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What are haemorrhoids?

Haemorrhoids, also called ‘piles’, are enlarged and engorged blood vessels in the anal cushions of the upper portion of the anal canal. The anal cushions normally serve an important role in the maintenance of continence and we are not normally aware they are there. However, when they become enlarged they may exhibit symptoms, and in this case they are known as haemorrhoids.


Symptoms of haemorrhoids

Haemorrhoids can give mild intermittent symptoms, or the problems can be more persistent and severe. Symptoms include rectal bleeding, perianal discomfort, anal seepage, pruritis (anal itch) and the sensation of something coming out of the bottom.


Grading of haemorrhoids

Haemorrhoids are classified into 4 grades:

  • Grade I haemorrhoids are also known as internal piles; they do not prolapse (push out) out of the anal canal. They usually bleed as the patient goes to the toilet; typically, the blood is fresh and red and seen to be separate from the stools, usually on the paper.


  • Grade II haemorrhoids are larger, and sometimes prolapse from the anus during defaecation; however, the piles return inside once the patient stops defaecating.


  • Grade III haemorrhoids prolapse from the anus during defaecation and the patient is able to push them back inside using a finger.


  • Grade IV haemorrhoids can permanently protrude from the anus and cannot be pushed back inside.



The most appropriate treatment option is usually determined by the severity and anatomy of the haemorrhoids. This is something that your surgeon will advise you on. Irrespective of the treatment offered, adopting a bowel friendly diet, which results in the passage of soft, formed stools without the need to strain, is advised.

Treatments offered include:

Rubber band ligation

Rafaelo procedure


Trans-anal haemorrhoidal dearterialisation - THD



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