Grade 1: increase in size of the natural anal cushions that are not visible outside the anus
Grade 2: larger piles that may come out of the anus when you go to the toilet, before going back in
Grade 3: piles that hang down from the anus but can be pushed back inside
Grade 4: Larger piles that hang down from the anus and cannot be pushed back inside
Haemorrhoids occur as a result of enlargement of naturally existing anal cushions which help to maintain anal continence.
The initial management of haemorrhoids includes:
Increased fluid intake
Increased dietary fibre
Stool softeners if above measures not sufficient in preventing constipation
Avoiding excessive straining at stool
If symptoms persist, rubber band ligation is the next step and can be performed in clinic without the need for anaesthesia.
Larger haemorrhoids can be treated by surgery such as HALO, haemorrhoidectomy or stapling. HALO has gained popularity because it causes less pain and patient satisfaction is high.