Haemorrhoids are masses of vascular tissue in the anal canal. Internal haemorrhoids arise from the superior (internal) haemorrhoidal vascular plexuses, above the pectinate line; they are covered by mucosa. External haemorrhoids are dilatations of the inferior (external) haemorrhoidal 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 haemorrhoids 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 haemorrhoids.

Reduction of pressure:

Stool softeners and a high-fibre diet with or without bulk agents help in relieving constipation, and reducing pressure on the haemorrhoids.

Classification and treatment of haemorrhoids:

Severity Description
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 Prolapse, irreducible