonsurgical treatment of hemorrhoids: a comparative analysis of infrared coagulation, rubber band ligation, and injection sclerotherapy.  Am J Gastroenterol. 1992;  87 (11) 1600-1606
  • 8 Bat L, Melzer E, Koler M, Dreznick Z, Shemesh E. Complications of rubber band ligation of symptomatic internal hemorrhoids.  Dis Colon Rectum. 1993;  36 (3) 287-290
  • 9 Savioz D, Roche B, Glauser T, Dobrinov A, Ludwig C, Marti M C. Rubber band ligation of hemorrhoids: relapse as a function of time.  Int J Colorectal Dis. 1998;  13 (4) 154-156
  • 10 Bayer I, Myslovaty B, Picovsky B M. Rubber band ligation of hemorrhoids. Convenient and economic treatment.  J Clin Gastroenterol. 1996;  23 (1) 50-52
  • 11 Poon G P, Chu K W, Lau W Y et al.. Conventional vs. triple rubber band ligation for hemorrhoids. A prospective, randomized trial.  Dis Colon Rectum. 1986;  29 (12) 836-838
  • 12 Lee H H, Spencer R J, Beart Jr R W. Multiple hemorrhoidal bandings in a single session.  Dis Colon Rectum. 1994;  37 (1) 37-41
  • 13 MacRae H M, McLeod R S. Comparison of hemorrhoidal treatment modalities. A meta-analysis.  Dis Colon Rectum. 1995;  38 (7) 687-694
  • 14 MacRae H M, McLeod R S. Comparison of hemorrhoidal treatments: a meta-analysis.  Can J Surg. 1997;  40 (1) 14-17
  • 15 Sim A J, Murie J A, Mackenzie I. Three year follow-up study on the treatment of first and second degree hemorrhoids by sclerosant injection or rubber band ligation.  Surg Gynecol Obstet. 1983;  157 (6) 534-536
  • 16 Fleshman J, Madoff R. Hemorrhoids. In: Cameron J, ed. Current Surgical Therapy. Philadelphia, PA: Elsevier; 2004: 245-252
  • 17 Pilkington S A, Bateman A C, Wombwell S, Miller R. Anatomical basis for impotence following haemorrhoid sclerotherapy.  Ann R Coll Surg Engl. 2000;  82 (5) 303-306
  • 18 Barwell J, Watkins R M, Lloyd-Davies E, Wilkins D C. Life-threatening retroperitoneal sepsis after hemorrhoid injection sclerotherapy: report of a case.  Dis Colon Rectum. 1999;  42 (3) 421-423
  • 19 Ratto C, Donisi L, Parello A, Litta F, Doglietto G B. Evaluation of transanal hemorrhoidal dearterialization as a minimally invasive therapeutic approach to hemorrhoids.  Dis Colon Rectum. 2010;  53 (5) 803-811
  • 20 Faucheron J L, Gangner Y. Doppler-guided hemorrhoidal artery ligation for the treatment of symptomatic hemorrhoids: early and three-year follow-up results in 100 consecutive patients.  Dis Colon Rectum. 2008;  51 (6) 945-949
  • 21 Conaghan P, Farouk R. Doppler-guided hemorrhoid artery ligation reduces the need for conventional hemorrhoid surgery in patients who fail rubber band ligation treatment.  Dis Colon Rectum. 2009;  52 (1) 127-130
  • 22 Palimento D, Picchio M, Attanasio U, Lombardi A, Bambini C, Renda A. Stapled and open hemorrhoidectomy: randomized controlled trial of early results.  World J Surg. 2003;  27 (2) 203-207
  • 23 Nisar P J, Acheson A G, Neal K R, Scholefield J H. Stapled hemorrhoidopexy compared with conventional hemorrhoidectomy: systematic review of randomized, controlled trials.  Dis Colon Rectum. 2004;  47 (11) 1837-1845
  • 24 Chung Y C, Wu H J. Clinical experience of sutureless closed hemorrhoidectomy with LigaSure.  Dis Colon Rectum. 2003;  46 (1) 87-92
  • 25 Person B, Wexner S D. Novel technology and innovations in colorectal surgery: the circular stapler for treatment of hemorrhoids and fibrin glue for treatment of perianal fistulae.  Surg Innov. 2004;  11 (4) 241-252
  • 26 Pescatori M. PPH stapled hemorrhoidectomy—a cautionary note.  Dis Colon Rectum. 2003;  46 (1) 131
  • 27 Pescatori M. Stapled hemorrhoidectomy: a word of caution.  Int J Colorectal Dis. 2002;  17 (5) 362-363
  • 28 Holzheimer R G. Hemorrhoidectomy: indications and risks.  Eur J Med Res. 2004;  9 (1) 18-36
  • 29 Chen H H, Wang J Y, Changchien C R et al.. Risk factors associated with posthemorrhoidectomy secondary hemorrhage: a single institution prospective study of 4880 consecutive closed hemorrhoidectomies.  Dis Colon Rectum. 2002;  45 1096-1099
