The Evaluation and Treatment of Hemorrhoids

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]

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Figure 3.

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

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Figure 4.

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

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