Hemorrhoids are normal vascular cushions surrounding the distal rectum and anal canal which helps to maintain anal continence(1,2). It commonly refers to the pathological changes and distal displacement of the haemorrhoidal tissue which affects nearly 40 % of adults(3,4). They are classified into four grades, grade I - they do not prolapse but only bulge into the anal canal, grade II - they prolapse during defecation and reduce spontaneously; grade III - they prolapse and require manual reduction in the size and grade IV - they prolapse and are irreducible(5). The factors that commonly assumed to increase the risk of haemorrhoids are constipation, low fiber diet/high protein rich foods, Obese, pregnancy and a sedentary life style(6). The symptoms includes anal bleeding, prolapse, itching, and/or perianal skin irritation which are known to cause discomfort, disability and effects the quality of life in haemorrhoid patients(7,8). There are 2 methods to manage haemorrhoids. First being the Non-invasive medical approach and second is the invasive medical approach (surgery) based on the grade of the disease(9-15). The most recent guidelines stated that the conservation treatment option is still considered as an effective first-line therapy prior to the surgery(11). The recurrence rate with conservative medical management is 10 to 50% over 5 years(16)

Haemorrhoids, medical approach, Age group.