  • 30 Bleday R, Pena J P, Rothenberger D A, Goldberg S M, Buls J G. Symptomatic hemorrhoids: current incidence and complications of operative therapy.  Dis Colon Rectum. 1992;  35 (5) 477-481
  • 31 You S Y, Kim S H, Chung C S, Lee D K. Open vs. closed hemorrhoidectomy.  Dis Colon Rectum. 2005;  48 (1) 108-113
  • 32 Khan S, Pawlak S E, Eggenberger J C et al.. Surgical treatment of hemorrhoids: prospective, randomized trial comparing closed excisional hemorrhoidectomy and the Harmonic Scalpel technique of excisional hemorrhoidectomy.  Dis Colon Rectum. 2001;  44 (6) 845-849
  • 33 Andrews B T, Layer G T, Jackson B T, Nicholls R J. Randomized trial comparing diathermy hemorrhoidectomy with the scissor dissection Milligan-Morgan operation.  Dis Colon Rectum. 1993;  36 (6) 580-583
  • 34 Ibrahim S, Tsang C, Lee Y L, Eu K W, Seow-Choen F. Prospective, randomized trial comparing pain and complications between diathermy and scissors for closed hemorrhoidectomy.  Dis Colon Rectum. 1998;  41 (11) 1418-1420
  • 35 Hoff S D, Bailey H R, Butts D R et al.. Ambulatory surgical hemorrhoidectomy—a solution to postoperative urinary retention?.  Dis Colon Rectum. 1994;  37 (12) 1242-1244
  • 36 Sneider E B, Maykel J A. Diagnosis and management of symptomatic hemorrhoids.  Surg Clin North Am. 2010;  90 (1) 17-32
  • 37 Rasmussen O O, Larsen K G, Naver L, Christiansen J. Emergency haemorrhoidectomy compared with incision and banding for the treatment of acute strangulated haemorrhoids. A prospective randomised study.  Eur J Surg. 1991;  157 (10) 613-614
  • 38 Wolkomir A F, Luchtefeld M A. Surgery for symptomatic hemorrhoids and anal fissures in Crohn's disease.  Dis Colon Rectum. 1993;  36 (6) 545-547
  • 39 Dietrich III C S, Hill C C, Hueman M. Surgical diseases presenting in pregnancy.  Surg Clin North Am. 2008;  88 (2) 403-419, vii–viii
  • 40 Saleeby Jr R G, Rosen L, Stasik J J, Riether R D, Sheets J, Khubchandani I T. Hemorrhoidectomy during pregnancy: risk or relief?.  Dis Colon Rectum. 1991;  34 (3) 260-261
  • 41 Hosking S W, Smart H L, Johnson A G, Triger D R. Anorectal varices, haemorrhoids, and portal hypertension.  Lancet. 1989;  1 (8634) 349-352
  • 42 Goenka M K, Kochhar R, Nagi B, Mehta S K. Rectosigmoid varices and other mucosal changes in patients with portal hypertension.  Am J Gastroenterol. 1991;  86 (9) 1185-1189
  • 43 Bernstein W C. What are hemorrhoids and what is their relationship to the portal venous system?.  Dis Colon Rectum. 1983;  26 (12) 829-834
  • 44 Johansen K, Bardin J, Orloff M J. Massive bleeding from hemorrhoidal varices in portal hypertension.  JAMA. 1980;  244 (18) 2084-2085
  • 45 Shibata D, Brophy D P, Gordon F D, Anastopoulos H T, Sentovich S M, Bleday R. Transjugular intrahepatic portosystemic shunt for treatment of bleeding ectopic varices with portal hypertension.  Dis Colon Rectum. 1999;  42 (12) 1581-1585
  • 46 Wexner S D, Smithy W B, Milsom J W, Dailey T H. The surgical management of anorectal diseases in AIDS and pre-AIDS patients.  Dis Colon Rectum. 1986;  29 (11) 719-723
  • 47 Safavi A, Gottesman L, Dailey T H. Anorectal surgery in the HIV + patient: update.  Dis Colon Rectum. 1991;  34 (4) 299-304
  • 48 Morandi E, Merlini D, Salvaggio A, Foschi D, Trabucchi E. Prospective study of healing time after hemorrhoidectomy: influence of HIV infection, acquired immunodeficiency syndrome, and anal wound infection.  Dis Colon Rectum. 1999;  42 (9) 1140-1144
  • 49 Scaglia M, Delaini G G, Destefano I, Hultén L. Injection treatment of hemorrhoids in patients with acquired immunodeficiency syndrome.  Dis Colon Rectum. 2001;  44 (3) 401-404

Bertram T ChinnM.D. 

Division of Colon and Rectal Surgery, UMDNJ–Robert Wood Johnson Medical School

3900 Park Ave., Edison, NJ 08820