Estimates suggest that 10 million patients experience symptoms attributed to hemorrhoids including pain, itching, burning and bleeding. In fact, hemorrhoids represent one of the most common medical and surgical disease processes encountered in the United States with more than 50% of the population over 50 years of age experiencing “hemorrhoidal” problems. Unfortunately, many other anorectal conditions are inappropriately attributed to hemorrhoids which include anorectal bleeding from other causes including cancer, perianal skin diseases, abscess, fistula and infections both bacterial and viral. In 2004, an estimated 2 million ambulatory care visits listed hemorrhoids as the primary diagnosis and an additional 3.2 million visits listed them as one a secondary diagnosis, placing hemorrhoids in the top five of gastrointestinal system complaints (after gastroesophageal reflux disease, ventral hernia, functional disorders such as irritable bowel syndrome, and diverticular disease). Furthermore, patients filled 2 million prescriptions for the treatment of hemorrhoids in addition to the over-the-counter medications that many use for self-treatment.
Hemorrhoids (or hemorrhoidal-like symptoms) are often self-diagnosed and treated with proprietary creams, ointments and devices putting some patients at risk by avoiding proper screening recommendations for colon and rectal cancer. Numerous remedies are available on the internet and in retail outlets. The American Society of Colon and Rectal Surgeons published in 2010 revised guidelines* detailing the evaluation and treatment of hemorrhoids indicating that “it is of paramount importance for all those treating patients with hemorrhoids to have a clear understanding of the evaluation and management of this disease process.”
Treatment of hemorrhoids requires a thorough history and physical as well as an anorectal examination. Once other pathology is excluded and consideration is given to colorectal cancer screening, if the diagnosis is confirmed, hemorrhoids are classified into six categories: External and external thrombosed and internal grades I through IV. Treatment options supported by evidence-based medicine include medical therapy, rubber band ligation, sclerotherapy, infrared coagulation, surgical excision, stapled hemorrhoidopexy and Doppler guided ligation. The latter three are not office procedures and require a surgical facility. More often, excision of a thrombosed hemorrhoid is often an office procedure.
The surgeons of Associated Surgical offer several methods of hemorrhoid treatment depending on the patient and their situation: rubber band ligation, infrared coagulation, stapled hemorrhoidectomy (PPH Procedure) and traditional hemorrhoidectomy. Thrombosed external hemorrhoids are most often treated in the office. An in-office evaluation is essential to determine the best option for treatment.

*Rivadeneira, D. E., Steele, S. R., Ternent, C., Chalasani, S., Buie, D. & Rafferty, J. L. (2010). Practice parameters for the management of hemorrhoids (Revised 2010). Diseases of the Colon and Rectum 54. 1059-1064.

Management of Hemorrhoids