There is no doubt that hemorrhoids are present in each of us to serve functions such as flatus continence. However, they become problematic when symptoms namely bleeding, constipation, pain and altered bowel habit occur. Due to the high incidence of symptomatic hemorrhoids in places where sedentary lifestyle prevails (i.e. Hong Kong), surgical consultation is mandatory to provide a thorough risk assessment, education, and all surgical options and their prognosis explained to the patient. Since patients with symptomatic hemorrhoids may also present in similar ages of colorectal cancer, colonoscopy may be required for work up in some of these patients to exclude symptoms of hemorrhoids masking the diagnosis of colorectal polyp or cancer. Stapled hemorrhoidopexy can now be offered to avoid external wounds as seen in patients receiving hemorrhoidectomy.