Grading of Hemorrhoids

Have you ever wondered why you might see blood on the toilet paper, feel a strange heaviness down there, or notice a soft lump near your anus after a bowel movement? You’re not alone. And no, it’s not always something serious like cancer. In most cases, it’s something much more common and treatable.

Haemorrhoids aren’t all the same. Some are barely noticeable. Others can seriously mess with your comfort, routine, and peace of mind. That’s where grading comes in. Just like the stages of any medical condition, grades help both doctors and you understand the severity of the situation and what actions to take next. 

In this blog, we’ll walk you through each grade of haemorrhoids. What it looks like, how it feels, and the smartest way to handle it, so you’re not left guessing or searching for answers in the middle of the night.

Types of Haemorrhoids

Not all haemorrhoids are the same. Where they show up, how they feel, and how serious they are can vary a lot. Doctors typically classify them into four types. Let’s break them down one by one.

1. External Haemorrhoids

These form under the skin around your anus, which means they’re visible and often painful. You might feel one or more soft bumps near the anal opening. External haemorrhoids can itch, burn, or bleed during wiping or bowel movements. Since they’re on the outside, they’re often easier to spot and can make sitting or walking uncomfortable.

Related Post: How to Get Rid of External Hemorrhoids in 48 Hours ?

2. Internal Haemorrhoids

Internal haemorrhoids develop deeper inside the rectum, so you usually can’t see or feel them. Most people don’t realise they have them until they see some blood after using the toilet. While they’re typically painless, straining during bowel movements, constipation, or chronic diarrhoea can irritate them and cause light bleeding.

3. Prolapsed Haemorrhoids

Sometimes internal haemorrhoids don’t stay inside. They push outward and bulge through the anal opening, especially when you strain or go to the bathroom. This is what’s known as a prolapsed haemorrhoid. In mild cases, the haemorrhoid might go back in on its own. In more advanced cases, it may need to be pushed back manually or treated by a doctor. Prolapsed haemorrhoids can be painful and itchy and can sometimes lead to swelling or discharge.

4. Thrombosed Haemorrhoids

This happens when a swollen external vein develops a clot, making it more painful and severe. Thrombosed haemorrhoids are usually hard, swollen, and extremely painful to the touch. The clot can stretch the skin, cause inflammation, and even lead to bleeding. In some cases, if the pain is too intense or the bleeding doesn’t stop, quick medical treatment may be required to relieve the pressure and remove the clot.

Grades of Internal Haemorrhoids

Internal haemorrhoids are classified into four grades based on how they behave:

Grade I:

Grade I haemorrhoids are the mildest form. These are enlarged veins deeper in the rectum that stay out of sight and don’t push outward. You might not even know you have them because they often don’t cause pain due to the lack of pain-sensing nerves above the dentate line, but they can still cause trouble.

• Symptoms: Slight bleeding during bowel movements, often seen as bright red blood on toilet paper or in the stool. You might feel mild itching or discomfort, but no prolapse.
• Diagnosis: These are usually spotted during a doctor’s examination, often with an anoscope (a small tube with a light) or during a colonoscopy.

Since they’re mild, Grade I haemorrhoids are often managed with simple changes, but ignoring them could let them progress to higher grades.

Grade II:

Grade II haemorrhoids are a step up in severity. These haemorrhoids prolapse, meaning they poke out of the anus during straining, like when you’re having a bowel movement or lifting something heavy, but they go back inside on their own afterwards.

• Symptoms: Bleeding, itching, or a feeling of fullness in the rectum. You might notice a small lump during a bowel movement that disappears. Some discomfort or mild pain can occur, especially if they’re irritated.
• Diagnosis: A doctor can confirm these with a physical exam or anoscopy, especially if you describe prolapse that retracts.

These haemorrhoids are still manageable with non-surgical treatments, but they’re a sign that you need to take action to prevent worsening.

Grade III:

Grade III haemorrhoids are more serious. They prolapse during straining or physical activity, but unlike Grade II, they don’t go back inside on their own; you have to manually push them back in. This can make them more bothersome.

