cedures is to try to minimize pain while maximizing outcomes. The most common and effective procedure is rubber- band ligation. The procedure is performed by placing rubber bands around the hemorrhoid pedicle, cutting off the blood supply causing the hemorrhoid to slough resulting brosis that helps to prevent future hemorrhoidal prolapses. Bands should be placed well above the dentate line to avoid pain from the sensory-rich anoderm. Studies have shown it to have outcomes at least equivocal to surgical hemorrhoidectomy, with slightly higher rates of post-procedure bleeding recur­rences but less pain and similar overall satisfac­tion. There is also the very small chance of Fournier’s gangrene with banding. Gangrene may be heralded by increasing pain, drainage, fevers, and an inability to void. Other tech­niques, including sclerotherapy, cryotherapy, and infrared coagulation, employ different modalities to achieve similar results. Sclerotherapy involves injections of sclerosing agents such as sodium tetradecyl, into the sub­mucosa beneath the hemorrhoid. It is quick and inexpensive, but is associated with a higher rate of recurrent symptoms. Cryotherapy requires expensive equipment, has a high rate of recur­rence, and can cause a foul-smelling dis­charge—it is therefore no longer used. Only infrared coagulation has shown results compa­rable to rubber band ligation, with reduced post­operative pain and only minimally inferior outcomes, and is a viable alternative. In general, it requires multiple applications and is not used as commonly any more. New techniques using lasers and radiofrequency ablation offer evolv­ing technologies and more treatment options. Overall, non-operative techniques are associ­ated with reduced morbidity and are all prefer­able to surgery choices.