Clinical features

Figure 7: The four degrees of internal haemorrhoids

Grading of haemorrhoids; It is not definite that the patient progresses through these grades, however the grading system is useful in discussing alternative treatments.

1. Visible on proctoscopy as bulges, painless bleeding
2. Prolapse on straining and spontaneously reduce, patients may complain of loss of the continence function of the anal cushions, irritation, minor soiling and mucus discharge
3. Prolapse on straining and have to be manually reduced, irritation and discharge and more pain, may thrombose or ulcerate
4. Prolapsed all the time, sclerotic and skin tags