Management of haemorrhoids

Haemorrhoids or "piles" are enlarged vascular cushions within the anal canal that have been described for many centuries and continue to form a large part of a colorectal surgeon's workload. The exact incidence of this common condition is difficult to estimate as many people are reluctant to seek medical advice for various personal, cultural, and socioeconomic reasons, but epidemiological studies report a prevalence varying from 4.4% in adults in the United States to over 30% in general practice in London. 1 2 The treatment of haemorrhoids is still evolving, and this article provides an update on the role of established and innovative treatments (fig