• Symptoms: You might feel discomfort like itching, burning, pain, or see more obvious bleeding. The prolapsed tissue can cause a feeling of pressure or discomfort, especially when sitting. These can impact your quality of life, which makes daily tasks like sitting or walking less comfortable.
• Diagnosis: A digital rectal exam or anoscopy can confirm the prolapse, and doctors may recommend a colonoscopy to rule out other issues like colorectal cancer if bleeding is significant.

Grade III haemorrhoids often need more aggressive treatment, and surgery might be considered if other methods fail.

Grade IV:

Grade IV haemorrhoids are the most severe. These are permanently prolapsed, meaning they stay outside the anus and can’t be pushed back in. They’re more likely to cause complications, like blood clots (thrombosis), which can be very painful.

• Symptoms: Significant pain, swelling, bleeding, and discomfort. You might feel constant irritation or have trouble with hygiene due to the protruding tissue. Thrombosed Grade IV haemorrhoids can cause intense pain and a hard lump near the anus.
• Diagnosis: These are visible during a physical exam, and a doctor might use anoscopy or other tools to assess the extent of the prolapse.

Because of their severity, Grade IV haemorrhoids usually require surgical intervention to relieve symptoms and prevent complications.

Do Haemorrhoids Need Treatment?

Not always. A lot of haemorrhoids heal naturally, especially if you adjust some everyday habits. But when symptoms stick around, get worse, or start affecting your everyday life, it’s time to consider treatment.

Here’s what you need to know.

When You Might Not Need Medical Treatment?

If your haemorrhoids are small and only cause mild discomfort without frequent bleeding, you can likely treat them at home. Eating more fibre, drinking enough water, and avoiding straining during bowel movements can make a big difference. Over-the-counter creams like hydrocortisone ointments or witch hazel pads can ease itching or swelling. Sitz baths (sitting in warm water for 10 to 15 minutes) can also help soothe the area naturally.

These conservative steps are usually enough if the haemorrhoids aren’t prolapsed, bleeding heavily, or causing sharp pain.

But not every case gets better with home care. When that happens, there are several effective medical treatments available.

Medical Treatments for Haemorrhoids

If your symptoms don’t improve or keep coming back, your doctor might suggest one of these options, depending on the type and severity of your haemorrhoids.

1. Rubber Band Ligation

Rubber band ligation is a simple treatment done right in the clinic. The doctor places a tight rubber band at the base of the internal haemorrhoid to block its blood flow, making it shrink and eventually fall off. After a few days, the haemorrhoid dries up and falls off. You might feel a bit of pressure or discomfort afterwards, but it’s usually manageable and doesn’t require stitches or a long recovery time.

2. Sclerotherapy

In sclerotherapy treatment, a chemical solution is injected directly into the haemorrhoid to shrink it over time. It’s quick, generally painless, and works well for smaller or less severe cases. This is like a non-surgical way to reduce the swelling from the inside.

3. Infrared Coagulation (IRC)

The doctor uses infrared light to heat and close off the blood vessels that supply the haemorrhoid, cutting off its support. Without blood flow, the haemorrhoid shrinks. It’s often done in a series of sessions and works well for internal haemorrhoids that aren’t too advanced.

4. Haemorrhoidal Artery Ligation (HALO or THD)

Haemorrhoidal artery ligation is a more advanced, minimally invasive procedure. A specialised ultrasound tool is used to identify the blood vessels feeding the haemorrhoid. Once found, those arteries are tied off with stitches. Blood flow is cut off, and the haemorrhoid starts shrinking. It’s often used for prolapsed or stubborn haemorrhoids and comes with less post-operation pain compared to full surgery.

5. LHP – Laser Haemorrhoidoplasty

Laser haemorrhoidoplasty treats haemorrhoids by applying targeted laser energy inside the tissue, causing it to shrink without any cutting. There are no large incisions or open wounds, and recovery is typically quicker than with traditional surgery. Many patients prefer this option because it’s clean, precise, and less painful.

