Classification of degree of protrution of internal heamorrhoids.

1st degree –

protrude in to the lumen and are visible on anoscope but do not prolapse outside the anal canal

2nd degree – prolapse outside the anal canal upon straining to defecate

but reduce spontaneously.

3rd degree – protrude upon straining and must be reduced manually.

4th degree – internal heamorrhoids cannot be reduced.

Pathogenetic Theories

1. Sliding down of part of the lining of anal canal as a result of stretching or damage to the submucosa.
2. Erect posture, sphincter spasm and fecal impaction prone to produce venous congestion.
3. Anal cushions consists of erectile like tissues with prominent arteriovenous connections and the fundamental defect is one of increased tone in anal sphincter.
4. Prolapse of anal musoca.