• Hemorrhoids are one of the most common conditions seen by colon and rectal surgeons.  • Medical therapy for symptoms should be the initial recommendation for the patient. These include fiber supplementation, increased water intake, and ointment therapy.  • Office-based procedures, such as rubber band ligation and injection sclerotherapy, are offered for internal hemorrhoids.  • Excisional hemorrhoidectomy is reserved for patients who cannot undergo an office-based procedure or who does not qualify for an office-based procedure due to characteristics of their hemorrhoids.  • Urgent hemorrhoidectomy is only reserved for hemorrhoids that are strangulated, incarcerated, or gangrenous.