Grades of Hemorrhoids

Internal hemorrhoids and their different grades

Do you know we all have hemorrhoids? They are normal pillow-like bundles of tissues and blood vessels at the end of our rectum and anus. Their job involves covering the anus area completely to prevent any leakage. But how do they turn into a medical condition?

Hemorrhoids cause problems only if they get bigger. They usually swell because of abdominal pressure, excessive straining, and increasing age. You might experience rectal bleeding during bowel movements, itching, discharge, and pain as a result. A timely diagnosis of this condition allows you to take care of yourself in the right way or seek medical help at the right time.

There are different categories of hemorrhoids based on their size, location, and degree of prolapse. Some hemorrhoids go away on their own, whereas others get better with home remedies and care. However, you might need a doctor if the symptoms are severe or do not go away with time.

Grades of Hemorrhoids

Based on the degree of prolapse, there are 4 different grades of hemorrhoids. Let’s discuss each grade in detail for better awareness.

Grade 1


The 1st grade involves internal hemorrhoids that protrude just above the anal cavity or pectinate line. There is no external protrusion or prolapse. They show up as small bulges in colonoscopy.


Grade 1 hemorrhoids do not cause pain. You will not face any evident symptoms at this stage except a little discomfort and itching.


Grade 1 hemorrhoids go away on their own over time with care. Doctors recommend you to include fiber-rich food into your diet and use some over-the-counter medicine or cream.

Fiber-rich food (like beans, broccoli, and whole grains) work as an antidote for hemorrhoids. Why? Because they reduce constipation and make your stool soft by improving your bowel movements. However, do not start taking too much fiber all at once, or you will end up feeling gassy and bloated. Introduce these foods gradually into your diet so that your body gets used to them.

Over-the-counter medicines and creams for hemorrhoids are quite common. They reduce the inflammation, swelling, and itching resulting from hemorrhoids. Some over-the-counter hydrocortisone ointments are Preparation H, Proctofoam, and Analpram.

Grade 2


Grade 2 refers to the hemorrhoids that prolapse when you strain too much during a bowel movement. They protrude outside the anus but go back inside on their own (without any intervention) after the straining subsides.


Grade 2 hemorrhoids may often cause pain and bleeding, especially if they are not taken care of.


To treat grade 2 hemorrhoids, doctors recommend the same methods used to treat grade 1 hemorrhoids (including fiber-rich foods and over-the-counter creams, laxatives and avoiding pressure down there). If these methods don’t work, doctors move to non-surgical medical procedures like rubber band ligation, injection sclerotherapy, or infrared coagulation.

Remember: These procedures do not focus on the root cause of hemorrhoids, so they don’t cure the condition completely. Their effects last only from six months to a year; the hemorrhoids might start appearing again if the procedure is not repeated after that.

  1. Rubber Band Litigation: The doctor uses rubber bands to tie off the hemorrhoids at their base, cutting off their blood flow. This procedure is performed by inserting a viewing instrument, called an anoscope, into the anus.
  2. Injection Sclerotherapy: The doctor injects a chemical solution into the hemorrhoid area that causes the hemorrhoids to shrink and dry over time. This scarring treatment requires examination of the hemorrhoids with the help of a proctoscope or endoscope (tube-shaped devices used to reach the inside of the bottom via the anus or bottom opening).
  3. Infrared Coagulation: Using light as a heat source, the doctor clogs the vessels that supply blood to the hemorrhoids. Small bursts of infrared light are delivered to the patient with a probe. Hemorrhoids shrivel up completely over time due to the heat.

Grade 3 & 4


Grade 3 hemorrhoids also prolapse out of the anus during a bowel movement. However, they don’t go back on their own. Doctors have to push them back into their place manually.

Grade 4 hemorrhoids do not go back and need to be surgically removed.


These are advanced grades of hemorrhoids that require serious medical attention. Common symptoms include rectal bleeding, pain, itching, and swelling around the area. Their symptoms do not usually get better with conservative measures or non-surgical treatments.


The treatment of grade 3 and 4 hemorrhoids usually require surgical procedures. The most common surgeries are explained below.

  1. Excisional Hemorrhoidectomy: Simply put, this procedure involves cutting the hemorrhoidal tissue. The doctor will either leave your tissue wound open or close it with stitches. Although very effective, this surgery can be quite painful for the patients.
  2. Stapled Hemorrhoidectomy: Here, the doctor cuts out only some part of the tissue rather than removing the whole tissue. The rest of the tissue is pushed back into the anal canal and stapled into the right position. This surgery is not as invasive and painful as an excisional hemorrhoidectomy. Plus, recovery also takes less time.

Final Words

Hemorrhoids are one of the most common medical issues. Due to the changes in our diets and lifestyles, they are now even more widespread than before. However, some people are still unaware of its causes, implications, and treatments.

There are 4 grades of hemorrhoids based on their degree of prolapse. From their descriptions to symptoms and treatment procedures, this blog has covered everything in detail. Right diagnosis at the right time can save you from pain and discomfort.

If you know anything else that helps with hemorrhoids, feel free to add it in the comment section below!