Review article| Volume 82, ISSUE 6, P1153-1167, December 2002


      The exact definition of hemorrhoids has been difficult to formulate, if for no other reason than that the pathophysiology of this condition remains elusive. The word, hemorrhoid (haima = blood; rhoos = flowing), derives from the Greek adjective, haimorrhoides [
      • Hulme-Moir M.
      • Bartolo D.C.
      Disorders of the anorectum.
      ]. As a disease entity, hemorrhoids have been reported to plague the human race since the earliest history of man. Data from the National Center for Health Statistics suggest that approximately 10 million people in the United States suffer from hemorrhoids [
      • Johanson J.F.
      • Sonnenberg A.
      The prevalence of hemorrhoids and chronic constipation. An epidemiologic study.
      ]. The exact prevalence of hemorrhoids is difficult to estimate, however, because patients presenting with any anorectal symptoms assume that they are suffering from this condition. Therefore, the ultimate diagnosis and management truly must rest with an experienced clinician.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribers receive full online access to your subscription and archive of back issues up to and including 2002.

      Content published before 2002 is available via pay-per-view purchase only.


      Subscribe to Surgical Clinics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Hulme-Moir M.
        • Bartolo D.C.
        Disorders of the anorectum.
        Gastroenterol Clin North Am. 2001; 30: 183-197
        • Johanson J.F.
        • Sonnenberg A.
        The prevalence of hemorrhoids and chronic constipation. An epidemiologic study.
        Gastroenterology. 1990; 98: 380
        • Thomson W.B.F.
        The nature of haemorrhoids.
        Br J Surg. 1975; 62: 542
        • Corman M.L.
        in: Corman M.L. Colon and rectal surgery. 4th edition. Lippincott-Raven, Philadelphia1998: 147-205
        • Keighley M.R.B.
        • Williams N.S.
        Haemorrhoidal disease.
        in: Keighley M.R.B. Williams N.S. Surgery of the anus, rectum, and colon. 2nd edition. W.B. Saunders Co, London1999: 351-427
        • Nivatvongs S.
        in: Gordon P.H. Nivatvongs S. Principles and practice of surgery for the colon, rectum, and anus. 2nd edition. Quality Medical Publishing Inc, St. Louis1999: 193-215
        • Kluiber R.M.
        • Wolff B.G.
        Evaluation of anemia caused by hemorrhoidal bleeding.
        Dis Colon Rectum. 1994; 37: 1006
        • Standards Task Force
        American Society of Colon and Rectal Surgeons. Practice parameters for the treatment of hemorrhoids.
        Dis Colon Rectum. 1993; 36: 1118
        • Moesgaard F.
        • Nielsen M.L.
        • Hansen J.B.
        • et al.
        High-fiber diet reduces bleeding and pain in patients with hemorrhoids.
        Dis Colon Rectum. 1982; 25: 454
        • Brief J.W.
        • Zimmerman D.D.
        • Schouten W.R.
        Treatment of acute strangulated internal hemorrhoid by topical application of isosorbide dinitrate ointment.
        Int J Colorectal Dis. 2000; 15: 253-254
        • Konsten J.
        • Beaten C.G.M.I.
        Hemorrhoidectomy vs. Lord's method: 17-year. follow-up of a prospective, randomized trial.
        Dis Colon Rectum. 2000; 43: 503-506
        • Khoury G.A.
        • Lake S.P.
        • Lewis M.C.A.
        • et al.
        A randomized trial to compare single with multiple phenol injection treatment for haemorrhoids.
        Br J Surg. 1985; 72: 741-742
        • Senapati A.
        • Nicholls R.J.
        A randomized trial to compare the results of injection sclerotherapy with a bulk laxative alone in the treatment of bleeding haemorrhoids.
        Int J Colorectal Dis. 1988; 3: 124-126
        • Neiger A.
        Hemorrhoids in everyday practice.
        Proctology. 1979; 2: 22
        • Reis Neto J.A.
        • Quilici F.A.
        • Cordeiro F.
        • et al.
        Ambulatory treatment of hemorrhoids: a prospective random trial.
        Coloproctology. 1992; 6: 342-347
        • Law W.-I.
        • Chu K.-W.
        Triple rubber band ligation for hemorrhoids: prospective, randomized trial of use of local anesthetic injection.
        Dis Colon Rectum. 1999; 42: 363-366
        • Beck D.E.
        Hemorrhoidal disease.
        in: Beck D.E. Wexner S.D. Fundamentals of anorectal surgery. 2nd editon. W.B. Saunders Co, London1998: 237-253
        • Corman M.L.
        • Veidenheimer M.C.
        The new hemorrhoidectomy.
        Sur Clin North Am. 1973; 53: 417-422
        • Rotheberg R.
        • Rubin R.J.
        • Eisenstat T.
        • et al.
        Rubber band ligation hemorrhoidectomy: long-term results.
        Am Surg. 1983; 49: 167
        • Wrobleski D.E.
        • Corman M.L.
        • Veideheiner M.C.
        • et al.
        Long-term evaluation of rubber ling ligation in hemorrhoidal disease.
        Dis Colon Rectum. 1980; 23: 478-482
        • MacRae H.M.
        • McLoad R.S.
        Comparison of hemorrhoidal treatment modalities: a meta-analysis.
        Dis Colon Rectum. 1995; 38: 687-694
        • Schouten W.R.
        • van Vroonhoven T.J.
        Lateral internal sphincterotomy in the treatment of hemorrhoids: a clinical and manometric study.
        Dis Colon Rectum. 1986; 29: 869-872
        • Leong A.F.P.
        • Hussain M.J.
        • Seow-Chen F.
        • et al.
        Performing internal sphincterotmy with other anorectal procedures.
        Dis Colon Rectum. 1994; 37: 1130-1132
        • Hayssen T.K.
        • Luchtefeld M.A.
        • Senagore A.J.
        Limited hemorrhoidectomy: results and long-term follow up.
        Dis Colon Rectum. 1999; 42: 909-915
        • Sayfon J.
        • Becker A.
        • Koltun L.
        Sutureless closed hemorrhoidectomy: a new technique.
        Ann Surg. 2001; 234: 21-24
        • Arbman G.
        • Krook H.
        • Haapaniemi S.
        Closed vs. open hemorroidectomy - is there any difference?.
        Dis Colon Rectum. 2000; 43: 311-334
        • Bleday R.
        • Pena J.P.
        • Rothenberger D.A.
        • et al.
        Symptomatic hemorrhoids: current incidence and complications of operative therapy.
        Dis Colon Rectum. 1992; 35: 477
      1. Longo A. Treatment of hemorrhoidal disease by reduction of mucosa and hemorrhoidal prolapse with circular suturing device: a new procedure. In: Mundozzi, editor. 6th World Congress of Endoscopic Surgery. Rome, June 3–6, 1998. p. 777–84.

