Hemorrhoids classification
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ahmed Younes M.B.B.CH [2]
Overview
Hemorrhoids can be classified according to their location as external or internal hemorrhoids. Furthermore, internal hemorrhoids can be graded according to severity into 4 grades.
Classification
Hemorrhoids can be classified according to their location as external or internal hemorrhoids.[1]
External hemorrhoids
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- External hemorrhoids occur below the dentate line at the external anal orifice.
- External hemorrhoids are often painful and can be accompanied by a bluish-purple swelling near the anal orifice.
- Itching, although often thought to be a symptom of external hemorrhoids, is more commonly due to skin irritation due to difficulty in cleaning fecal matter after defecation.
- External hemorrhoids are prone to thrombosis; if a vein ruptures and a blood clot develops, the hemorrhoids become thrombosed.[2] A thrombosed external hemorrhoid can lead to bright red bleeding.
- External hemorrhoids may leave a painless skin tag that causes difficulty in maintaining anal hygiene.
Internal hemorrhoids
- Internal hemorrhoids occur above the dentate line.
- As this area lacks pain receptors, internal hemorrhoids are usually not painful and most people are not aware that they have them.
- Internal hemorrhoids, however, may bleed when irritated. Bleeding is painless and seen as blood covering the outer part of solid stool.
- Itching can occur due to deposition of mucus on skin around the anal orifice.
- Untreated internal hemorrhoids can lead to two severe forms of hemorrhoids: prolapsed and strangulated hemorrhoids.
- Hemorrhoid may be strangulated when it is trapped by the anal sphincter.
By degree of prolapse
Furthermore, internal hemorrhoids can be graded according to severity into 4 grades. The most common grading system was developed by Banov:[3]
- Grade I: The hemorrhoids prolapse into the anal canal.
- Grade II: The hemorrhoids prolapse upon defecation but spontaneously reduce.
- Grade III: The hemorrhoids prolapse upon defecation, but must be manually reduced.
- Grade IV: The hemorrhoids are prolapsed and cannot be manually reduced.
References
- ↑ Rivadeneira DE, Steele SR, Ternent C, Chalasani S, Buie WD, Rafferty JL (2011). "Practice parameters for the management of hemorrhoids (revised 2010)". Dis. Colon Rectum. 54 (9): 1059–64. doi:10.1097/DCR.0b013e318225513d. PMID 21825884.
- ↑ E. Gojlan, Pathology, 2nd ed. Mosby Elsevier, Rapid Review series.
- ↑ name="pmid3861909">Banov L, Knoepp LF, Erdman LH, Alia RT (1985). "Management of hemorrhoidal disease". J S C Med Assoc. 81 (7): 398–401. PMID 3861909.