Hemorrhoids

Abstract

Hemorrhoids represent a sizeable source of patient morbidity, with a broad array of associated symptoms. • Knowledge of anorectal and hemorrhoid anatomy is critical to selecting the appropriate treatment. • Minimizing straining, improving hydration, and increasing fiber intake are the first step for patients with symptomatic hemorrhoids. • Most office procedures are best suited for symptomatic grade I-III internal hemorrhoids or thrombosed external hemorrhoids. • One's armamentarium should include a variety of techniques for symptomatic hemorrhoids to optimize outcomes and provide individualized therapy. • Complications of hemorrhoid surgery include urinary retention, bleeding, infection, stenosis, incontinence, and recurrence. • Special considerations include pregnant patients, as well as those with Crohn's disease, immunocompromise, or portal hypertension.