Comprehensive Review on Hemorrhoids: From Epidemiology to Preclinical Assessment of Anti-Hemorrhoidal Agents

Abstract

The review discusses the etiology, epidemiology, classification, risk factors, assessment, the role of biomarkers in the development of hemorrhoids, Operative, and Non-operative treatment options, postoperative complications of hemorrhoids, preclinical evaluation methods of anti-hemorrhoidal drugs, and different medicinal plants that show anti-hemorrhoidal activity. Hemorrhoids are characterized by the expansion and dislocation of typical anal cushions. One of the most significant discoveries regarding hemorrhoids is the atypical vascular channel dilatation and distortion, along with damage and modifications to the anal cavity's supporting connective tissue. Based on different factors, hemorrhoids are categorized in different classifications out of which Golingher’s classification is commonly used which divides the hemorrhoidal condition into 4 grades according to prolapse and development of hemorrhoids. Hemorrhoids are recognized as one of the main causes of morbidity which affects millions of people worldwide and also increases the economic overload on the health care system. Using current treatment options hemorrhoids are often treated conservatively using a variety of techniques, including fiber supplements, anti-inflammatory medications, lifestyle changes, and venotonic medicines. As well as using operative treatments like rubber band ligation, hemorrhoidectomy, and Injection sclerotherapy also various biomarkers play an important role in the progression of hemorrhoids like Matrix Metalloproteinase (MMP), inducible nitric oxide synthase (iNOS), and C-reactive protein (CRP), and Vascular endothelial growth factor (VEGF). These biomarkers can be a potential target for the development of new anti-hemorrhoidal agents.