From the Guidelines
A prolapsed pile is classified as either a third-degree or fourth-degree hemorrhoid, according to the grading system published by Banov et al. in 1985, as referenced in the American Gastroenterological Association technical review 1.
Grading System for Hemorrhoids
The grading system is as follows:
- First-degree hemorrhoids: internal hemorrhoids that bleed but do not prolapse
- Second-degree hemorrhoids: prolapse and reduce spontaneously
- Third-degree hemorrhoids: prolapse and require reduction
- Fourth-degree hemorrhoids: prolapsed internal hemorrhoids that cannot be reduced, usually including both internal and external components
Importance of Accurate Classification
Accurate classification of hemorrhoids is crucial for assessing the efficacy of various treatments and selecting the optimal treatment for an individual patient, as noted in the American Gastroenterological Association technical review 1. The American Society of Colon and Rectal Surgeons uses the Banov classification in its practice parameters for the treatment of hemorrhoids.
Treatment Options
Treatment for prolapsed hemorrhoids, particularly third-degree and fourth-degree, may vary depending on the severity and symptoms. While conservative measures like increased fiber intake and sitz baths may be sufficient for some cases, others may require surgical intervention such as hemorrhoidectomy or other procedures to remove or reduce the prolapsed tissue and alleviate symptoms, as discussed in the context of the Banov classification 1.
From the Research
Hemorrhoid Grades
- Internal hemorrhoids are traditionally graded from I to IV based on the extent of prolapse 2
Prolapsed Pile Grade
- A prolapsed pile is typically considered a grade III or IV hemorrhoid, as these grades are characterized by the extent of prolapse 2
Treatment Options
- Treatment options for hemorrhoids vary depending on the grade and severity of the condition, and may include medical management, dietary modifications, behavioral therapies, and office-based or surgical procedures 2, 3
Grade-Specific Treatment
- Rubber band ligation is a preferred treatment for grades I to III internal hemorrhoids, while hemorrhoidectomy may be reserved for recurrent or higher-grade disease 2
- Hemorrhoidal artery ligation may be useful in grade II or III hemorrhoids, and stapled hemorrhoidopexy may be used to elevate grade III or IV hemorrhoids to their normal anatomic position 2