Symptoms and diagnosis of internal haemorrhoids

Internal haemorrhoids originate above the dentate line and have columnar epithelium that is insensitive to touch or temperature, so they are not typically painful.

Internal haemorrhoids are diagnosed using medical history and physical examination. Symptoms of internal haemorrhoids include bleeding, mucus discharge and pruritis. They may or may not prolapse down the anal canal (ie protrude below the dentate line).

Internal haemorrhoids are classified according to the degree of prolapse from the anal canal:

• Grade I haemorrhoids do not prolapse
• Grade II haemorrhoids prolapse during defecation and reduce spontaneously
• Grade III haemorrhoids prolapse and require manual reduction
• Grade IV haemorrhoids prolapse and are irreducibleClinical Practice Committee, 2004Davis, 2018.