Hemorrhoids are masses of vascular tissue in the anal canal. Internal hemorrhoids arise from the superior (internal) hemorrhoidal vascular plexuses, above the pectinate line; they are covered by mucosa. External hemorrhoids are dilatations of the inferior (external) hemorrhoidal plexuses; they lie below the pectinate (dentate) line and are covered by anoderm and perinanal skin. Because the two plexuses anastomose freely, many patients have a combination of both types.
Internal hemorrhoids are graded according to their size and degree of prolapse. They are more common with increasing age.
The treatment can be tailored according to the severity of the hemorrhoids.
Stool softeners and a high-fibre diet with or without bulk agents help in relieving constipation, and reducing pressure on the hemorrhoids.
Classification and treatment of hemorrhoids:
1. First degree
Project into the anal canal, no prolapse
2. Second degree
Prolapse with defaecation
3. Third degree
Prolapse, require to be reduced manually
4. Fourth degree
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