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What are Hemorrhoids?

Hemorrhoids are actually present in all individuals whether healthy of not. They are the vascular cushions which surround the general area of the rectum and anus. The term we call hemorrhoids is associated with the symptoms when this part of the body becomes enlarged, inflamed, thrombosed or prolapsed.  Internal hemorrhoids are located inside the anus while external hemorrhoids are located outside.

What are the types of internal hemorrhoids?

First degree hemorrhoids - hemorrhoids that bleed but do not come out during passage of bowel movement.

Second degree hemorrhoids - hemorrhoids that occasionally bleed and come out during bowel movement but go back in.

Third degree hemorrhoids - jemorrhoids that occasionally bleed and come out during bowel movement but can be pushed back in manually.

Fourth degree hemorrhoids - hemorrhoids that are pushed outside and cannot be pushed back in manually anymore.


There is usually bleeding of bright red blood dripping into the toilet bowl during bowel movement. Often, a mass or fleshy tissue comes out during straining.

Medical management

For first and second degree internal hemorrhoids:

• A high fiber diet that includes fruits and leafy vegetables.

• Adequate fluid intake.

• Avoidance of straining in the bathroom.

Rubber band ligation: for bleeding first and second degree internal hemorrhoids. This involves application of an elastic band at the base of the internal hemorrhoid.

Surgery: for persistent symptoms of bleeding, fleshy mass coming out, and problems with hygiene; unresponsiveness to medical management; or third or fourth degree or mixed (internal and external component) hemorrhoids.

• Hemorrhoidectomy -  for third and fourth degree internal hemorrhoids. This is the traditional method of removing hemorrhoids. It makes use of a knife, scissors and other devices such as ligasure or harmonic scalpel.

• Stapled hemorrhoidopexy makes use of a surgical stapler to remove hemorrhoids and is associated with minimal post-operative pain.

  • Transanal hemorrhoidal dearterialization -  for second and third degree internal   

  hemorrhoids. This method makes use of Doppler ultrasound to detect arteries which are  

  then ligated. This method is also is associated with minimal post-operative pain.

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