The Modern Management of Haemorrhoids

Haemorrhoidal disease has been recognised and treated for millennia. An extensive portfolio of literature has built up, particularly in the last 40 years. Despite this, the optimal management remains confusing, mainly because of the contradictory nature of some literature, much of which is of poor methodological quality. Even guidelines vary in their quality and subsequent recommendations. Undoubtedly management has altered, with an increasing ethos to tailor treatment according to patient wishes and the severity of disease. Novel innovations are rife and driven by the fact that industry recognises a common condition with outcomes, particularly pain that can be improved. This chapter summarises the current quality evidence and concludes with an evidence-based algorithm of care highlighting areas where future evidence may change management.