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Dr Mohd Fadhil General Surgeon

Health information

Haemorrhoid Grades

Colorectal & perianal · 1 min

A simple explanation of Grades I to IV.

Grades I to IV, by how far the haemorrhoid comes out

Internal haemorrhoids are graded by how far they come out (prolapse), because the grade helps decide which treatment is suitable.

Illustration of the anal canal showing internal and external haemorrhoids.

  • Grade I — prominent haemorrhoidal tissue, but no prolapse.
  • Grade II — comes out when straining, and goes back in on its own.
  • Grade III — comes out and has to be pushed back in.
  • Grade IV — stays out and cannot be pushed back in.

The grade is only one part of the picture: your symptoms matter just as much when treatment is chosen.

If your symptoms persist or you are unsure of the cause, arrange an assessment.

Haemorrhoids are swollen blood vessels in and around the anal canal. They can cause bleeding, a lump that protrudes from the anus, itching or discomfort. However, rectal bleeding can also be caused by anal fissures, polyps, bowel inflammation or colorectal cancer.

When should you be assessed?

  • Fresh red blood during bowel movements
  • A lump protruding from the anus
  • Itching, mucus or discomfort
  • Pain or swelling at the anal margin
  • Recurrent symptoms despite medication

Treatment Options

Treatment depends on the grade and symptoms of the haemorrhoids. It may begin with high fiber diet, adequate fluid intake, stool softeners and medication. If symptoms persist, procedures or surgery may be discussed according to the type of haemorrhoid and the patient’s needs.

Read More: Haemorrhoids

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