What are the Grades or Severity of Piles or Hemorrhoids?

Hemorrhoids, also known as piles, occur when clusters of veins in your anus or rectum swell or dilate. In either case, blood collects inside, making the veins expand outward into the membranes surrounding your anal and rectal tissue, causing pain and uneasiness.

There are four types of hemorrhoids: Internal, External, Prolapsed, and Thrombosed. Not all hemorrhoids are serious medical disorders. They can go unnoticed, as symptoms are present in fewer than five percent of people affected. Furthermore, the number of people needing treatment is fewer.

But you need to visit a healthcare professional if hemorrhoids are causing pain or affecting your normal life. A doctor’s visit is a must if your rectum is continuing to bleed even after a week’s treatment.

It is estimated that about 50% of India’s population would have been affected by hemorrhoids at least once in their lifetime by the time they are aged 50, and about 5% of all Indians are suffering from hemorrhoids at any random time [1].

There is also a possibility of suffering from more than one type of hemorrhoid simultaneously.

Different types of hemorrhoids

Internal hemorrhoids:

Internal hemorrhoids, which can be noticed within your rectum, are usually not threatening and subside on their own. If internal hemorrhoids swell and protrude out of your anus, they are prolapsed hemorrhoids.

Because none of the nerves can feel pain in your rectum, it may not always be possible to become aware of internal hemorrhoids. If they grow bigger, the symptoms that can appear are pain, discomfort, itchiness, burning, and visible swelling close to your anus.

An internal hemorrhoid can also be irked by stools that pass through your rectum, causing bleeding that could be visible on your toilet tissue.

You need to visit a doctor if you are experiencing pain, discomfort, or bleeding from your rectum.

When bowel movements are causing you a lot of pain, it may not be hemorrhoid, but it could be because of a swelling or fissure in the anal area.

Prolapsed hemorrhoid:

Prolapsed hemorrhoid crops up when internal hemorrhoid surges and protrudes from your anus. A grade can be designated to a prolapsed hemorrhoid based on the distance it swells. If it is Grade I, it is not all prolapsed. Grade II means prolapsed, but it will withdraw itself. This only prolapses when your rectal area is pressurized during your bowel movement and could return to normalcy later [2].

In Grade III, it is prolapsed, and you need to force it back in yourself. It may need treatment so that it does not become too infected. Grade IV is definitively prolapsed, and you will not be able to force it back in without a lot of discomfort. It usually needs treatment to avoid pain, discomfort, or further complications [3].

Prolapsed piles seem like swollen red lumps jutting out of your anus. You can view them with a mirror. These may not have other symptoms apart from the swelling. They could be the reason behind pain, burning, or itchiness.

In certain instances, surgical intervention may be needed to eliminate or rectify a prolapsed hemorrhoid so that it stops causing any pain or problems.

External hemorrhoids:

External hemorrhoids appear on the area surrounding your anus or on it. They are always visible but show up as swellings on the anal area. Although these also are not serious medical conditions, you could visit a healthcare professional if they cause pain or uneasiness that affect your normal routine [4].

The symptoms of external piles are similar to those of internal piles. But as they crop up outside the area surrounding your rectum, you may feel pain or soreness when you physically exert or are passing stools.

They are also visible when they swell, and their dilated veins are bluish in color and are noticeable beneath the skin surface of the anus.

Visit a doctor if external piles cause discomfiture.

Thrombosed hemorrhoid:

Thrombosed hemorrhoids contain thrombosis, or blood clots, within the tissue of the hemorrhoid. They look like lumps or swelling surrounding your anal area.

Thrombosed hemorrhoids are, in essence, a complication of piles where they cause a blood clot to form.

During both internal and external hemorrhoids, blood clots can occur, and the symptoms may be severe pain, irritation, bulge, and bluishness surrounding the hemorrhoid area.

Visit a doctor immediately if you feel growing pain or inflammation around your anal area. It is vital to treat thrombosed piles immediately to discourage complications arising from a scarcity of blood supply to your rectal tissue.

If you want to prevent hemorrhoids (piles), contact us at Vitality’s Laser Piles Clinics. Fix an appointment with one of our expert health providers immediately.


  1. Agarwal N, Singh K, Sheikh P, Mittal K, Mathai V, Kumar A. Executive Summary – The Association of Colon & Rectal Surgeons of India (ACRSI) Practice Guidelines for the Management of Haemorrhoids-2016. Indian J Surg. 2017 Feb;79(1):58-61. doi: 10.1007/s12262-016-1578-7. Epub 2017 Jan 9. PMID: 28331268; PMCID: PMC5346092. – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5346092/#:~:text=It%20has%20been%20projected%20that,time%20%5B1%2C%202%5D.
  2. Becaris Publishing Limited (BPL) – https://becarispublishing.com/doi/10.2217/cer-2020-0159.
  3. Lohsiriwat V. Hemorrhoids: from basic pathophysiology to clinical management. World J Gastroenterol. 2012 May 7;18(17):2009-17. doi: 10.3748/wjg.v18.i17.2009. PMID: 22563187; PMCID: PMC3342598. – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3342598/.
  4. National Library of Medicine (NLM) – https://www.ncbi.nlm.nih.gov/books/NBK500009/#:~:text=Grade%20I%20hemorrhoids%20prolapse%20beyond,can%20only%20be%20reduced%20manually.

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