This is a randomized prospective study conducted at the American University of Beirut Medical Center involving patients suffering from hemorrhoidal disease requiring therapeutic intervention. 

1. Composite pain score from days 0 (day of procedure), day 3 and day 7 following procedure of either hypertonic saline sclerotherapy or rubber band ligation (primary objective)
2. Pain medication usage (secondary objective)
3. Bleeding during day 1 through 7 post procedure (secondary objective)
4. Bleeding and pain during long term follow up (week 1 through week 7 post procedure, month 3, and month 6) (secondary objective)

30 consecutive patients presenting to the private clinics for assessment of their hemorrhoidal disease and found to require therapeutic intervention will be enrolled in this study. Patients will be randomized to either hypertonic saline sclerotherapy or rubber band ligation for their hemorrhoidal disease.

Patients will be consecutively recruited from the private clinics following assessment of their hemorrhoidal disease and conclusion of their requirement of therapeutic intervention. Patients will be randomized to either Rubber band ligation or Hypertonic saline sclerotherapy injection, each procedure to be performed by one endoscopist respectively.