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- [Instructor] Your Dr. May recommend a hemorrhoidectomy to remove your hemorrhoids if they do not respond to more conservative treatment. Hemorrhoidal veins are blood vessels within the walls of the rectum and anal canal. Hemorrhoids also known as piles occur when these veins becomes swollen and the tissue around them becomes inflamed. A swollen vein near the opening of the anal canal is called an external hemorrhoid. A swollen vein within the rectum is called an internal hemorrhoid. Internal hemorrhoids are classified by how advanced they are. First-degree internal hemorrhoids are those that always remain inside the rectum. Second-degree internal hemorrhoids will extend outside the rectum during a bowel movement, and then return to the inside of the rectum on their own. Third-degree internal hemorrhoids extend outside the rectum during a bowel movement and then must be pushed back inside the rectum. Fourth-degree internal hemorrhoids always remain outside the rectum and cannot be pus