Rethinking What We Know About Hemorrhoids

  • Robert S. Sandler
    Reprint requests Address requests for reprints to: Robert S. Sandler, MD, MPH, Division of Gastroenterology and Hepatology, Department of Medicine, CB#7555, 4157 Bioinformatics Building, University of North Carolina, Chapel Hill, North Carolina 27599-7555. fax: (919) 966-9185.
    Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina
    Search for articles by this author
  • Anne F. Peery
    Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina
    Search for articles by this author
Published:March 27, 2018DOI:
      Although hemorrhoids are responsible for considerable economic cost and personal suffering, they have received surprisingly little research attention. In the United States, hemorrhoids are the third most common outpatient gastrointestinal diagnosis with nearly 4 million office and emergency department visits annually. The etiology of hemorrhoids is speculative. A low-fiber diet and constipation have historically been thought to increase the risk for hemorrhoids, but not proven. Symptoms commonly attributed to hemorrhoids include bleeding, pain, pruritus, fecal seepage, prolapse, and mucus discharge. Research has found that these symptoms were equally reported by patients with and without hemorrhoids. Medical therapies for hemorrhoids have not been formally studied except for fiber where the results have been inconsistent. A number of office-based interventions such as rubber band ligation and infrared coagulation are widely used and economically favorable for practitioners. Surgical procedures are effective at eliminating hemorrhoids but may be painful. Given the burden of disease and numerous gaps in our understanding, the time has come for targeted research to understand the cause, symptoms, and best treatment for patients with symptomatic hemorrhoids.


      Abbreviations used in this paper:

      HCUP (Healthcare Cost and Utilization Project), IRC (infrared coagulation), OR (odds ratio), PRO (patient-reported outcome)
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