These are third degree haemorrhoids. First degree haemorrhoids ae present and bleed; second degree piles may bleed but they prolapse and reduce spontaneously; third degree piles prolapse and remain external or have to be replaced manually. Possible complications of third degree haemorrhoids are strangulation and thrombosis. In a small proportion of cases it is reported that portal pyaemia may occur. Treatment of third degree haemorrhoids is by formal haemorrhoidectomy. More recently stapled haemorrhoidectomy has gained popularity