Hemorrhoids: Grades, Complications and Treatments

Hemorrhoids are graded on a scale from I to IV, with IV being the most serious and advanced grade. Most people will only get hemorrhoids at the lower end of the scale, Grades I and II, which are less painful and easier to treat, but if the hemorrhoids continue to swell and progress to Grades III and IV, then surgery may become necessary in order to relieve the symptoms.

Hemorrhoid Grading System:

Grade I: This type of hemorrhoid isn’t swollen enough to prolapse. (Prolapse means fall out of the anal canal.)

Grade II: These hemorrhoids may extend outside the anal canal after using the bathroom, but will shrink back into the anal canal on their own.

Grade III: These hemorrhoids will also fall out of the anal canal after using the bathroom, but they won’t shrink back on their own, they are however capable of being manually placed back within the anal canal.

Grade IV: These are prolapsed hemorrhoids that are trapped outside the anal canal.

Types of Hemorrhoids and Potential Complications

Internal Hemorrhoids: Just as you would expect, these hemorrhoids are located within the anal canal. The anal canal is divided into two separate sections by the dentate line, with the upper 2/3rds of the anal canal having no pain receptors and the lower 1/3rd of the anal canal having pain receptors; this means that internal hemorrhoids located above the dentate line will be pain free with bleeding the only potential symptom. This lack of symptoms may make them harder to initially identify and may lead to potential complications if they aren’t treated early enough.

  • Prolapsed Hemorrhoid: These are internal hemorrhoids that swell so much that they fall out of the anal canal.
  • Strangulated Hemorrhoid: These are prolapsed hemorrhoids that get trapped outside the anal canal due to the sphincter muscles contracting.

External Hemorrhoids: Due to their location below the dentate line, these hemorrhoids will usually be more symptomatic. Potential symptoms include: anal bleeding, discomfort, pain, a burning sensation, itching and swelling at the anal opening.

  • Thrombosed Hemorrhoid: This type of hemorrhoid occurs when a hemorrhoid develops a blood clot in it, this potential complication can result in sudden sharp pain that will probably send you running to a doctor.

Non-Surgical Treatment Options

High fiber diet. Fiber helps reduce straining while using the bathroom. This is essential for both the prevention and treatment of hemorrhoids, since this type of straining is the leading cause of hemorrhoids.

Sitz baths or regular baths. A sitz bath is a specially designed soaking tub that submerges just the anal region, used with warm water 2-3 times a day it can help minimize swelling and provide temporary hemorrhoid relief. If you don’t have a sitz bath, a regular bath also works, but is less convenient for frequent soaks. Don’t use salts or oils when using either the sitz bath or the bathtub as they can further irritate hemorrhoids.

Ice packs. Just as you would expect, ice packs applied to the anal region can help reduce swelling and also temporarily numb the area.

Surgical Options for Treating Hemorrhoids

Rubber band ligation: This is the most common hemorrhoid surgical procedure. Small rubber bands are placed around the hemorrhoids cutting off the blood supply, this eventually causes the hemorrhoids to dry up and slough off.

Stapled hemorrhoidectomy: Staples are used to cut off the hemorrhoids blood supply allowing it to dry up.

Laser surgery: This procedure uses a laser to quickly cut off the hemorrhoids. This procedure also has the benefit of cauterizing the wound at the same time, so bleeding after the procedure is minimal to non-existent.

Hemorrhoidectomy: This is the most serious hemorrhoid surgery and only used in very serious cases, in this procedure the hemorrhoids are actually removed with a scalpel. Due to the fact that this is a cutting surgery, there is a greater risk of infection and potential complications plus there is usually more pain and a longer recovery time.

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