Prolapsing Hemorrhoids

Hemorrhoids are a common anorectal disease and are often found in clinical practice. Patients mostly come with a complaint of anal bleeding or prolapsing mass. Grade III and IV prolapsing hemorrhoids are distinguished from grade II by the fact that grade II prolapse only during defecation and returns simultaneously after defecation and usually does not cause complaint. Prolapsing hemorrhoids should be differentiated from prolapsing rectal polyps, small rectal prolapse, anorectal tumors, hypertrophy of the anal papilla, and condylomas. Nowadays, the management of prolapsing hemorrhoids varies. Medical therapy is rarely used alone, it is used to improve the effect of surgical therapy. The surgical gold standard for prolapsing hemorrhoids is excision surgery (hemorrhoidectomy) with or without suturing. However, since it comes with pain complaints, non-excision surgery is now offered. Non-excision surgery is divided into two types—stapled hemorrhoidopexy and hemorrhoidal artery ligation and rectoanal repair. Each method of surgery has its own advantages and disadvantages. This chapter review discusses the anatomy, pathophysiology, diagnosis, and management of prolapsing hemorrhoids.