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]


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

By BruceBlaus. When using this image in external sources it can be cited as:Blausen.com staff (2014). "Medical gallery of Blausen Medical 2014". WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.010. ISSN 2002-4436. - Own work, CC BY 3.0, https://commons.wikimedia.org/w/index.php?curid=27924388
  • External hemorrhoids occur below the dentate line.
  • External hemorrhoids are sometimes painful and can be accompanied by swelling and irritation.
  • Itching, although often thought to be a symptom of 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 hemorrhoids become thrombosed.[2]

Internal hemorrhoids

  • 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.
  • 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:[3]

  • 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.


  1. Rivadeneira DE, Steele SR, Ternent C, Chalasani S, Buie WD, Rafferty JL (2011). "Practice parameters for the management of hemorrhoids (revised 2010)". Dis. Colon Rectum. 54 (9): 1059–64. doi:10.1097/DCR.0b013e318225513d. PMID 21825884.
  2. E. Gojlan, Pathology, 2nd ed. Mosby Elsevier, Rapid Review series.
  3. name="pmid3861909">Banov L, Knoepp LF, Erdman LH, Alia RT (1985). "Management of hemorrhoidal disease". J S C Med Assoc. 81 (7): 398–401. PMID 3861909.