Except for complications, therapeutic strategy for hemorrhoidal disease depends on patient complaint and data from clinical examination. Management is mostly progressive and first aims at releasing symptoms rather than achieving anatomic resilience. In patients with haemorrhoids responsible for insignificant symptoms and with no alteration of quality of life, no treatment is mandatory. Patient complaint, either related to bleeding or prolapse, must prone active management. Medical treatment must be offered as a primary approach in the majority of patients with non-complicated hemorrhoidal disease, followed if necessary by office-based procedure. Surgical treatment is indicated when office-based procedures proved ineffective or immediately after medical treatment failed in patients with Grade IV haemorrhoids. In case of local or general complication, or associated proctologic disease, surgical management is most often required.