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Know the grades of hemorrhoids using an easy-to-read size chart. Learn symptoms, severity, and treatment options by grade.
Know the grades of hemorrhoids using an easy-to-read size chart. Learn symptoms, severity, ...and treatment options by grade.Read More
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Internal Hemorrhoids
External Hemorrhoids
| Grade | Size | Prolapse Status | Symptoms | Common Treatment |
| Grade I | Small (≤0.5 cm) | No prolapse | Bleeding, discomfort | Diet changes, creams |
| Grade II | Moderate (0.5–1 cm) | Prolapse with straining, retracts on its own | Bleeding, itching | Rubber band ligation, sclerotherapy |
| Grade III | Large (1–2 cm) | Prolapse requires manual reduction | Pain, bleeding, swelling | Stapler surgery, banding |
| Grade IV | Very Large (>2 cm) | Permanent prolapse, cannot be pushed back | Severe pain, leakage, thrombosis | Hemorrhoidectomy, laser surgery |
| Size in cm | Appearance | Grade Indicator |
| 0.2 – 0.5 cm | Mild swelling, internal only | Grade I |
| 0.5 – 1 cm | Mild prolapse with straining | Grade II |
| 1 – 2 cm | Bulging, needs manual push | Grade III |
| 2 – 3+ cm | Always prolapsed, visible | Grade IV |
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| Degree of Piles | Symptoms |
| I | Light bleeding, discomfort, itching |
| II | Bright red blood, mild pain, mucous discharge |
| III | Swelling, persistent bleeding, sensation of incomplete evacuation |
| IV | Severe pain, difficulty sitting, fecal leakage, thrombosis |
| Features | Thrombosed | Non-thrombosed |
| Color | Blue, purple, black | Similar to the color of your skin |
| Pain | Yes, usually very painful | Soft to touch |
| Blood clot | Forms in the vein | Do not have a blood clot |
You should consult a proctologist if:
Grade I & II
Non-surgical methods
Grade III
May require:
Grade IV
Surgical options:
Surgery is recommended when:
| Feature | Grade I | Grade II | Grade III | Grade IV |
| Visible Outside? | ❌ | ❌ (temporarily) | ✅ (manual push required) | ✅ (permanently) |
| Bleeding | Mild | Moderate | Heavy | Severe |
| Pain Level | Low | Mild | Moderate | Severe |
| Treatment Type | Conservative | Non-surgical | Semi-surgical | Surgical |
Grade IV is the most severe and usually requires surgical removal due to permanent prolapse.
Yes. With lifestyle changes and topical medications, Grade I hemorrhoids often resolve without advanced treatment.
No. Grading is based on prolapse behavior, not just physical size.
Yes. If untreated, hemorrhoids may worsen from Grade I to IV, increasing in size and symptoms.
No. External hemorrhoids are not graded but assessed based on pain, size, and clot formation.
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Consult with our expert surgeon for more than 50+ diseases
Once you share your details, our care coordinator will get in touch with you.
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Happy Patients
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