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Haemorrhoidal disease is associated with vascular symptoms - oedema, constipation and bleeding - which usually occur when the faecal bolus goes through the anus with defecation. The disease advances over time, and haemorrhoidal cushions protrude outside the anus with defecation: in the early stages of the disease, they reduce spontaneously after defecation, while at an advanced stage it is necessary to place them back inside the anus manually.

When the disease reaches its most advanced stage, haemorrhoidal cushions remain outside the anus permanently, thus forming the so-called prolapse. Prolapse can frequently lead to complications, such as blood clots forming inside it (haemorrhoidal thrombosis).

Certain conditions can make the symptoms of haemorrhoids worse, such as pregnancy, repeated straining, constipation, diarrhoea, changes in dietary and/or working habits, travels, and seasonal changes. The symptoms of haemorrhoids can be subject to either remission or aggravation.



About 10% of adults (aged between 25 and 65) are estimated to have experienced minor rectal bleeding.

The most frequent causes of rectal bleeding are the following: (source: Nicholls 1985)

Perianal lesion


Anal rhagas




Neoplastic lesion


Inflammatory disease


Alterations in bowel movements


Other causes


Unidentified causes



Internal haemorrhoids usually cause no pain. In most cases acute anal pain is associated with acute rhagades; it may be less frequently associated with an ano-rectal abscess, with a thrombosed perianal varix or with internal haemorrhoid prolapse/thrombosis. In such cases pain is felt or even worsened with defecation.


Prolapse is caused by an increase in the volume of either one or all the haemorrhoidal cushions, as well as by a concurrent sinking of the supporting connective tissue. These two attendant phenomena make haemorrhoids slide down the anal canal, and protrude outside the anus with defecation. Depending on the degree of haemorrhoids, prolapse can reduce spontaneously (2nd degree haemorrhoids), it can be manually reduced (3rd degree haemorrhoids) or it cannot be reduced at all (4th degree haemorrhoids).

Constipation and prolapse may sometimes occur when people stand for a prolonged period of time. In such a situation, people usually feel a sense of discomfort and congestion in both the anal and the perianal area.

Serum and mucus discharge, as well as anal itching as a consequence of dermatitis, may also occur.

Haemorrhoid treatment is chosen depending on the severity of prolapse, since haemorrhoid classification is actually a classification of haemorrhoidal prolapse. This is why prolapse should be thoroughly assessed, both at rest and during straining upon defecation.

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