Internal hemorrhoids

According to the degree of protruding parts, three degrees may be recognized.

First degree
In this tage the veins are varicosed, but do not form a very distinct mass. They remain inside the anal canal and do not protrude during defecation or straining.

Second degree
The veins are dilated and sacculated, forming fleshy swellings covered with mucous membrane which protrudes during defecation, but return spantaneously after the act, or can be returned by the patient.

Third degree
In this degree, the hemorrhoid remains protruded, or can be returned with much difficulty. It is oftern complicated with a relaxed sphincter ani muscle and prolapse of the mucous membrane.

Irreducible Internal Hemorrhoids

A condition in which a protruding second or third degree internal hemorrhoids has become irritated by drastic purgatives, trauma, or infection, and is caught by the spincter ani muscle which is so contracted that the blood supply is practically blocked from the protruding mass.

A strangulated condition is usually due to a tight sphincter ani muscle around the protruding part which cuts off, more or less, the blood supply to and from the part which causes swelling of the protruding part.
Occasionally a strangulated internal hemorrhoids becomes trombosed. If the strangulation cuts off the blood supply of the protruding part completely, gangrene or death en masse of the protruding part follows.

Inflamed Internal Hemorrhoids

This may be any type of internal hemorrhoids complicated by infection.