Internal Hemorrhoids - Classification

Grade l: 

 • 1st-degree or primary hemorrhoids - normal or near-normal

 • Prominent vasculature with engorgement, but no prolapse

Grade II: 

 • 2nd-degree or secondary hemorrhoids - some symptoms

 • Hemorrhoidal tissue prolapses only with straining but spontaneously reduces

Grade Ill: 

 • 3rd-degree or tertiary hemorrhoids

Hemorrhoidal tissue prolapses beyond the dentate line with straining and can only be reduced manually 

 • Itching, staining from mucous discharge, soilage, and swelling may occur

Grade IV: 

 • 4th-degree or quaternary hemorrhoids 

 • Prolapsed tissues are evident that cannot be reduced manually

 • Chronic inflammatory changes with maceration, mucosal atrophy, friability, and ulceration are commonly observed



Dr. Enrik Aguila @enrrikke



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