A recent review on hemorrhoids (Clin Gastroenterol Hepatol 2013; 11: 593-603) had a few useful quotes:

“Why are hemorrhoids called hemorrhoids and asteroids called asteroids? Wouldn’t it make more sense if it was the other way around? But if that were true, then a proctologist would be an astronaut.”  Robert Schimmel

“My troubles are all behind me” George Brett (on returning to World Series after treatment for a thrombosed external hemorrhoid)

Besides the quotes, the review article provides a concise approach to the epidemiology, anatomy, pathophysiology, diagnosis, and management of hemorrhoids.

Specific points:

• The word ‘Hemorrhoid’ is derived from the Greek words “haima” meaning blood and “rhoos” meaning flow.  The word “pile” is derived from the Latin word “pila” meaning a ball.
• Conservative treatment: increasing fiber, avoidance of straining/minimizing time on toilet, and sitz baths several times per day.
• “Well-designed studies have found no evidence to support the use of any of the myriad of over-the-counter topical preparations that contain low-dose local anesthetics, corticosteroids, keratolytics, protectants, or antiseptics.”  “Long-term use of these products, particularly steroid preparations, …should be discouraged.”
• Rubber band ligation: “highly effective…in a meta-analysis of 18 prospective, randomized trials, RBL was overall superior to injection sclerotherapy or infrared coagulation in the treatment of grades I, II, and III (internal) hemorrhoids.”  “Risk of complications is low <1-3%, including pain, bleeding, and vasovagal symptoms.” Higher rates of pain are reported in some studies and may be dependent on location of RBL.
• Cryosurgery and Lord’s procedure ..”have lost favor in the United States.”
• Surgical treatment: “Nonsurgical approaches are successful in 80-99% of patients.” “Surgical hemorrhoidectomy is more effective than RBL in the treatment of grade III hemorrhoids but incurs additional complications, pain, and disability.”  Complications have included urinary retention, bleeding, infection, anal stenosis, and incontinence (2-12%)–Ouch!