The Evaluation and Treatment of Hemorrhoids

A Guide for the Gastroenterologist

Robert A. Ganz


Clin Gastroenterol Hepatol. 2013;11(6):593-603. 

In This Article

Grading of Hemorrhoidal Disease

Internal hemorrhoids have been staged or graded on the basis of their severity. The classification of Banov et al[36] is based on the degree of hemorrhoidal prolapse during defecation (Table 1 and Figure 3). Hemorrhoids can also be classified by their location.[31] Mixed hemorrhoids arise from both the internal and external plexuses along with their anastomotic connections (Figure 4).[7,8]

Figure 3.

Photograph of grade 3 hemorrhoid with prolapse (left) and after manual reduction (right). Courtesy of Iain Cleator, MD, Vancouver, BC, Canada.

Figure 4.

Illustration of a "mixed" hemorrhoid involving the internal, external, and bridging spaces. Courtesy of Iain Cleator, MD, Vancouver, BC, Canada.