Understanding the Grading System for Hemorrhoids
Not all hemorrhoids are the same, and their severity can vary from mild discomfort to significant pain and complications. To standardize diagnosis and treatment, medical professionals use a four-grade classification system that helps determine the best course of action for relief and recovery.
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Grade 1: Internal swelling with no prolapse, often manageable with lifestyle changes.
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Grade 2: Hemorrhoids prolapse but retract on their own, causing mild discomfort or occasional bleeding.
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Grade 3: Prolapsed hemorrhoids that require manual repositioning, often leading to noticeable lumps and increased discomfort.
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Grade 4: Permanently prolapsed hemorrhoids that cannot be pushed back, often requiring medical intervention.
Knowing your hemorrhoid grade can help you make informed decisions about self-care, prevention, and when to seek medical treatment.
How Doctors Use the Hemorrhoid Grading Scale
Medical professionals rely on this classification system to:
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Assess severity and choose the most effective treatment approach.
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Determine whether lifestyle changes, medications, or procedures are necessary.
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Set expectations for recovery, so patients understand how to manage their condition.
Lower-grade hemorrhoids are typically manageable with diet, hydration, and proper hygiene, while higher-grade cases may require procedures such as rubber band ligation, sclerotherapy, or surgery.
How It Feels and What to Do for Each Grade
Grade 1: Mild Internal Swelling with No Prolapse
Symptoms:
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No visible hemorrhoids; swelling occurs inside the rectum.
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May cause mild itching, occasional discomfort, or minor irritation.
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Often goes unnoticed unless mild bleeding occurs after a bowel movement.
What to Do:
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Increase fiber intake and drink plenty of water to prevent constipation.
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Avoid straining during bowel movements to reduce pressure on rectal veins.
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Consider over-the-counter creams or sitz baths for symptom relief.
Key Statistic: Over 50% of hemorrhoid cases begin at Grade 1, often progressing if left unmanaged. (Source: American Journal of Gastroenterology)
"I barely noticed anything, but I had some itching after long days of sitting. A fiber-rich diet and drinking more water made a huge difference." — Alan, 32
Grade 2: Prolapse That Retracts on Its Own
Symptoms:
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Hemorrhoids may bulge out during bowel movements but retract on their own.
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May cause occasional bleeding, mild pressure, or discomfort.
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Symptoms come and go but worsen without lifestyle adjustments.
What to Do:
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Continue high-fiber diets and hydration to avoid straining.
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Apply over-the-counter creams or witch hazel pads to ease discomfort.
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Consider stool softeners to prevent hard stools and excessive pushing.
Key Statistic: Hemorrhoids at Grade 2 have a 40% chance of worsening if not properly managed. (Source: National Institutes of Health)
"I started seeing a little blood on the toilet paper. It freaked me out, but my doctor reassured me that with more fiber and less straining, I could manage it easily." — Rachel, 45
Grade 3: Prolapsed Hemorrhoids That Need Manual Pushing Back
Symptoms:
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Hemorrhoids do not retract on their own and require manual repositioning.
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May cause noticeable lumps, swelling, and moderate discomfort.
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Increased risk of inflammation and persistent irritation.
What to Do:
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Use prescription-strength creams or anti-inflammatory treatments.
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Avoid heavy lifting and prolonged sitting to reduce strain on rectal veins.
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If home treatments fail, consult a doctor about non-surgical procedures like rubber band ligation or sclerotherapy.
Key Statistic: Approximately 30% of people with Grade 3 hemorrhoids will eventually need medical intervention. (Source: International Journal of Colorectal Disease)
"At first, I thought I had a growth. When I found out it was a Grade 3 hemorrhoid, I adjusted my habits and used a prescribed cream, which really helped." — Mark, 50
Grade 4: Permanent Prolapse That Cannot Be Pushed Back
Symptoms:
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Hemorrhoids remain outside the anus permanently.
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Often painful, swollen, and at risk for thrombosis (blood clots).
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May cause chronic bleeding, discomfort while sitting, and hygiene difficulties.
What to Do:
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Consult a doctor immediately to discuss medical or surgical treatment options.
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Minimally invasive procedures such as rubber band ligation or laser therapy may help.
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Surgical hemorrhoidectomy or hemorrhoidopexy may be necessary for severe cases.
Key Statistic: More than 90% of patients with Grade 4 hemorrhoids require medical intervention. (Source: American Society of Colon and Rectal Surgeons)
"I waited too long, and my hemorrhoid became too painful to ignore. My doctor recommended a procedure, and honestly, I wish I had gotten help sooner." — Lisa, 58
How to Prevent Hemorrhoids from Progressing
While some hemorrhoids naturally progress through the grading system, many cases can be prevented or managed early with the right approach:
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Eat a high-fiber diet (fruits, vegetables, whole grains) to keep stools soft.
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Stay hydrated to prevent constipation.
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Avoid prolonged sitting, especially on the toilet.
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Exercise regularly to improve circulation and reduce rectal pressure.
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Practice proper hygiene to minimize irritation and inflammation.
Final Thoughts: Understanding Your Hemorrhoid Grade Can Help You Get the Right Treatment
Identifying which grade of hemorrhoid you have can make a significant difference in choosing the right treatment and preventing worsening symptoms.
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Grades 1 & 2 can often be managed with diet and lifestyle changes.
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Grade 3 may require prescription treatments or minimally invasive procedures.
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Grade 4 typically needs surgical intervention to relieve severe symptoms.
At Norms, we’re here to help you understand, manage, and find real relief—without stigma or unnecessary suffering.