Background: Haemorrhoidal disease (HD) is a benign condition affecting a considerable
part of adult population. HD can be considered a social and economic burden with high impact
on patients’ lifestyle. Several new techniques and devices have been proposed for HD treatment;
however, preoperative assessment is essential and the use of classification system is recommended.
Methods: In the last two decades many studies described the preoperative assessment and several
attempts of classification for HD. This review focuses on the most relevant studies found in literature
where classification systems and clinical evaluation with differential diagnosis have been evaluated.
Results: The knowledge of classification systems and differential diagnosis for HD has been
shown to play a central role in the clinical assessment and the best treatment choice. Although
there are new challenging techniques and devices for HD treatment, a preoperative assessment is always
Conclusion: Preoperative clinical evaluation is essential for HD patient treatment and outcome.
Classification systems are useful for the therapeutic choice and researches on new medical or surgical
treatments. In fact, the international guidelines advise several therapeutic options depending on
the severity of the HD.