HHemorrhoids are located in the interior of the anal canal and are specialized highly vascular cushions . Somehow, they are like “ bags “ of thick submucosal tissue containing blood vessels,smooth muscle and elastic and connective tissue.

These three cushions lie always in constant sites. If we imagine the anus as a clock , the hemorrhoids would be located in 4-6 h. , 7-9 h. , and 10-12 h.
This is the normal anatomic location and is present in children ,in the fetus and even in the embryo. So we can say that humans are borned with two eyes , two ears , one nose and……three piles or hemorrhoids.

Regarding their function, it seems that they contribute to anal continence .During the defecation they become engorged and tense with blood , cushioning the anal lining and because they are separated estructures they allow the anal canal to dilate without tearing.

When these cushions get engorged and descend outside the anal canal is when symptoms appear and tratment is usually needed.


The classification of hemorrhoids is very important from the medical point of view. It is going to dictate the tratment option we are going to offer the patient

First Degree Hemorrhoids

The hemorrhoids can be seen bulging into the lumen of the anal canal.

Second Degree Hemorrhoids

The hemorrhoids protrude outside the anal canal during defecation but reduce spontaneously.

Third Degree Hemorrhoids

When the hemorrhoids protude outside the anal canal either spontaneously or after defecation and require manual replacement.

Fourth Degree Hemorrhois

Are those which are permanently outside the anal canal , prolapsed and irreducible despite attempts at manual replacement

External Hemorroids

These are the dilated venules of the inferior hemorroidal plexus located ibelow the limits of the anal canal mucosa, almost in the anal skin and are clinically less important.


Bleeding is usually bright red and painless , ocurring most of the time at the end of defecation . Usually it is a dripping or squirting into the toilrt bowl. In some instances it can occur spontaneously without defecation embarrasing the patient.

Prolapse of the internal hemorrhoids , appearing outside the anal canal which some reduce spontaneously , some need to be reduced manually and in advanced cases the prolapse turns irreducible.

Discomfort and a sensation of incomplete defecation

Itching and excoriation of the skin due to mucus and fecal leakage produced by the prolapse.

Pain is not a symptom of hemorrhoids , but when present , usually indicates an associated disease ( i.e. a fissure ) or a complication of the hemorrhoids such as a thrombosed or an strangulated hemorrhoid.


Besides a general assesment to ascertain the general health status of the patient , a complete anorectal examination should be performed in the office. This includes an anal inspection to ascertain the disease and to rule out other conditions that could render the rest of the exploration painful. If the surgeon has enough experience , the rest of the procedure ,digital exploration of the anal canal and the ano-cectoscopy are painless. At this stage, any other exploration can be ordered if neccesary.

The examination will allow the doctor, to offer the patient the treatment most suited for his case.


The treatment depends on the Hemorrhoid´s Degree that the patient presents. In our Instituto , besides advice to follow an adequate diet that regulates bowel movements , we offer two types of tratment:


No surgery at all is indicated in these grades. Rubber banding is an office procedure and is performed without any anesthesia because the procedure is painless. It consists in the placement of a constricting rubber band at the base of each hemorroidal nodule , causing a submucosal scarring that prevents irrigation of the tissue above the band .Subsequent sloughing and dissapearence of the nodules occurs in the next 10 to 14 days


Surgery is the treatment of choice for this type of hemorrhoids being the Milligan –Morgan the Golden Standard technique .The end point is to remove the whole hemorroidal tissue from its anatomical origin in the anal canal. Since 1993 we have operated more than 1.500 patients with CO2 LASER with excellent results and with hospital stay from 8 to 24 h. The CO2 Laser Surgery is the most advanced surgical treatment we can offer our patients nowadays for the following reasons :
  • Complete erradication of the hemorrhoids.
  • Much less postoperative pain ( pain is what scares patients ).
  • Smaller wounds.
  • Much less postoperative inflamation.
  • Less time for complete healing of the wounds.
  • Quick return to normal life .



Hospital Dr. Gálvez

C/Císter, 11 (1ª planta – derecha). 29015 · Málaga.




+34 952 609 426
+34 952 609 888