What are the grades of hemorrhoids?

From the Guidelines

Hemorrhoids are graded on a scale from first-degree to fourth-degree based on their severity and physical characteristics, as outlined in the Banov classification system 1. The grading system is crucial for determining the appropriate treatment approach for each patient.

• First-degree hemorrhoids are internal and bleed but do not prolapse.
• Second-degree hemorrhoids prolapse and reduce spontaneously, with or without bleeding.
• Third-degree hemorrhoids prolapse and require manual reduction.
• Fourth-degree hemorrhoids are permanently prolapsed and cannot be reduced manually, often including both internal and external components and are confluent from skin tag to inner anal canal, as described in the study by Banov et al. 1. This classification system is important for assessing the efficacy of various treatments and selecting the optimal treatment for an individual patient, as emphasized by the American Society of Colon and Rectal Surgeons 1. The grading system helps healthcare providers determine the best course of treatment, ranging from conservative measures for lower grades to surgical interventions for higher grades, and accurate classification is essential for effective management of hemorrhoids 1.

From the Research

Hemorrhoids Grading

• Hemorrhoids are traditionally graded from I to IV based on the extent of prolapse 2
• The grading of hemorrhoids is important in determining the treatment approach, with higher grades often requiring more invasive procedures 3, 4
• The severity of hemorrhoids can be classified into four grades:
  • Grade I: Hemorrhoids that bleed but do not prolapse
  • Grade II: Hemorrhoids that prolapse but reduce spontaneously
  • Grade III: Hemorrhoids that prolapse and require manual reduction
  • Grade IV: Hemorrhoids that are irreducibly prolapsed 5

Treatment Approaches

• Treatment approaches for hemorrhoids vary depending on the grade and severity of the condition, and may include medical management, dietary modifications, behavioral therapies, and surgical procedures 2, 3, 4
• For grades I to III internal hemorrhoids, rubber band ligation is a preferred treatment option due to its lower failure rate compared to infrared photocoagulation 2
• For higher-grade hemorrhoids, surgical procedures such as open or closed hemorrhoidectomy, stapled hemorrhoidopexy, and doppler-guided hemorrhoidal artery ligation may be necessary 3, 4, 5

Factors Influencing Treatment

• The degree of discomfort, bleeding, comorbidities, and patient preference should be taken into account when determining the treatment approach for hemorrhoids 2
• The location of the hemorrhoids, whether internal or external, also plays a role in determining the treatment approach 3, 4