Hemorrhoids classification
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ahmed Younes M.B.B.CH [2]
Overview
Hemorrhoids can be classified according to their site into external and internal hemorrhoids. Furthermore, internal hemorrhoids can be graded according to severity into 4 grades.
Classification
Hemorrhoids can be classified according to their site into external and internal hemorrhoids.
External hemorrhoids
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- External hemorrhoids are those that occur below the dentate line.
- 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.
- External hemorrhoids are prone to thrombosis: if the vein ruptures and a blood clot develops, the hemorrhoid becomes a thrombosed hemorrhoid.[1]
Internal hemorrhoids
- Internal hemorrhoids are those that occur above the dentate line.
- 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.
- Untreated internal hemorrhoids can lead to two severe forms of hemorrhoids: prolapsed and strangulated hemorrhoids:
By degree of prolapse
Furthermore, internal hemorrhoids can be graded according to severity into 4 grades. The most common grading system was developed by Banov:[2]
- 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.