Haemorrhoids happen when the vascular anal cushions become enlarged. Some patients may be asymptomatic, but others have symptoms of bleeding, itching or discomfort. Small symptomatic haemorrhoids are classified as grade I. If the haemorrhoids are large, they may prolapse out of the anus. Haemorrhoids that prolapse may reduce spontaneously after defaecation (grade II); they may need to be reduced digitally (grade III); or they may not be reducible, remaining continually prolapsed (grade IV).
Grade I and II haemorrhoids may be managed by changes in diet or using laxatives, or treated with 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 symptomatic grade III and IV haemorrhoids include haemorrhoidectomy, stapled haemorrhoidopexy or haemorrhoidal artery ligation and bipolar electrocoagulation using diathermy.
Electrotherapy is another treatment option, which is used for grade I to IV haemorrhoids.