1. Hemorrhoidal disease affects 10 million in the U.S.
2. Symptoms include bleeding, pain, and swelling.
3. Treatment is guided by severity: internal, external, mixed.
4. First-line therapy includes increased fiber and hydration.
5. Rubber band ligation is preferred for grades I-III; excisional hemorrhoidectomy is for grades III-IV.
6. Recurrence rates can be high with conservative treatments.
7. Postoperative complications may include pain and incontinence.
8. Transanal hemorrhoidal dearterialization has higher recurrence but less discomfort.

Source: JAMA Network