Clinical stages and pathology

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Stage 1

First-degree internal haemorrhoids: three bulges form above the dentate line. Bright bleeding is common.

Stage 2

Second-degree internal haemorrhoids: the bulges increase in size and slide downwards so that the patient is aware of lumps when straining at stool, but they disappear upon relaxing. Bleeding is a feature.

Stage 3

Third-degree internal haemorrhoids: the pile continues to enlarge and slide downwards, requiring manual replacement to alleviate discomfort. Bleeding is also a feature.

Stage 4

Fourth-degree internal haemorrhoids: prolapse has occurred and replacement of the prolapsed pile into the anal canal is impossible.

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