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Internal haemorrhoids (usually third or fourth degree) giving rise to unacceptable symptoms (eg, frequent bleeding) require referral to a colorectal surgeon who might use: Haemorrhoidectomy (by surgery or stapling) Rubber band ligation (a band is applied around the haemorrhoid, cutting off the blood supply and causing it to drop off) Sclerotherapy (injection of a hardening or sclerosing agent [eg, oily phenol injection] into the vein, causing it to scar and drop off) Infrared coagulation to restrict blood flow to the haemorrhoid, causing it to shrink and drop off Cryosurgery Anal fissures An anal fissure is a small tear or ulcer of the lining of the anal canal, immediately within the anal verge (see Figure 2)