Misunderstandings, false myths and diagnostic approximations in proctology with reporting of obsolete concepts and observations from a new point of view

SUMMARY The greatest ignorance in Medicine is probably in the field of anal diseases. The competence index of a Proctologist is inversely proportional to the number of times he repeats the term “hemorrhoids”. The real hemorrhoidal plexuses (internal) are normal anatomical structures that play an important physiological role in perfecting continence in synergy with the sphincter system. The so-called “hemorrhoids” represent a popular myth for patients and a serious educational gap in the training of the Doctor and the Surgeon. In reality, “hemorrhoidal disease” represents a minimal percentage of rectal-anal pathology and the term is abused to indicate a wide range of pathological situations that include bleeding, pain, anal swelling and various growths: however, these are only symptoms, common to many other pathologies, but in low-level proctology they are all lumped together, invariably, with a phantom disease called “hemorrhoids”, giving up right from the start on trying to understand their origin and evolutionary path. “Hemorrhoids” are found more “in the mouth” (of patients) and “in the brain” (of Doctors), than in the place where they should really be, representing a social cognitive bias. The causes of the numerous and varied anal problems must be carefully researched, both anatomical and physiopathological, to arrive at a precise diagnosis and consequently plan a correct therapy, always different for each patient who must be “tailored”. The text will contain simple sentences that correspond to those generally used to communicate with patients and some of my personal explanatory quotes and aphorisms.