Hemorrhoid Symptoms & Stages: Complete Guide

If you’re experiencing discomfort, bleeding, or swelling around your anus, you’re likely dealing with hemorrhoids.

But not all hemorrhoids are the same. Understanding your symptoms and the stage (if internal) is key to choosing the right treatment — and knowing when to see a doctor.

This guide combines our two most popular articles into one complete resource:

→ Detailed Symptoms Guide
→ 4 Stages of Internal Hemorrhoids

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Quick Symptom Checker

Ask yourself:

• 🔴 Bright red blood on toilet paper? → Likely internal hemorrhoid
• 🔴 Painful lump near anus? → Likely external or thrombosed hemorrhoid
• 🔴 Tissue bulging out? → Could be Grade II–IV internal hemorrhoid
• 🔴 Itching or moisture? → Often external hemorrhoid or skin irritation

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The 4 Stages of Internal Hemorrhoids (Goligher Classification)

Stage	What Happens	Treatment
Grade I	Bleeding, no prolapse	Fiber, hydration, sitz baths
Grade II	Prolapses during straining, retracts on its own	OTC creams, banding
Grade III	Prolapses, must be pushed back	Banding, surgery if recurrent
Grade IV	Permanent prolapse	Surgery required

✅ Visual Tip:
Grade I: ( ) → Inside, no bulge
Grade II: ( )→ → Bulges out, goes back
Grade III: ( )=> → Bulges out, you push back
Grade IV: =O= → Always out, swollen

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When Symptoms and Stages Overlap

• Bleeding + no pain → Usually Grade I internal
• Bleeding + prolapse → Grade II–III
• Pain + lump → External or thrombosed
• Pain + permanent bulge → Grade IV or thrombosed

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What to Do Next

1. Identify your main symptom → Use our Symptoms Guide
2. If you have prolapse → Check Stages Guide
3. If severe pain or bleeding → See When to See a Doctor

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FAQs

Can external hemorrhoids have stages?

No — the staging system is only for internal hemorrhoids. External are classified by size, pain, and whether thrombosed.

Can Grade I progress to Grade IV?

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

I have symptoms but no prolapse — what stage am I?

If no prolapse, you’re likely Grade I — the mildest form. Focus on fiber, hydration, and avoiding straining.

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