Hemorrhoid Grading System

Grade 1:

 Grade 1

Grade 1

Grade 1 - Hemorrhoid protrudes into the anal canal but does not prolapse outside the anus.

Grade 1 hemorrhoids are internal hemorrhoids which do not prolapse, or protrude out of the anus. For Grade 1 hemorrhoids doctors will most likely recommend a hemorrhoid treatment regimen of adding fiber to your diet and trying one of many new over-the-counter hemorrhoid treatments. Preparation H is a very popular over-the-counter hemorrhoid treatment in the United States. Proctofoam, Tucks hydrocortisone ointment, and Analpram are all over-the-counter hydrocortisone creams for hemorrhoid treatment. These hemorrhoid treatment creams decrease inflammation, swelling, and itching from hemorrhoid irritation.


Grade 2:

 Grade 2

Grade 2

Grade 2 - Hemorrhoid protrudes through the anus during straining or evacuation but returns spontaneously.

Grade 2 hemorrhoids are internal hemorrhoids which prolapse, but then go back inside the anus spontaneously without interference. For Grade 2 hemorrhoids, doctors will often try conservative hemorrhoid treatment therapies, starting with treatment for Grade 1 hemorrhoids and moving to painless in-office hemorrhoid treatment procedures as needed. Such painless hemorrhoid treatment therapies include rubber band ligation, injection sclerotherapy, or infrared coagulation. It is very important to note that all of these hemorrhoid treatments are performed on internal prolapsed hemorrhoids only, not external hemorrhoids. These procedures can require multiple applications and these hemorrhoid treatment options do not address the source of the problem hemorrhoid, so they are not curative. While these treatments for Grade 2 hemorrhoids usually only last six months to a year before they need to be repeated, results have shown that they can be effective on many patients. The obvious advantages of these in-office hemorrhoid treatment procedures are that they are done without anesthesia and cause minimal discomfort.


Grades 3 & 4:

 Grade 3

Grade 3

Grade 3 - Hemorrhoid protrudes through the anus during straining or evacuation but needs to be manually returned to position.

Grade 4 - Hemorrhoid remains prolapsed outside of the anus.

Grade 3 hemorrhoids are internal hemorrhoids which prolapse, but do not go back inside the anus until the patient pushes them back in. Grade 4 hemorrhoids are prolapsed internal hemorrhoids which will not go back inside the anus. For treatment of Grade 3 hemorrhoids and Grade 4 hemorrhoids, doctors will often refer patients to surgeons for more serious hemorrhoid treatment procedures. The most common surgical hemorrhoid treatments are surgical hemorrhoid excision or a surgical hemorrhoid stapling procedure.

 Grade 4

Grade 4

An excisional hemorrhoidectomy is the most common surgical hemorrhoid treatment and generally has the best results. Unfortunately, the procedure is very painful so the patient’s recovery is quite difficult. Most patients require a full two weeks to recover. Due to the amount of pain after an excisional hemorrhoidectomy, a new hemorrhoid treatment technique was created to be minimally invasive.

The stapled hemorrhoidectomy procedure is far less painful hemorrhoid treatment because of the incision location. Inside the anus, where there are no nerve endings, a special device cuts a rim of tissue in a circular shape. At the same time, the instrument uses small staples to hold the tissue together. Proponents of the stapled hemorrhoid treatment state that by removing a rim of tissue, the blood supply to the hemorrhoids is disrupted and the hemorrhoids are lifted back in place. This hemorrhoid treatment procedure does have risks, however, including: stapling the rectum to the vagina, damage to the small bowel if done too high in the rectum, bleeding and severe infection. Furthermore, the stapled hemorrhoid treatment procedure will necessarily leave permanent staples within the rectum, which is a downside for some patients.