Hemorrhoids are swollen veins around the rectum or anus. They can become very uncomfortable but are not life threatening. They’re categorized by grades that rank them in order of severity.

Hemorrhoids are swollen veins that develop within the rectum or around the anus. They’re also referred to as piles.

Hemorrhoids are common and range in severity. The type and grade of the hemorrhoids you have will determine whether you need treatment.

Hemorrhoids can be internal or external. There are four types:

  • Internal hemorrhoids: These are swollen veins that develop inside the rectum. They’re common and don’t always cause discomfort. Frequent bowel movements, diarrhea, and straining while passing stool can irritate internal hemorrhoids and cause minor bleeding.
  • Prolapsed hemorrhoids: Prolapsed hemorrhoids are internal hemorrhoids that push out and hang outside of the anal opening. They’re sometimes referred to as protruding hemorrhoids. Prolapsed hemorrhoids can cause minor to severe pain.
  • External hemorrhoids: External hemorrhoids are swollen veins that develop under the skin around the anus. When these occur, you may see or feel one or several small bumps. External hemorrhoids can hurt and itch. They may also bleed.
  • Thrombosed hemorrhoids: Thrombosed hemorrhoids are external hemorrhoids that develop a blood clot. Thrombosed hemorrhoids can be swollen and very painful. They may also bleed. If a newly formed thrombosed hemorrhoid causes excessive bleeding or severe pain, emergency medical support may be needed to remove the clot.

Internal hemorrhoids are further differentiated by location and severity:

Grade 1

Grade 1 hemorrhoids are slightly enlarged veins that prolapse past the dentate line.

The dentate line is also referred to as the pectinate line. It separates the upper two-thirds of the anal canal from the bottom third.

Grade 1 hemorrhoids remain internal and do not hang outside of the anus.

Grade 2

Grade 2 hemorrhoids are larger than grade 1.

Grade 2 hemorrhoids prolapse outside of the anus while straining during a bowel movement. They may also prolapse during physical activity, although this is less common.

Grade 2 hemorrhoids revert inside the anus spontaneously on their own without the need for manual intervention.

Grade 3

Grade 3 hemorrhoids prolapse outside of the anus while straining during a bowel movement.

Unlike hemorrhoids that are grade 2, grade 3 hemorrhoids must be pushed back into the anal opening manually. They won’t revert inside on their own.

Grade 4

Grade 4 hemorrhoids are large internal hemorrhoids that prolapse through the anus and remain there. They cannot be pushed back inside manually.

If you have a grade 4 hemorrhoid, you may also experience rectal prolapse. This condition occurs when a small amount of anal lining extends outside of the anus and remains there.

Hemorrhoid treatments vary by grade and type.

Grade 1 hemorrhoids typically resolve with conservative, at-home treatment. You may be advised to add fiber to your diet, which will reduce your strain during bowel movements. Keeping the area clean and using topical treatments should be enough to alleviate grade 1 hemorrhoids within a few days. Preparation H and Tucks hydrocortisone cream are popular over-the-counter options.

Grade 2 hemorrhoids may respond to the conservative treatments used for grade 1. If home remedies aren’t enough to alleviate grade 2, your healthcare professional may recommend minimally invasive, in-office procedures, such as:

  • Injection sclerotherapy: Chemicals called sclerosing agents are injected into the hemorrhoid, shrinking it.
  • Infrared coagulation: Infrared light or heat cuts off the hemorrhoid’s blood supply, causing it to shrink.
  • Rubber band ligation: One or two tiny, tight rubber bands will be placed around the base of the hemorrhoid. This will cut off its blood flow so that it shrivels and falls off.

Grade 3 and grade 4 hemorrhoids are often removed surgically through a hemorrhoidectomy. The extent of the prolapse and the location of the hemorrhoid will determine the procedure that is recommended to you.

Hemorrhoidectomy procedures include:

  • excisional hemorrhoidectomy
  • stapled hemorrhoidectomy

Thrombosed hemorrhoids that don’t respond to conservative treatment may also be excised surgically.

Hemorrhoids are not life threatening. Most resolve with conservative treatment. Untreated hemorrhoids can, however, be very painful. They can also bleed excessively. In some instances, untreated hemorrhoidal bleeding can cause anemia.

The pain and bleeding caused by untreated hemorrhoids can make it hard for you to leave home, reducing your ability to work and overall quality of life.

Hemorrhoids are often the result of pressure on the lower rectum. Certain conditions, such as pregnancy and getting older, put you at risk for hemorrhoids.

Not all hemorrhoids can be prevented, but you can significantly reduce your risk with these tips:

  • eating a high fiber diet
  • drinking lots of fluids, such as water
  • trying not to strain during bowel movements
  • limiting the amount of time you spend sitting
  • not holding in bowel movements
  • exercising several times per week to aid in digestion
  • avoiding heavy lifting

Hemorrhoids vary by grade and by type. Most hemorrhoids can be treated successfully at home with over-the-counter remedies. Diet and other lifestyle choices can help prevent and treat hemorrhoids.

Some hemorrhoids require removal through in-office procedures. Serious or higher-grade hemorrhoids may require surgical removal.