Reviewed on : 3 Jun 2013

Reviewed by : GP Gateway Editor

Expires : 1 Oct 2025

Assessment

Haemorrhoids can be graded into four grades:

• Grade 1 – do not prolapse out of the anal canal
• Grade 2 – prolapse on defecation but reduce spontaneously
• Grade 3 – require manual reduction
• Grade 4 – cannot be reduced

Management

Often haemorrhoids (especially early stage haemorrhoids) can be treated by simple measures such as eating more fibre or drinking more water.

If unsuccessful many patients will respond to outpatient treatment in the form of banding or perhaps injection.

Surgical treatment should ONLY be considered for those that do not respond to these non-operative measures or if the haemorrhoids are more severe and the patient specifically meets the following criteria:

• Recurrent Grade 3

OR

• Grade 4 combined internal/external haemorrhoids with persistent pain or bleeding;

OR

• Irreducible and large external haemorrhoids

In cases where there is significant rectal bleeding the patient should be examined internally by a specialist.