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Haemorrhoids are spongy tissue structures, characterised by a strong presence of capillaries, veins and arteries, located in the anal canal. Here they form real “buffers” which play an important role in the continence of faeces and gases and, during defecation, in reducing the trauma of the passage of the faeces. They are distinguished in:

  • internal haemorrhoids: placed inside the anal orifice, above the dentate line (also called the “pain line” because painful stimuli are perceived below it);
  • external haemorrhoids: located below the dentate line.



Alterations or modifications of the spongy tissue structure may cause haemorrhoidal disease, which in common language is incorrectly identified by the term “haemorrhoids”. This is certainly one of the most widespread problems, especially in the Western world, up to the point that, according to some studies, more than 40% of the adult population would suffer from it at least once in their lives. Numerous different factors and components can contribute to or cause haemorrhoidal disease, the most common being:

  • familiarity;
  • age;
  • obesity;
  • constipation;
  • abuse of laxatives;
  • diarrhoeas;
  • low-fibre diet;
  • increased efforts;
  • traumatising sports (cycling, motorcycling, horse riding);
  • insufficient physical activity;
  • remaining seated for a long time throughout the day;
  • pregnancy.



Haemorrhoidal disease manifests itself with vascular symptoms that can often be mistaken for manifestations common to other pathologies. The most common symptoms are:

  • bleeding;
  • itching;
  • pain and/or burning;
  • mucus secretions;
  • feeling of heaviness in the area concerned;
  • prolapse.

Haemorrhoidal disease is characterised by a discharge of the haemorrhoidal buffers during defecation, which however in smaller cases return spontaneously soon after. As the disease develops, this phenomenon tends to worsen, causing the haemorrhoidal buffers to prolapse, and the patient is forced to reposition them manually. In the most severe stage of the disease, prolapsed haemorrhoidal buffers remain outside permanently.


Haemorrhoid classification is of great importance for the choice of treatment to be followed. According to the most common classification, haemorrhoidal disease can be classified in four degrees:

  • Grade I: characterised by inflammation, possible bleeding but without pain and without external prolapse.
  • Grade II: inflammation and moderate haemorrhoidal congestion. In this case there is external prolapse only under stress (usually during defecation), which comes back autonomously after the effort.
  • Grade III: characterised by congestion and an important external prolapse still under stress. In this case, the haemorrhoids only return through manual help.
  • Grade IV: important haemorrhoidal congestion and inflammation. The prolapse is perennial and it is impossible to reduce the lumps manually.



The first thing to do when you suspect that you have haemorrhoidal disease is to seek medical advice from a doctor who specialises in proctology and avoid aggravating the situation by resorting to do-it-yourself remedies or following advice collected on websites of dubious scientific value. Haemorrhoid treatments can be extremely varied, according to multiple factors (degree, symptoms, frequency of disorders, physical conditions, associated diseases).Haemorrhoid treatment can be substantially divided into:

  • Conservative: recommended in grade I and II haemorrhoidal disease characterised by minor symptoms. It includes a high-slag diet and possible integration of fibres, intake of liquids, abstention from the consumption of irritant foods, of alcohol, adequate intimate hygiene with suitable detergents, possibly the prescription of a pharmacological therapy.
  • Parasurgery: it finds its application in grade I and II, and sometimes grade III haemorrhoidal disease. This type of treatment consists of ambulatory instrumental techniques performed with the aid of an anoscope. Treatments include elastic binding, sclerotherapy, photocoagulation and cryotherapy.
  • Surgery: it is usually indicated in grade II haemorrhoidal disease with more accentuated symptoms, and in grade III and IV. Surgical techniques, as well as choices of anaesthesia, may be different according to the clinical picture.


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