Haemorrhoids occur when the vascular anal cushions become enlarged. Some patients may be asymptomatic, but others have symptoms of bleeding, itching or discomfort (grade 1). If the haemorrhoids are large, they may prolapse out of the anus. Haemorrhoids that prolapse may reduce spontaneously after defaecation (grade 2); they may need to be reduced digitally (grade 3); or they may not be reducible, remaining continually prolapsed (grade 4).
Grade 1 and 2 haemorrhoids can be managed by dietary modification or use of laxatives, or treated by topical applications (such as corticosteroid creams or local anaesthetics). Established interventional treatments include rubber band ligation, sclerosant injections, infrared coagulation or bipolar electrocoagulation using diathermy.
Established treatments for grade 3 and 4 haemorrhoids include bipolar electrocoagulation using diathermy, haemorrhoidectomy, stapled haemorrhoidopexy or haemorrhoidal artery ligation.