Hemorrhoidal disease is the consequence of pathological changes of fibrovascular anal cushions producing symptoms. Symptomatic hemorrhoids may include bleeding, prolapse, pruritus, soiling, thrombosis and pain. Different invasive treatment modalities are explored, which vary from office treatment (rubber bands, sclerotherapy, infrared coagulation, cryotherapy) and surgical procedure (hemorrhoidectomy, stapled hemorrhoidopexy). Only 5-10% of patients require surgery. The authors of this book review and discuss recent innovations of post-hemorrhoidectomy pain control and wound healing. Stapled haemorrhoidopexy (SH) as an attractive alternative to conventional haemorrhoidectomy (CH) is looked at as well. In addition, new techniques (Doppler guided transanal haemorrhoidal dearterialisation) with new devices in order to attain improved patient satisfaction (THD and haemorrhoid laser procedure) is analyzed. Finally, anal ultra slow wave (USW), a manometric finding observed in some patients with hemorrhoids, is presented and its clinical relevance is discussed.