Etiology Based and Stage-Adapted Management of Hemorrhoidal Disease: Clinical Outcomes, Functional Impact, and Quality of Life — A Narrative Review
DOI:
https://doi.org/10.12775/QS.2026.53.70276Keywords
hemorrhoids, hemorrhoid disease, etiology, staged-adapted therapy, clinical outcomes, functional impact, quality of lifeAbstract
Background: Hemorrhoidal disease is a highly prevalent anorectal condition impacting quality of life and functional capacity. Modern understanding highlights a complex interplay of mechanical, vascular, and inflammatory pathologies. Optimal management demands an etiology- and stage-specific approach.
Aim: This narrative review aims to integrate current evidence on the etiology, pathophysiology, and classification of hemorrhoidal disease to evaluate therapeutic strategies. It focuses on correlating treatment efficacy, recurrence rates, and functional outcomes with specific disease stages, including their impact on patient quality of life and engagement in active lifestyles.
Material and methods: A comprehensive literature search was conducted using PubMed, PubMed Central (PMC), MEDLINE, Embase, and the Cochrane Library for studies published between 2015 and 2025. Selected articles focused on hemorrhoid etiology, staging, and both physical and psychological treatment outcomes.
Results: Hemorrhoidal disease progresses from vascular congestion (Grade I-II) to significant connective tissue failure (Grade III-IV). Conservative and office-based interventions effectively manage early vascular-dominant disease with minimal downtime. Minimally invasive surgical techniques balance efficacy with reduced morbidity for mixed vascular-structural pathologies (Grade III). Excisional hemorrhoidectomy remains the definitive treatment for severe structural collapse (Grade IV), offering the lowest recurrence. Treatment success, measured by physical relief and high patient-reported quality of life, strongly correlates with precise stage- and etiology-matched therapy, facilitating return to active lifestyles.
Conclusions: A tailored, etiology- and stage-adapted approach to hemorrhoidal disease management is crucial for optimizing clinical outcomes, preventing recurrence, and enhancing patient functional status and psychological well-being.
References
1. Perera, N., Liolitsa, D., Iype, S., Croxford, A., Yassin, M., Lang, P., Ukaegbu, O., van Issum, C. Phlebotonics for haemorrhoids. Cochrane Database of Systematic Reviews 2022,CD004322https://www.cochrane.org/evidence/CD004322_phlebotonics-haemorrhoids
2. Bharathi, S. S., Biradar, S., & Biradar, S. (2023). Hemorrhoids: From Basic Pathophysiology to Clinical Management. International Journal of Pharmaceutical Science, 02(12),https://www.ijpsjournal.com/article/Hemorrhoids+From+Basic+Pathophysiology+to+Clinical+Management
3. Longfang, Q., Xuelian, B., Fang, C., Jin, C., Hangkun, M.,Pengfei, W., Ling, Y.,Shaosheng, B. (2025). Comparison of efficacy and safety between surgical and conservative treatments for hemorrhoids: a meta-analysis. BMC Gastroenterology, 25(492),https://link.springer.com/article/10.1186/s12876-025-04089-2
4. Hasan, E., Erkan, A., Özlem Karaca, O., Zeynep, E. (2024). Laser Therapy for Grade II and III Hemorrhoids: Threeyear Clinical Experience, Kafkas Joural of Medical Sciences, 14(2), 109–114. https://dergipark.org.tr/en/pub/kaftbd/article/1542061
