Hemorrhoid Stages (Grade I to IV): What Each Means & How to Treat Them

Internal hemorrhoids are classified into 4 grades — and your treatment options depend heavily on which stage you’re in.

This system (called the Goligher Classification) helps doctors — and you — understand severity and choose the right approach.

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Grade I: Mild — No Prolapse

Symptoms:

• Bright red bleeding during bowel movements
• No tissue protrudes outside
• No pain

Treatment:

• High-fiber diet (30g/day)
• Drink 2L water daily
• Avoid straining
• OTC stool softeners (if needed)

✅ Prognosis: Excellent — often resolves in days with lifestyle changes.

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Grade II: Moderate — Temporary Prolapse

Symptoms:

• Bleeding
• Tissue bulges out during straining — but retracts on its own
• May feel pressure or fullness

Treatment:

• All Grade I treatments +
• Sitz baths 2x/day
• OTC creams with hydrocortisone (short-term)
• Fiber supplements (psyllium)

✅ Prognosis: Good — may recur if triggers persist.

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Grade III: Severe — Manual Reduction Needed

Symptoms:

• Bleeding
• Tissue bulges out and must be pushed back manually
• Discomfort, difficulty sitting or cleaning

Treatment:

• All previous treatments +
• Rubber band ligation (most common procedure)
• Infrared coagulation
• Prescription-strength creams

⚠️ Note: Surgery not usually needed yet — but likely if lifestyle changes fail.

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Grade IV: Very Severe — Permanent Prolapse

Symptoms:

• Tissue is permanently outside — cannot be pushed back
• Pain, swelling, risk of strangulation
• Often requires urgent care

Treatment:

• Surgery (hemorrhoidectomy or stapled hemorrhoidopexy)
• Not treatable with home remedies or OTC products

🚨 Important: Don’t delay treatment — risk of tissue death or infection.

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Visual Guide (Text-Based)

• Grade I: [Rectum] ( ) ← Bleeding, no bulge
• Grade II: [Rectum] ( )→ ← Bulges out, goes back
• Grade III: [Rectum] ( )=> ← Bulges out, you push back
• Grade IV: [Rectum] =O= ← Always out, swollen

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FAQs

Can Grade I progress to Grade IV?

Yes — if ignored. Chronic straining or constipation can worsen hemorrhoids over time.

Is surgery the only option for Grade IV?

Yes — no creams or home remedies can fix permanently prolapsed tissue. Surgery is safe and effective.

Can children have Grade III or IV hemorrhoids?

Extremely rare — if a child has severe symptoms, see a pediatric gastroenterologist to rule out other conditions.

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Learn more about symptoms and stages.