Signs and symptoms (in order of prevalence)

  • The Lowdown on Haemorrhoids
  • Symptoms
  • Classification
  • Treatment
  • HAL - RAR
  • MIPH
  • IRC
  • Cryo
  • Surgery
  • Sclerotherapy
  • Rubber Band Ligation

The Lowdown on Haemorrhoids

What are haemorrhoids?

Haemorrhoids, also known as piles, are natural cushions of tissue and veins located at the junction of rectum and anus. Along with the sphincter, this normal tissue is responsible for complete closure of the anus and prevents any leakage. During a bowel movement, these cushions become smaller to allow stool to pass through. Everyone has them, and problems only arise when they become larger than they should.

Are there different types?

These anal cushions are normally fastened in the sphincter region by muscles and tissue. If too much pressure is exerted on them, the system of securing them may be damaged and the cushions swell, When they protrude outside the anus, they are referred to as prolapsing Hemorrhoids. The enlarged cushions are classified into four grades, depending on their size and severity:


Bleeding : principal and earliest symptoms . At first it is slight ,bright red and occurs during defaecation.

Prolapse : piles comes out during strain.

Discharge : a mucoid discharge is a frequent accompaniment of prolapsed piles and this almost certainly produce itching or pruritus.

Pain : usually not present ,its presence indicates complications.

Anaemia : means deficiency of blood.


There are two types of hemorrhoids, External , Internal, which are differentiated via their position with respect to the dentate line.


External hemorrhoids are those that occur outside the anal verge (the distal end of the anal canal They are sometimes painful, and often accompanied by swelling and irritation. Itching, although often thought to be a symptom of external hemorrhoids, is more commonly due to skin irritation. External hemorrhoids are prone to thrombosis: if the vein ruptures and/or a blood clot develops, the hemorrhoid becomes a thrombosed hemorrhoid


Internal hemorrhoids are those that occur inside the rectum. Specifically, they are varicosities of veins draining the territory of branches of the superior rectal arteries. As this area lacks pain receptors, internal hemorrhoids are usually not painful and most people are not aware that they have them. Internal hemorrhoids, however, may bleed when irritated. Untreated internal hemorrhoids can lead to two severe forms of hemorrhoids: prolapsed and strangulated hemorrhoids. Prolapsed hemorrhoids are internal hemorrhoids that are so distended that they are pushed outside the anus. If the anal sphincter muscle goes into spasm and traps a prolapsed hemorrhoid outside the anal opening, the supply of blood is cut off, and the hemorrhoid becomes a strangulated hemorrhoid.


Internal hemorrhoids can be further graded by the degree of prolapse.

  • Grade I: No prolapse.
  • Grade II: Prolapse upon defecation but spontaneously reduce.
  • Grade III: Prolapse upon defecation and must be manually reduced.
  • Grade IV: Prolapsed and cannot be manually reduced


  • Etiologic factors thought to be contributory to the pathological changes in the vascular cushions include
  • Constipation : Most common cause
  • Prolonged straining : It is a habit of some to read while seated on the toilet for prolonged period each day. Although the bathroom is a place of refuge, the constant congestion of the hemorrhoidal veins during this period is one of the chief factors in the development of haemorrhoids. So this is the instruction to patient to move the library to another room.
  • Irregular bowel habits
  • Diarrhea
  • Pregnancy : During pregnancy, pressure from the fetus on the abdomen and hormonal changes cause the hemorrhoidal vessels to enlarge. Delivery also leads to increased intra-abdominal pressures which leads to devlopment of piles.
  • Hereditary the condition is so frequent ly seen in the same family
  • Morphological or erect posture In humans the weight of the column of blood unassisted by valves produces a high venous pressure in the lower rectum, unparalleled in the body .Except in a few fat old dogs piles are exceedingly rare in animals.


By history, digital examination, proctoscopy and sigmoidoscopy

Grade I


No prolapsed,only bleeding

Treatement Advise
  • Diet – high fibre diet
  • Drugs – Euphorbia prostate and other
  • Sclerotherapy
  • IRC

Grade II


Prolapse, spontaneously Reducible

Treatement Advise
  • Sclerotherapy
  • RBL
  • MIPH (if other procedures failed)

Grade III


Prolapse ,manually reducible

Treatement Advise
  • MIPH*
  • Suture Anopexy***
  • Cryotherapy
  • Surgery*****

Grade IV


Prolapse irreducible

Treatement Advise
  • MIPH*
  • Suture Anopexy
  • Surgery

* 1st Option ** 2nd Option *** 3rd Option **** 4th Option ***** 5th Option

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