6. Haemorrhoidectomy

Haemorrhoidectomy is the go-to surgical treatment for large, prolapsed, or chronic haemorrhoids that haven’t responded to anything else. There are two main methods:

• Excisional haemorrhoidectomy involves physically cutting out the haemorrhoid.
• Stapled haemorrhoidectomy repositions and reduces the haemorrhoid using a circular stapling device.

Both are effective but come with longer recovery times, so they’re usually reserved for more serious cases.

Related Post: Is Hemorrhoid Surgery Worth It?

What Happens If Haemorrhoids Are Left Untreated?

Haemorrhoids aren’t life-threatening, but ignoring them can lead to ongoing discomfort and bigger issues. Here’s what can happen if you leave them untreated:

• Persistent pain: Swollen or clotted haemorrhoids can cause steady pain and a feeling of heaviness. This discomfort can make it difficult to sit, walk, or even go to the bathroom.
• Excessive bleeding: Occasional spotting might not seem serious, but chronic haemorrhoidal bleeding can lead to iron-deficiency anaemia. It happens when your body lacks sufficient red blood cells, which leads to tiredness, lightheadedness, and a general feeling of weakness.
• Irritation and itching: Constant inflammation and discharge can lead to itchiness or skin irritation around the anal area, increasing the risk of secondary infections.
• Reduced mobility and discomfort during daily tasks: Pain from untreated haemorrhoids can make it hard to focus at work, exercise, or enjoy normal activities. Over time, this can affect your productivity and mental well-being.
• Impact on mental health: Dealing with chronic pain, fear of bleeding, or embarrassment around the condition can lead to anxiety, stress, or avoidance of social situations.

How to Prevent Haemorrhoids?

The best way to manage haemorrhoids is to stop them from getting worse. Here are a few tips to remember:

• Eat More Fibre: Load up on fruits, vegetables, and whole grains to keep stools soft.
• Maintain Hydration: To help in digestion, consume 8–10 glasses of water each day.
• Exercise Regularly: Physical activity helps prevent constipation and reduces pressure on veins.
• Avoid Straining: Don’t push too hard during bowel movements, and don’t linger on the toilet.
• Maintain Good Hygiene: To prevent inflammation, gently wash the anal region with water or a toilet paper roll.

These habits can prevent haemorrhoids from progressing to higher grades and reduce the need for invasive treatments.

Final Thoughts

Haemorrhoids aren’t exactly a fun topic, but they’re something a lot of people deal with. Understanding how they’re graded, from Grade I to Grade IV, helps doctors figure out the right treatment, whether that’s a few simple lifestyle changes or surgery for more serious cases. 

The more you know about the grades, symptoms, and treatment options, the more control you have over your health and recovery. If you’re dealing with haemorrhoids, talk to a doctor. 

Frequently Asked Questions

1. What are Grade 4 haemorrhoids?

Grade 4 haemorrhoids are the most advanced type. They stay outside the anus and can’t be pushed back in. They often cause pain, bleeding, and mucus discharge.

2. How are haemorrhoids classified?

Haemorrhoids are graded from 1 to 4. Grade 1 stays inside. Grade 2 prolapse appears with straining but returns inside without help. Grade 3 stays out until it’s pushed back in by hand. Grade 4 stays outside all the time.

3. Is surgery needed for Grade 4 haemorrhoids?

Yes, in most cases. Grade 4 haemorrhoids usually don’t respond to home treatments, so doctors often recommend surgery like haemorrhoidectomy or stapled haemorrhoidopexy.

4. Can haemorrhoids go away completely?

Mild haemorrhoids often heal on their own in a few days. But for some people, they keep coming back and may need treatment to fully resolve.

5. When is surgery necessary for haemorrhoids?

Surgery is usually needed for Grade 3 or 4 haemorrhoids, especially if they’re painful, bleeding a lot, or not improving with other treatments.