Hemorrhoidal disease is a common disorder requiring surgical intervention in approximately 10% of cases[1]. The overall prevalence is unknown because asymptomatic patients are less likely to seek medical help. Some sources estimate the incidence of symptomatic patients in the U.S is 4.4%, with patients between the ages of 45 to 65 years old being the most affected.[2][3][4] Hemorrhoids are columns of vascular connective tissue within the anal submucosa aiding in maintaining continence and bulk to the anal canal. The pathophysiology of hemorrhoids is mostly unknown, but one theory states that hemorrhoids develop due to varicose veins in the anal canal; however, most healthcare providers reject this idea. Instead, the current thought is that hemorrhoids develop due to decay or deterioration of the vascular cushions.[5] The three primary hemorrhoidal columns are in the left lateral, right anterolateral, and right posterolateral positions of the anal canal and can be either internal or external based on their location relative to the dentate line.[3] Internal hemorrhoids can be further divided on a scale from I to IV based on the degree of prolapse, which also helps guide the treatment options[2]. Patients presenting with symptomatic internal hemorrhoids complain of painless, bright red bleeding, described as streaks of blood in the stool, anal itching, pain, worrisome grape-like tissue prolapse, or a combination of these symptoms. External hemorrhoids are asymptomatic in most patients except for thrombosed external hemorrhoids, which cause significant pain due to their innervation by somatic nerves.[4][2] Hemorrhoids can have treatment with both medical and surgical interventions depending on their degree of prolapse and whether they are internal or external. The most effective treatment for recurrent, symptomatic grade III, or IV hemorrhoids, is surgical excision. Surgical procedures primarily include closed, also called Ferguson hemorrhoidectomy, which is the most common technique in the United States, or the open, also called Milligan-Morgan hemorrhoidectomy, used in the United Kingdom and Europe.[4][2]