What is Internal Hemorrhoid Grading?

Internal hemorrhoid grading is the way that medical professionals categorize how severe your hemorrhoid condition is. Internal hemorrhoids are the only ones that are graded.

Internal hemorrhoids are located on the inner wall of your anal canal and are anal veins that become swollen and irritated as the result of passing a hard stool and straining during bowel movements. There are different types of internal hemorrhoid conditions some of which are mild in nature and others that are more severe and cause pain and discomfort in your anal area.

Internal hemorrhoids are caused by straining during bowel movements, poor diet, lack of fluid intake, weakened anal veins, sedentary lifestyle, heredity, and a number of other factors. Different types of internal hemorrhoid conditions vary from person to person and according to how and when you seek treatment for the condition.




Different Grades of Internal Hemorrhoid Grading

Internal hemorrhoids are graded on a scale of one to four and according to their degree of severity. The following information describes the different grades of internal hemorrhoids and how to recognize each grade.

  • Grade 1

  • Grade 1 represents the initial phase of internal hemorrhoid development. This is the stage where internal hemorrhoids are mild and just beginning to develop on the inner walls of the anal canal. Grade 1 internal hemorrhoids are not painful and it is difficult to identify them unless you observe your stool after a bowel movement. When grade 1 internal hemorrhoids are present you will notice a small amount of blood in your stool, on the toilet paper, or in the toilet water. You may also experience anal itching and general discomfort.

  • Grade 2

  • Grade 2 internal hemorrhoids mark the beginning stages of a prolapsed hemorrhoid. Prolapsed hemorrhoids occur when the tissue around the hemorrhoid collapses as the result of weak anal veins or a weak anal lining. This causes the hemorrhoid tissue to slide down the anal canal and protrude from the anal opening. Grade 2 prolapsed hemorrhoids will push outside of the anal opening during a bowel movement and then retract back into the anal canal when the bowel movement is completed. Grade 2 prolapsed hemorrhoids can be painful and an overall nuisance and you will often have a feeling of fullness and general discomfort.

  • Grade 3

  • Grade 3 internal hemorrhoids represent a slightly different type of prolapsed hemorrhoid. In the grade 3 stage the prolapsed hemorrhoid protrudes from the anal opening during a bowel movement and will not retract after the bowel movement is finished. Often you have to place them back inside the anal canal with your fingertip. This type of internal hemorrhoid can be painful and will tend to bleed if it becomes irritated. It can also be a nuisance because you never know when it will suddenly protrude form the anal opening after you push it back inside.

  • Grade 4

  • Grade 4 internal hemorrhoids protrude from the anal opening and stay outside of the opening. This stage of internal hemorrhoids is the most severe and often requires medical attention. Grade 4 prolapsed hemorrhoids tend to get irritated and bleed easily and can be prone to infection. They can also develop into a thrombosed hemorrhoid which is a hemorrhoid with a blood clot inside the tissue.


There are a number of measures that you can take to prevent internal hemorrhoids from getting to the grade 4 stage. Feel free to browse this website to find lots of great information on how to treat existing hemorrhoid conditions at different stages of internal hemorrhoid grading and prevent them from returning. Remember to seek medical attention if internal hemorrhoids have developed past the grade 1 stage. It will provide you with the piece of mind that nothing else is wrong and prevent internal hemorrhoids from reaching further stages of severity.





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