Haemorrhoids

Haemorrhoidal tissue is part of the normal anatomy which contributes to anal continence. These mucosal vascular cushions are found in the left lateral, right posterior and right anterior portions of the anal canal (3 o'clock, 7'o'clock and 11 o'clock respectively). Haemorrhoids are said to exist when they become enlarged, congested and symptomatic

Clinical features

painless rectal bleeding is the most common symptom
pruritus
pain: usually not significant unless piles are thrombosed
soiling may occur with third or forth degree piles

Types of haemorrhoids

External

originate below the dentate line
prone to thrombosis, may be painful

Internal

originate above the dentate line
do not generally cause pain

Grading of internal haemorrhoids

Grade I	Do not prolapse out of the anal canal
Grade II	Prolapse on defecation but reduce spontaneously
Grade III	Can be manually reduced
Grade IV	Cannot be reduced

Management

soften stools: increase dietary fibre and fluid intake
topical local anaesthetics and steroids may be used to help symptoms
outpatient treatments: rubber band ligation is superior to injection sclerotherapy