5. Prasad, K. B. (2024). Comprehensive Review on Hemorrhoids: From Epidemiology to Preclinical Assessment of Anti-Hemorrhoidal Agents. International Journal of Pharmaceutical Sciences and Drug Research, 16(3), 195-201. https://ijpsdronline.com/index.php/journal/article/view/9408
6. Matthew Z. Wilson (2019). The Effect of Nonoperative Management of Chronic Anal Fissure and Hemorrhoid Disease on Bowel Function Patient-Reported Outcomes, Diseases of the Colon & Rectum. https://journals.lww.com/dcrjournal/abstract/2018/10000/the_effect_of_nonoperative_management_of_chronic.16.aspx
7. Mallmann, C.,Langenbach, M. R., Florescu, R., Köhler, A., Barkus, J., Ritz, J., Gebauer, F., Lefering, R., Boenicke, L. (2023) Parameters predicting postoperative pain and quality of life after hemorrhoidectomy: follow-up results from a prospective multicenter randomized trial, International Journal of Colorectal Disease, 3,38(1):262 https://link.springer.com/article/10.1007/s00384-023-04557-9
8. Chun-Ying Qu et al. (2024). Endoscopic polidocanol foam sclerobanding for the treatment of grade II-III internal hemorrhoids: A prospective, multi-center, randomized study,World Journal of Gastroenterology, 30 (27):3326-3335 https://www.wjgnet.com/1007-9327/full/v30/i27/3326.htm
9. Sabry, A., Rashid, I., Tamer, S., Sami, M., Yousif, A., Ali Yasen M., (2025), Hemorrhoidal Artery Ligation (HAL) vs. Rubber Band Ligation (RBL) for Second- and Third-Degree Hemorrhoids: A Systematic Review and Meta-Analysis,Cureus Journal of Medical Science, 17(2):e79810 https://www.cureus.com/articles/345408-hemorrhoidal-artery-ligation-hal-vs-rubber-band-ligation-rbl-for-second--and-third-degree-hemorrhoids-a-systematic-review-and-meta-analysis#!/
10. Anjun, Xu, Yangliang, Y., Dejun, Wu, (2023). The Safety and Efficacy of Endoscopic Rubber Band Ligation for Hemorrhoids: A Systematic Review and Meta-Analysis,Research Square https://www.researchsquare.com/article/rs-3565555/v1
11. Ding, Z., Xuan, J., Tang, G.,Shi, S.,Liang X.,An, Q., Wang, F., (2023), Rubber band ligation versus coagulation for the treatment of haemorrhoids: a meta-analysis of randomised controlled trials, Postgraduate Medical Journal,99(1175):946-953) https://academic.oup.com/pmj/article/99/1175/946/7146680
12. Lauricella, S., Brucchi, F., Mascianà G., Battista Levi Sandri G., Banchini F., Dionigi G., Cassini D., Casati M., Cirocchi, R., (2026) Long-term outcomes of stapled haemorrhoidopexy versus conventional haemorrhoidectomy: An updated systematic review, meta-analysis and trial-sequential analysis of randomized controlled trials, International Journal of Cororectal. Disease, 41(34) https://link.springer.com/article/10.1007/s00384-026-05080-3
13. Gupta, K., (2022). Minimal Invasive Procedures for Hemorrhoids, Lasers in Proctology https://link.springer.com/chapter/10.1007/978-981-19-5825-0_7
14. Cristea, C., Lewis, C. R., (2024). Hemorrhoidectomy, StatPearls https://www.ncbi.nlm.nih.gov/sites/books/NBK549864/
15. Hawkin, A. T., Davis, B. R., Bhama, A. R., Fang, S. H., Dawes, A. J., Feingold, D. L., Lightner A. L.,Paquette, I. M., (2024). The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Hemorrhoids. Diseases of the Colon & Rectum, 67(3), 243–257. https://pubmed.ncbi.nlm.nih.gov/38294832/
