Hemorrhoids classification

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Classification

• (I84.3-I84.5) External hemorrhoids are those that occur outside of the anal verge (the distal end of the anal canal). They are sometimes painful, and can be accompanied by swelling and irritation. Itching, although often thought to be a symptom from external hemorrhoids, is more commonly due to skin irritation.
  • (I84.3) External hemorrhoids are prone to thrombosis: if the vein ruptures and a blood clot develops, the hemorrhoid becomes a thrombosed hemorrhoid.
• (I84.0-I84.2) Internal hemorrhoids are those that occur inside the rectum. As this area lacks pain receptors, internal hemorrhoids are usually not painful and most people are not aware that they have them. Internal hemorrhoids, however, may bleed when irritated.
• (I84.1) Untreated internal hemorrhoids can lead to two severe forms of hemorrhoids: prolapsed and strangulated hemorrhoids:
  • Prolapsed hemorrhoids are internal hemorrhoids that are so distended that they are pushed outside the anus.
  • If the anal sphincter muscle goes into spasm and traps a prolapsed hemorrhoid outside the anal opening, the supply of blood is cut off, and the hemorrhoid becomes a strangulated hemorrhoid.

By degree of prolapse

The most common grading system was developed by Banov:

• Grading of Internal Hemorrhoids
  • Grade I: The hemorrhoids do not prolapse.
  • Grade II: The hemorrhoids prolapse upon defecation but spontaneously reduce.
  • Grade III: The hemorrhoids prolapse upon defecation, but must be manually reduced.
  • Grade IV: The hemorrhoids are prolapsed and cannot be manually reduced.