Enlarged Hemorrhoids: Severity Classification

Hemorrhoids: What’s their deal?

You could say that everyone has hemorrhoids. In simple terms, they are pockets or clumps of veins that live under the membranes lining the inferior section of the rectum and anus. Hemorrhoids occur when these veins become more prominent, resulting in irritation and swelling around the area, causing an uncomfortable and painful feeling.

Pregnant women and the elderly most often suffer from hemorrhoids, although young people can get them too.

Hemorrhoids can occur for various reasons. Simple activities like staying seated for too long or lifting heavy objects can cause hemorrhoids. Diarrhea, obesity or having a low-fiber diet can also cause hemorrhoids to form.


Some symptoms or consequences of having hemorrhoids may include rectal bleeding, itching or irritation, discharge of feces, or general discomfort and soreness. Some people may also experience lumps.

There are many different treatments for hemorrhoids. Over-the-counter medicines and even some home remedies can provide relief from any itching, swelling, or discomfort. Sometimes, though, the more severe cases may require medical, including surgical, attention.

Even though most patients are embarrassed to recognize their symptoms and ask for help, you should never hesitate to contact a medical professional. Some cases of hemorrhoids can be dangerous to your health.

Learning more about the severity classification of hemorrhoids and how to recognize each type may help you determine when you develop a case of hemorrhoids, whether you should have a specialist examine you.

Severity Classifications

The severity classifications are divided into four grades: Two internal and two external.


Grades 1 and 2 are internal hemorrhoids. This means they usually stay inside the anal canal and do not cause any pain or discomfort. The most that can occur in this instance, is an irritation when passing a stool, causing damage to the hemorrhoid’s structure that may result in slight bleeding from the anus.


  • Grade 1


For Grade 1, the veins tend to accumulate, but the bulge stays in the canal but is still visible on the surface of the anus. Grade 1 hemorrhoids are sometimes nicknamed “stealth” hemorrhoids as individuals who get them rarely notice them. One way that people with Grade 1 hemorrhoids may notice them is by the presence of blood stains on toilet tissue after wiping.


  • Grade 2


These hemorrhoids are larger than Grade 1 as they have begun to prolapse and bleed. Often, these bundles can manage to make their way down the anal canal from either physical activities or passing a stool. Normally, these retract back to the canal on their own and eliminate themselves. When this happens, the amount of blood from wiping may be alarming, but this stage of hemorrhoids is not dangerous.


Grades 3 and 4, internal hemorrhoids, have clumps of veins which have become larger and traveled down the anal canal. These clumps become exposed and visible. Because of the number of sensitive nerves in the area at the end of the anus, these types of hemorrhoids are more painful and more likely to bleed when passing a stool or wiping.


  • Grade 3


Physical activity or simply going to the bathroom can cause these types of hemorrhoids to become exposed. The larger bundles can come entirely out of the anus. It is possible to push Grade 3 hemorrhoids back inside.

A gentle massage around the area while carefully pushing will move the hemorrhoids back inside.

You can usually treat Grade 3 hemorrhoids with over-the-counter medications until it eventually goes away.


  • Grade 4


This is the most dangerous type of hemorrhoid. Grade 4 hemorrhoids are considered “thrombosed hemorrhoids” The term “rectal prolapse” is also common. In a Grade 4, the hemorrhoid will not be able to be returned to the anal canal.  The hemorrhoid may need to be removed through surgery.


Overall, a hemorrhoids is an uncomfortable and painful condition that is worth taking care of from the moment it is detected. Waiting for it to eliminate on its own can be risky, as the possibility for it to worsen exists. Of course, the best way of solving this issue is from prevention. Make sure to keep a rich-in-fiber diet and drink a sufficient amount of liquids to stay hydrated; about a liter and a half or two per day. A very important but often disregarded tip is to go to the toilet as soon as you need to. If you don’t, your stool risks drying out and becoming more difficult to eliminate. Exercising and avoiding sitting for prolonged periods will reduce pressure on veins, so there will be fewer chances of build-up. If you suspect you have hemorrhoids, please contact our office to schedule an appointment.