16. Romano, L., Giuliani, A., Paniccia, F., Masedu, F., Tersigni, L., Padula, M., Pietroletti, R., Clementi, M., Vistoli, F., (2025). Sport practice and hemorrhoidal disease: results from a self-assessment questionnaire among athletes, International Journal of Cororectal. Disease, 40(8) https://link.springer.com/article/10.1007/s00384-024-04797-3
17. Rørvik, H. D., Davidsen, M., Gierløff, M. C., Brandstrup, B., Olaison, G. (2023). Quality of life in patients with hemorrhoidal disease 12, 22-28 https://www.surgopensci.org/article/S2589-8450(23)00006-4/fulltext
18. Lohsiriwat, V. (2023) Recurrence Rates and Pharmacological Treatment for Hemorrhoidal Disease: A Systematic Review,Advances in Therapy, 40, 117-132 https://link.springer.com/article/10.1007/s12325-022-02351-7
19. Albuquerque, A. (2016). Rubber band ligation of hemorrhoids: A guide for complications, World Journal of Gastrointestinal Surgery, 8(9):614-620 https://www.wjgnet.com/1948-9366/full/v8/i9/614.htm
20. Rybak, Z., Popow, A., Kurczewski, P., Korzekwa, P. (2016). Effectivness of sclerotherapy in the treatment of haemmorrhoids. Phleobological Review https://www.termedia.pl/Effectiveness-of-sclerotherapy-in-the-treatment-of-haemorrhoids,76,28084,0,1.html
21. Nikshoar M. R., Maleki Z., Honar B. N. (2017) The Clinical Efficacy of Infrared Photocoagulation Versus Closed Hemorrhoidectomy in Treatment of Hemorrhoid, Journal of Lasers in Medical Science, https://pubmed.ncbi.nlm.nih.gov/29399307/
22. Shehata, A.; Saleh, A. F.; Elheny, A. (2016) Clinical outcome after Doppler-guided hemorrhoidal artery ligation and rubber-band ligation for the treatment of primary symptomatic hemorrhoids, The Egyptian Journal Surgery,35(1):5-10, https://journals.lww.com/ejos/fulltext/2016/35010/clinical_outcome_after_doppler_guided_hemorrhoidal.2.aspx
23. Dekker L., Bak, M. T. J., Bemelman, W. A., Felt-Bersma, R.J.F.,Han-Geurts I.J.M, (2022), Hemorrhoidectomy versus rubber band ligation in grade III hemorrhoidal disease: a large retrospective cohort study with long-term follow-up, Ann Coloproctal, 38(2):146-152, https://coloproctol.org/upload/pdf/ac-2020-01011-0144.pdf
24. Gosavi, R., Tan, R. , Zula, D., Xu, S., Shiki, F., Lim, J., Chien Nguyen, T., Teoh, W., Narasimhan, V., (2025) Doppler-Guided Haemorrhoidal Artery Ligation and Rectoanal Repair (HAL-RAR): An Institutional Experience, J Clin Med.,14(15),5397 https://www.mdpi.com/2077-0383/14/15/5397
25. Shengwei, Z. Li, X., Yang, Y., Zeng, Y., Yang, Y., Gan, Q., Su, J., Lu, C., (2025), A Comprehensive Evidence Summary for Pain Assessment and Management After Hemorrhoidal Surgery to Inform Clinical Practice Guidelines, Journal of Multidisciplinary Healthcare,18:6857-6870 https://www.dovepress.com/a-comprehensive-evidence-summary-for-pain-assessment-and-management-af-peer-reviewed-fulltext-article-JMDH
26. Zhang C., Zhang, W., Jian, Xu (2022), Comparison of the outcomes of hemorrhoidectomy and PPH in the treatment of grades III and IV hemorrhoids,Medicine Baltimore,101(11):e29100 https://journals.lww.com/md-journal/fulltext/2022/03180/comparison_of_the_outcomes_of_hemorrhoidectomy_and.47.aspx
27. Dursun, A., Tuncer, G. K., Tuncer, K., Karaali, C., Erdogan, G., Emiroglu, M., (2023), Effectiveness of laser hemorrhoidoplasty in the treatment of hemorrhoidal disease,Cirugia y Cirujanos,91(2):179-185, https://www.cirugiaycirujanos.com/frame_esp.php?id=826
