About True Hemorrhoids:

Hemorrhoids: (True piles) are characterized by painless, fresh bleeding at defecation. Sometimes there may be pain. Hemorrhoids are vascular cushions or sponge like pads composed of blood vessels located at 3 sites in the anal canal. At time of defecation they may bleed due to rupture of the overlying mucus membrane.

Internal Hemorrhoids: Initially the pile masses are small and remain confined inside the anal canal, seen only on examination. At this stage they are called internal piles( grade 1 and 2). The patient complains that at time of motions there is fresh, bright red blood which is passed painlessly.

Interno- external hemorrhoids: As the disease progresses there is a natural enlargement in the size of the internal piles. They tend to drag on their attachments to the inner walls and start projecting out of the anus (prolapsing) at time of stools. Now in addition to bleeding the patient feels that some flesh is coming out. Initially these piles retract inside after passage of stools. Later the patient has to push them back with fingers(grade3,4). Once the disease advances to this stage, methods like infrared coagulation do not result in a cure and surgery is advised

Early piles Can be controlled by infrared coagulator.!!

External:  Many patients have small swellings at anal margin which are already in the external locations. These do not bleed. However they can become swollen and painful intermittently. Again these generally require to be surgically removed.