BACKGROUND: Hemorrhoidal disease is a widespread problem in healthy working patients. The traditional surgical approaches cause a loss of several working days related to the post-operative course that is often painful. To avoid these problems while offering a symptoms resolution in patients with low degrees hemorrhoids, the non-surgical treatments are nowadays largely proposed in proctological clinics.
METHODS: We resume the recent literature on the issue to offer a practical and easy to use guide for clinicians.
RESULTS: Rubber band ligation, injection sclerotherapy and infrared coagulation are cost effective, safe and effective treatments for patients with II- and III-degree hemorrhoids. Relapses are commons even if the procedures can be repeated until symptoms resolution. IV-degree hemorrhoids are not suitable of these treatments.
CONCLUSION: The proctological clinics must evaluate the quality of life offered to patients and discuss with them the appropriate treatment in order to select the most appropriate one for symptoms resolution and disease cure. Less is not always the best but can be an alternative to be offered.