28. De Robles, M. S., Young, C., (2021), Surgical technique is the main predictor of recurrence in the management of haemorrhoids, ANZ Journal of Surgery,91(9):1854-1858 https://onlinelibrary.wiley.com/doi/10.1111/ans.16738
29. Run-Yi Geng, Yin, L., Cao, Y-Q., Shen, X., Ding, Ya-Q., Yao, Y-B., Wang, C., (2026), Modified Ferguson hemorrhoidectomy for grade II–IV hemorrhoids offers low recurrence and complication rates: a retrospective cohort study, Sec.Gastroenterology,12https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2025.1710244/full
30. Yilmaz, I., Karakas, D., Sucullu, I., Saydam, M., (2017), Grade II-III Hemorrhoidal Disease Treatment: Rubber Band Ligation versus Hemorrhoidal Artery Ligation, Turkish Journal of Colorectal Disease,27(2):44-49 https://turkishjcrd.com/articles/doi/tjcd.60783
31. Wang, W., Yang, Y., Hou, L., Wu, S., (2025), Comparative effectiveness and recurrence rates of endoscopic sclerotherapy, ligation, and combined therapy for grades I-III internal hemorrhoids,BMC Surgery,25(543) https://link.springer.com/article/10.1186/s12893-025-03289-7
32. Samrobinson, J., Jeyaganesh, R., Arumugam, G., Vignesh, N. J., (2024), A Hospital-Based Longitudinal Study of Rubber Band Ligation and Sclerotherapy Treatment for Internal Hemorrhoids From South India,Cureus Journal of Springer Nature,16(7):e64570 https://www.cureus.com/articles/257725-a-hospital-based-longitudinal-study-of-rubber-band-ligation-and-sclerotherapy-treatment-for-internal-hemorrhoids-from-south-india#!/
33. Lopez, F., Alonso, C. H.,Gomez, M. J., Escribano, D. T., Bisbal M., Marcia, A., Brito, J. A. (2019), Prospective Randomized Trial Comparing HAL-RAR Versus Excisional Hemorrhoidectomy: Postoperative Pain, Clinical Outcomes, and Quality of Life,Surgical Innovation,26(3) https://journals.sagepub.com/doi/10.1177/1553350618822644
34. Lawrence, A., McLaren E. R., (2023), External Hemprrhoid,StatPearls https://www.ncbi.nlm.nih.gov/books/NBK500009/?utm_source=chatgpt.com
35. Tavani, M., Partovi, Y., Poursaki, T., Gharibi, F. (2025), The Complications of Hemorrhoidectomy From Patients' Perspective: A Qualitative Study, Health Science Reports,8(5):e70724 https://onlinelibrary.wiley.com/doi/10.1002/hsr2.70724
36. Al-Kubati, Radman, W. (2024), The Effect of Hemorrhoids and Hemorrhoidectomy on the Sexual Activity of Yemeni Male Patients: A Prospective Study of 600 Cases, Arab Board Medical Journal, 25(3):133-138 https://journals.lww.com/abmj/fulltext/2024/25030/the_effect_of_hemorrhoids_and_hemorrhoidectomy_on.5.aspx
37. Kostev, K., Konrad, M., Smith, L.,Krieg, S. (2024), Hemorrhoids are associated with an increased risk of depression in Germany: A retrospective cohort study in primary care outpatients, Journal of Psychiatric Research,175:381-385 https://www.sciencedirect.com/science/article/abs/pii/S0022395624002875?via%3Dihub
38. Labidi, A., Maamouri, F., Letaief-Ksontini, F., Maghrebi,H., Serghini, M., Boubaker, J., (2019) Dietary habits associated with internal hemorrhoidal disease: a case-control study,Tunis Med.,97(4):572-578 https://pubmed.ncbi.nlm.nih.gov/31729708/
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Zuzanna Tabor
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Stats
Number of views and downloads: 13
Number of citations: 0
