Hameorrhoids - vascular-rich connective tissue cushions in anal canal. If they become swollen and distended, they are referred to as pathological haemorrhoids.

In pathology - The anal cushions are usually located at 3, 7 and 11 o’clock.

Internal haemorrhoids - proximal to pectinate line

• Painless–above dentate line
• 1st degree: no prolapse
• 2nd degree: prolapse when straining and return on relaxing
• 3rd degree: prolapse when straining, do not return on relaxing, but can be pushed back
• 4th degree: prolapsed permanently

External haemorrhoids - Distal to the pectinate line

• Painful

Risk factors:

• Age between 45-65 years
• Constipation (and straining)
• Pregnancy or a space occupying pelvic lesion - ⬆️ pressure ⬇️ venous return

Other (weaker) R/F - Hepatic insufficiency (more likely to cause rectal varices), ascites

PC

Key diagnostic factors

*presence of R/F