## Basic Introduction
- Haemorrhoids are dilated veins of the haemorrhoidal plexus (rectal venous plexus) in the anal canal.
- Haemorrhoids are also defined as varicosities of haemorrhoidal plexus that is often complicated by inflammation, thrombosis, and bleeding.
- They are classified into two categories: internal hemorrhoids and external hemorrhoids
- Internal haemorrhoids are found above the dentate line (or pectinate line) while external haemorrhoids are found in the perianal skin just inside and outside the anal verge below the dentate line.
- Occasionally, both internal and external hemorrhoids can co-exist
## Internal hemorrhoids
- They are classified into Grade I – IV
- Grade I or 1st degree hemorrhoids (grade I) do not prolapse
- Grade II or 2nd degree haemorrhoids prolapse on straining but they reduce spontaneously
- Grade III or 3rd degree haemorrhoids prolapse on straining and they can be reduced manually
- Grade IV or 4th degree haemorrhoids are permanently prolapsed and they cannot be reduced manually.
## External hemorrhoids
- They can be visible on external examination
- They can also be painful and itchy as they have sensory innervation
- Globally, the prevalence of haemorrhoids has been estimated at 4 - 34%
- Globally, 50- 66% of the people will have haemorrhoid at one time in their lives.
- Globally, the age that is most affected by haemorrhoids is 45-65 years old
- The prevalence of haemorrhoids at Kenyatta National Hospital, Kenya, has been reported to be 21% for all ages and 29% among those who are ≥ 50 years (all of them being Grade I and mainly asymptomatic).
## Risk factors
- Sitting on the toilet for a long time
- Chronic cough
- Genetic factors
- Heavy lifting
## Complications of treatment of haemorrhoids
- Urinary retention
- Anal stricture
- Rectal perforation
- Rectovaginal fistula
- Skin tag