Hemorrhoids classification

Hemorrhoids can be classified according to their location as external or internal hemorrhoids. Furthermore, internal hemorrhoids can be graded according to severity into 4 grades.

Hemorrhoids can be classified according to their location as external or internal hemorrhoids.^[1]

• External hemorrhoids occur below the dentate line at the external anal orifice.
• External hemorrhoids are often painful and can be accompanied by a bluish-purple swelling near the anal orifice.
• Itching, although often thought to be a symptom of external hemorrhoids, is more commonly due to skin irritation due to difficulty in cleaning fecal matter after defecation.
• External hemorrhoids are prone to thrombosis; if a vein ruptures and a blood clot develops, the hemorrhoids become thrombosed.^[2] A thrombosed external hemorrhoid can lead to bright red bleeding.
• External hemorrhoids may leave a painless skin tag that causes difficulty in maintaining anal hygiene.

• Internal hemorrhoids 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. Bleeding is painless and seen as blood covering the outer part of solid stool.
• Itching can occur due to deposition of mucus on skin around the anal orifice.
• Untreated internal hemorrhoids can lead to two severe forms of hemorrhoids: prolapsed and strangulated hemorrhoids.
• Hemorrhoid may be strangulated when it is trapped by the anal sphincter.

Furthermore, internal hemorrhoids can be graded according to severity into 4 grades. The most common grading system was developed by Banov:^[3]

• Grade I: The hemorrhoids prolapse into the anal canal.
• 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.

Template:WH Template:WS