        • Ho Y.H.
        • Cheong W.K.
        • Tsang C.
        • et al.
        Stapled hemorrhoidectomy - cost and effectiveness. Randomized, controlled trial including incontinence scoring, anorectal manometry, and endoanal ultrasound assessments at up to three months.
        Dis Colon Rectum. 2000; 43: 1666-1675
        • Shalaby R.
        • Desoky A.
        Randomized clinical trial of stapled versus Milligan-Morgan haemorrhoidectomy.
        Br J Surg. 2001; 88: 1049-1053
        • Wexner S.I.D.
        The quest for painless surgical treatment of hemorrhoids continues.
        J Am Coll Surg. 2001; 193: 174-178
        • Arnaud J.-P.
        • Pessaux P.
        • Huten N.
        • et al.
        Treatment of hemorrhoids with circular stapler, a new alternative to conventional methods: a prospective study of 140 patients.
        J Am Coll Surg. 2001; 193: 161-165
        • Seow-Choen F.
        Stapled hemorrhoidectomy: pain or gain.
        Br J Surg. 2001; 88: 1-3
      2. Milito G, Cortese F, Casciani CU. Surgical treatment of mucosal prolapse and haemorrhoids by stapler. In: Proceedings of the 6th World Congress of Endoscopic Surgery. Rome, June 3–6, 1998.

        • Mehigan B.J.
        • Monson J.R.T.
        • Hartley J.E.
        Stapling procedure for haemorrhoids versus Milligan-Morgan haemorrhoidectomy: randomized controlled trial.
        Lancet. 2000; 355: 782-785
        • Rowsell M.
        • Bello M.
        • Hemingway D.M.
        Circumferential mucosectomy (stapled haemorrhoidectomy) versus conventional haemorrhoidectomy: randomized controlled trial.
        Lancet. 2000; 355: 779-781
        • Boccasanta P.
        • Capretti P.G.
        • Venturi M.
        • et al.
        Randomised controlled trial between stapled circumferential mucosectomy and conventional circular hemorrhoidectomy in advanced hemorrhoids with external mucosal prolapse.
        Am J Surg. 2001; 182: 64-68
        • Ganio E.
        • Altornare D.F.
        • Gabrielli F.
        • et al.
        Prospective randomized multicentre trial comparing stapled with open haemorrhoidectomy.
        Br J Surg. 2001; 88: 669-674
        • Molloy R.G.
        • Kingsmore D.
        Life threatening pelvic sepsis after stapled hemorrhoidectomy.
        Lancet. 2000; 355: 810
        • Pescatori M.
        Stapled rectal prolapsectomy.
        Dis Colon Rectum. 2000; 43: 876-877
        • Perroti P.
        • Antropoli C.
        • Molino D.
        • et al.
        Conservative treatment of acute thrombosed external hemorrhoids with topical nifedipine.
        Dis Colon Rectum. 2001; 44: 405-409
        • Wexner S.D.
        AIDS: what the colorectal. surgeon needs to know.
        Prespect Colorect Surg. 1990; 2: 19-54
        • Scaglia M.
        • Delaini G.G.
        • Destafano I.
        • et al.
        Injection treatment of hemorrhoids in patients with acquired immunodeficiency syndrome.
        Dis Colon Rectum. 2001; 44: 401-404
        • Mazier W.B.
        in: Mazier W.B. Levin D.H. Luchtefeld M.A. Surgery of the colon, rectum and anus. W.B. Saunders Co, Philadelphia1995: 229-254