Synopsis
Distinguish haemorrhoidal symptoms from colorectal or inflammatory disease, grade prolapse accurately, and escalate conservative, office and operative treatment with safe follow-up.
- Haemorrhoids are symptomatic vascular anal cushions; internal disease arises above the dentate line and external disease below it.
- Uncomplicated internal haemorrhoids commonly cause painless bright-red bleeding, prolapse, mucus or soiling rather than severe pain.
- Grade I internal haemorrhoids bleed without prolapse; grade II reduce spontaneously, grade III need manual reduction and grade IV remain prolapsed.
Key red flags
A tender bluish perianal swelling appears abruptly and is often worst over the first few days. Skin necrosis, expanding haematoma or diagnostic uncertainty warrants surgical review.
Investigation priorities
Identify external thrombosis, prolapse, skin disease, fissure, fistula or mass.
Management branches
Mild bleeding, itch or reducible prolapse with no red-flag alternative diagnosis.
- Confirm a compatible history and examination, assess cancer risk and actively look for fissure, abscess, prolapse, proctitis or a suspicious anal lesion.
- Optimise stool consistency with suitable fibre, fluids and a laxative when constipation persists; reduce straining, heavy breath-holding and prolonged sitting on the toilet.
Key medicines
Bulk-forming or osmotic laxativeSelect and titrate the current formulary preparation to produce soft formed stools.
Short-course topical haemorrhoid preparationApply only for the brief duration specified by the product and formulary.