JAMA Clinical Reviews Diagnosis and Treatment of Hemorrhoidal Disease
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Aug 18, 2025 Join Jean H. Ashburn, an associate professor of surgery at Wake Forest University, as she dives into the often-taboo subject of hemorrhoidal disease. Discover the stark differences between normal hemorrhoids and pathological conditions, affecting around 10 million people in the U.S. Ashburn also tackles the various risk factors, particularly in pregnant women, and discusses common misconceptions that leave many in discomfort. Explore diagnostic processes and treatment options, emphasizing the importance of individualized care and understanding.
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Hemorrhoids Are Normal Anatomy
- Hemorrhoids are normal vascular and connective tissue that help continence and protect the anal canal.
- Hemorrhoidal disease is when this tissue becomes abnormal, engorged, or causes bothersome symptoms.
Location Determines Presentation
- The dentate line divides internal (above) from external (below) hemorrhoid tissue and determines symptoms and treatment options.
- Location relative to the dentate line is crucial for diagnosis and management.
High Prevalence and Cost
- Hemorrhoidal disease affects about 10 million people in the U.S. and causes roughly 4 million ambulatory visits annually.
- It costs roughly $1.3 billion per year and is likely undercounted because many self-treat or don't seek care.