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Acute and chronic hemorrhoids  and coexisting  conditions  remain  an important medical problem  at  the  intersection of medical specialties. Among the  proposed  approaches to  therapy  is the  use  of immunomodulating agents, which allows to  ensure  the influence  on several  pathogenetic mechanisms  of development and progression  of the  disease. Ointments  containing  bacterial cultural suspension of E. coli (BCS) as an active component  have a solid experience in clinical practice  and a strong evidence base, including meta-analysis of multicenter randomized trials.