What Are The Different Stages of Hemorrhoids?

Hemorrhoids, also known as piles, are made up of swollen and inflamed veins in the rectum and anus. As these veins begin to swell and bulge, they can cause moderate to severe pain and discomfort, often requiring medical intervention for severe cases. While most cases of hemorrhoids are mild and are treatable with at-home remedies or over-the-counter medication, understanding the different stages of hemorrhoids and the various options for hemorrhoid treatment can help you recognize the signs and symptoms of hemorrhoid progression before they worsen. 

Here, we will explore the different stages of hemorrhoids, their causes, and how to prevent them from worsening over time. By understanding the stages of hemorrhoids and their impact on the human body, you can make necessary lifestyle changes to prevent hemorrhoids for a pain-free and comfortable life. 

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What are Hemorrhoids?

As blood travels through the human body, blood vessels near the anus and rectum can often become inflamed and enlarged as a result of increased pressure in the lower rectum. Similar to varicose veins in the legs, pressure from prolonged sitting, straining, or poor lifestyle habits can cause blood vessels to bulge, causing pain, discomfort, and in severe cases, protrusion of veins or prolapse. Some of the most common contributors to hemorrhoids include:

Straining during bowel movements: Chronic constipation or diarrhea can cause significant strain and increased pressure on the anal area. Forcing and straining when attempting a bowel movement can draw blood flow to the rectum, causing hemorrhoid development. 

Pregnancy: Hormonal changes and increased pressure from fetal growth can contribute to the development of hemorrhoids during pregnancy. Straining during the labor and delivery processes can also cause an increase in rectal pressure, exacerbating hemorrhoids. 

Obesity: Excess weight can increase pressure on the pelvic veins, contributing to hemorrhoid formation.

Aging: Tissues in the anus and rectum can weaken with age, increasing the risk of hemorrhoids as veins are more susceptible to bulging and pooling with blood. 

Prolonged sitting: Occupations requiring prolonged sitting can increase pressure on the pelvic veins. Prolonged standing may also be a contributor.

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Types of Hemorrhoids

Two types of hemorrhoids exist in the human body: internal and external. Internal hemorrhoids are located inside the rectum and cause bulging and swelling of the veins along the intestinal or rectal walls. Internal hemorrhoids may cause discomfort or bleeding during bowel movements. 

External hemorrhoids are located under the skin around the anus, and can cause discomfort and pain. When external hemorrhoids swell they can cause intense pain, itching, and discomfort. While they can often be soothed and treated with at-home remedies for pain management, severe cases of external hemorrhoids may require surgical intervention. 

The Stages of Hemorrhoid Severity

Hemorrhoids can be classified into four stages or grades based on their severity levels. Doctors use the grading system to determine the next course of treatment for hemorrhoids and the level of concern for monitoring and screening. When hemorrhoids become severe in grades three and four, the risk of blood clotting or thrombosis becomes a significant concern, usually indicating the need for intervention. 

Hemorrhoid stages can be graded on the following criteria:

Grade 1: Characterized as internal hemorrhoids, grade 1 hemorrhoids remain inside of the anal canal and do not protrude outside of the anus. Treating grade 1 hemorrhoids typically requires minor lifestyle changes, such as implementing more fiber into your diet and using over-the-counter remedies as needed.  When lifestyle changes are ineffective, non-surgical hemorrhoid treatment can be an excellent option for grade 1 hemorrhoids.

Grade 2: Straining and increased pressure can cause hemorrhoids to protrude through the anus intermittently, often returning back into the anal canal spontaneously without any interference. At this stage, doctors may recommend more lifestyle changes, such as exercise, increasing fiber intake, and implementing at-home remedies for pain and swelling reduction, such as using a sitz bath or over-the-counter ointments.  When lifestyle changes are ineffective, non-surgical hemorrhoid treatment can be an excellent option for grade 2 hemorrhoids. 

Grade 3: Fully protruding out of the anus, grade 3 hemorrhoids often require manual manipulation to return hemorrhoids back into the anal canal. Grade 3 hemorrhoids are categorized as a complete prolapse, requiring either a doctor or patient to push them back into the anus manually.   The same lifestyle changes mentioned above are recommended. When lifestyle changes are ineffective, non-surgical hemorrhoid treatment can be an excellent option for grade 3 hemorrhoids.  Surgical hemorrhoidectomy is another option for grade 3 hemorrhoids.  However, most patients should have a trial of non-surgical hemorrhoid treatment prior to being referred for surgery.

Grade 4: Grade 4 hemorrhoids are completely prolapsed hemorrhoids that will not return back into the anus. At this stage, hemorrhoidectomies are usually the best treatment option, requiring medical intervention to remove, shrink, or band hemorrhoids. If left untreated, grade 4 hemorrhoids can be extremely painful and uncomfortable, making it difficult for patients to sit down properly.  While grade 4 hemorrhoids may respond to non-surgical treatment, surgery is often the best approach when hemorrhoids reach this stage.

A doctor's physical examination is required to diagnose hemorrhoids. There are multiple conditions with symptoms similar to hemorrhoids and an expert exam is needed for accurate diagnosis. Procedures such as rubber band ligation sclerotherapy, or infrared coagulation serve as minimally invasive methods for hemorrhoid removal, offering the least amount of pain and discomfort than traditional surgical methods. 

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Dr. Ernest Castro, M.D. — Specialized Hemorrhoid Care in Denver

Understanding the different stages of hemorrhoids, implementing lifestyle changes, and utilizing appropriate treatment options can help patients manage symptoms and improve their quality of life. If you are experiencing hemorrhoid symptoms, consulting a healthcare professional, such as your primary care provider or gastroenterologist, can help you to diagnose and determine the severity of your hemorrhoids and receive quality care to prevent worsening symptoms. 

Dr. Ernest Castro, M.D., is Denver’s premiere gastroenterology provider, specializing in endoscopy, colonoscopy, and hemorrhoid removal. Using minimally invasive medical practices and emphasizing personalized and comprehensive care, Dr. Castro delivers the highest quality of care to patients seeking hemorrhoid relief and removal. For more information or to request an appointment, visit our website or call (720) 706-6157. 

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