Hemorrhoids are one of the best-described diseases in medical history. There are a huge number of suggestions as to why you get them and how you can get rid of them, but even today, there is no consensus about the best treatment.

Throughout our history, diseases have haunted humanity. Many were most likely the same as we see today, but most of them were poorly understood, and their names are often hard to interpret.

Ulcer of the stomach, appendicitis, colorectal cancer, and cirrhosis of the liver, were first described fairly correctly in the 18th century, and myocardial infarction (heart attack) even later.

So, it is pretty difficult to be sure of which diseases our ancestors suffered and died. Examination of skeletons, as well as chemical and molecular biological investigations, sometimes give valuable information.

However, one group of diseases is different: hemorrhoids and other disorders of the anus have been described fairly precisely from as far back as ancient times and from all parts of the world.

The reason is undoubted that these diseases were common, directly observable, and present with rather simple symptoms such as pain and bleeding. But even so, the understanding of their origin and treatment has varied a lot over the years, and this continues up to the present day.

Here, I describe a number of different assertions and recommendations that have appeared throughout the past 2,000 years and beyond. But, I do not attempt to offer a definitive answer as to the best treatment. Unfortunately, hemorrhoids are still a bit of a mystery.

What are hemorrhoids?

Hemorrhoids are clusters of vascular tissue, smooth muscle, and connective tissue, arranged in three columns along the anal canal the final four centimeters of the digestive tract, stretching from the rectum to the anus. These clusters are named the anal cushions.

Hemorrhoids are quite normal structures and are present in all individuals, but we only use the term for pathologic or symptomatic hemorrhoids. According to their location, they can be divided into internal hemorrhoids, located in the upper part of the anal canal (above a mucosal fold called the dentate line), and external, located below.

Internal hemorrhoids are characterized by bleeding and varying degrees of prolapse and may be followed by itching, pain, mucus discharge, and fecal seepage. External hemorrhoids usually only give major symptoms when they thrombose and are then very painful.

However, many patients with these symptoms do not actually have hemorrhoids, and a thorough examination of the area is always recommended in order to exclude other, possibly far more serious diseases.

An encyclopedia with 227 pages about hemorrhoids

The oldest convincing descriptions of hemorrhoids and other diseases of the anus and anal canal date back to 1500 BCE in Mesopotamia. But there are even older records in Indian and Chinese literature, although we do not know exactly how old these are.

The Egyptian "Chester Beatty Medical Papyrus" from about 1200 BCE deals exclusively with these diseases, and the old Europeans as the Greek Hippocrates (c. 460 to 370 ) and Galen (129 to c. 216), who worked in Rome, wrote numerous extensive papers on the same subject.

Since then, many famous doctors have written pages upon pages on the topic of hemorrhoids. For instance, Francois de Montègre wrote 227 pages on hemorrhoids in the great French Encyclopaedia published in 1817. He classified 20 variants. As a side note, a Danish Encyclopaedia from 2001 dedicated just half a page to the subject.

The famous German pathologist Rudolph Virchow used 30 pages in his large book on tumors from 1863, and the American William Bodenhamer in 1884 wrote a book of nearly 300 pages entirely about hemorrhoids. More recently, there is at least one new article every week published in medical periodicals on the topic.