Most clinicians use a grading system proposed by Banov et al in 1985, which classifies internal hemorrhoids based on the presence of bleeding and their degree of prolapse into the anal canal. This system is clinically more useful than the anatomical classification (into internal hemorrhoids, external hemorrhoids, and both), correlates with symptoms, and guides therapeutic management.
| Classification of Hemorrhoids | ||
|---|---|---|
| aMay occur with or without complications (ie, strangulation, ulceration, fibrosis, gangrene, sepsis). From AAFP and Medscape. |
||
| Grade | Degree | Examination Findings |
| I | First | Rectal bleeding, prominent hemorrhoidal cushions without prolapse. “The hemorrhoids project into the anal canal and often bleed but do not prolapse.” |
| II | Second | Rectal bleeding, hemorrhoids prolapse on straining but reduce spontaneously. “The hemorrhoids may protrude beyond the anal verge with straining or defecating but reduce spontaneously when straining ceases (ie, return to their resting point by themselves)” |
| III | Third | Rectal bleeding, hemorrhoids prolapse spontaneously, require manual reduction. “The hemorrhoids protrude spontaneously or with straining and require manual reduction (ie, require manual effort for replacement into the anal canal)” |
| IV | Fourtha | Rectal bleeding, hemorrhoids remain prolapsed all the time, manual reduction ineffective. “The hemorrhoids chronically prolapse and cannot be reduced; these lesions usually contain both internal and external components and may present with acute thrombosis or strangulation” |
Resources
http://emedicine.medscape.com/article/775407-clinical#b4
http://www.aafp.org/test/fpcomp/FP-E_419/fpe419-pt1.html
http://www.aafp.org/afp/2012/0315/p624.html