Key Concepts

• 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.