Select City

Call Us

Book FREE Appointment

Hemorrhoids Grading & Size Chart

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

Book FREE Doctor Appointment

Anup Soni - the voice of Pristyn Care pointing to download pristyncare mobile app

Patient Name

Mobile Number

Select City

Call Us

We are Rated

3 M+ Happy Patients

200+ Hospitals

30+ Cities

3M+

Happy Patients

50+

Disease

200+

Hospitals

30+

Cities

Free Cab Facility

No-Cost EMI

Support in Insurance Claim

1-day Hospitalization

USFDA-Approved Procedure

Best Doctors for Piles

Choose Your City

It help us to find the best doctors near you.

Ahmedabad

Bangalore

Bhubaneswar

Chandigarh

Chennai

Coimbatore

Delhi

Hyderabad

Indore

Jaipur

Kochi

Kolkata

Kozhikode

Lucknow

Madurai

Mumbai

Patna

Pune

Raipur

Ranchi

Thiruvananthapuram

Vijayawada

Visakhapatnam

Delhi

Hyderabad

Pune

Mumbai

Bangalore

Dr. Galla Murali Mohan

MBBS, MS-General Surgery

34 Yrs.Exp.

5.0/5

34 Years Experience

Pristyn Care Archana Hospital, Madeenaguda, Hyderabad

Call Us

080-6542-3724
Dr. Vipin Nagpal

MBBS, MS-General Surgery

31 Yrs.Exp.

5.0/5

31 Years Experience

Pristyn Care Elantis Hospital, Lajpat Nagar, Delhi

Call Us

080-6542-3711
Dr. Rakesh Shivhare

MBBS, MS(GI & General Surgeon)

30 Yrs.Exp.

5.0/5

30 Years Experience

Opp.Badwani Plaza, Manorama Ganj, Old Palasia, Indore, Madhya Pradesh 452003

Call Us

080-6542-3720
Dr. Apoorv Shrivastava

MBBS, DNB-General Surgery

25 Yrs.Exp.

4.5/5

25 Years Experience

Pristyn Care Eminent Hospital 6/1 Opp. Barwani Plaza, Manorama Ganj, Old Palasia, Indore - 452018

Call Us

080-6542-3720

What are Hemorrhoids?

Hemorrhoids (also called piles) are swollen blood vessels in the rectal or anal area, often caused by straining, constipation, or prolonged sitting. They can be internal or external, and vary in size and severity.

Free Piles Surgery Cost Calculator

Fill details to get actual cost

Classification of hemorrhoids

Internal Hemorrhoids

Located inside the rectum
Painless bleeding
Classified by grades (I to IV)

External Hemorrhoids

Located under the skin around the anus
Painful, may form clots (thrombosed)
Not graded by size, but by symptoms

Internal Hemorrhoids Grading and Size Chart

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

Key Differences in Internal Hemorrhoid Grades

Grade I: Only visible through endoscopy, usually painless.
Grade II: May protrude while passing stool but go back on their own.
Grade III: Needs manual push-back after prolapse.

Grade IV: Always outside, risk of clot formation (thrombosis).
Hemorrhoid Size Reference Table (Approx.)

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

Pristyn Care’s Free Post-Operative Care

Diet & Lifestyle Consultation

Post-Surgery Recovery Follow up

Free Cab Facility

24*7 Patient Support

List of Top Health Insurance Provider for Piles Surgery

Insurance Providers FREE Quotes

Aditya Birla Health Insurance Co. Ltd.

National Insurance Co. Ltd.

Bajaj Allianz General Insurance Co. Ltd

Bharti AXA General Insurance Co. Ltd.

Future General India Insurance Co. Ltd.

HDFC ERGO General Insurance Co. Ltd.

Symptoms of Hemorrhoids by Grade

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

External hemorrhoids classification

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

When to Seek Medical Help?

You should consult a proctologist if:

Bleeding lasts >1 week
Pain worsens while sitting or walking
Hemorrhoids protrude and don’t retract
There’s a noticeable lump or clot

Diagnostic Methods

Digital Rectal Examination (DRE)
Anoscopy
Proctoscopy
Colonoscopy (if bleeding origin is unclear)

Treatment Options Based on Grading

Grade I & II

High-fiber diet
Sitz bath
Topical creams (lidocaine, hydrocortisone)
OTC medications (Daflon)

Non-surgical methods

Rubber band ligation
Infrared coagulation (IRC)
Sclerotherapy

Grade III

May require:

Stapled Hemorrhoidopexy
Doppler-guided hemorrhoidal artery ligation (DG-HAL)
Minimally invasive laser surgery

Grade IV

Surgical options:

Conventional Hemorrhoidectomy (Milligan-Morgan)
Laser Hemorrhoidoplasty
Stapled Hemorrhoidopexy

When is Surgery Needed?

Surgery is recommended when:

Hemorrhoids are Grade III or IV
Recurrent bleeding despite treatment
Severe thrombosis (clot)
Non-surgical methods fail

Summary

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

FAQs

What is the most severe grade of hemorrhoids?

Grade IV is the most severe and usually requires surgical removal due to permanent prolapse.

Can Grade I hemorrhoids go away on their own?

Yes. With lifestyle changes and topical medications, Grade I hemorrhoids often resolve without advanced treatment.

Is size the only indicator of hemorrhoid grade?

No. Grading is based on prolapse behavior, not just physical size.

Can hemorrhoid size increase with time?

Yes. If untreated, hemorrhoids may worsen from Grade I to IV, increasing in size and symptoms.

Are external hemorrhoids graded the same way?

No. External hemorrhoids are not graded but assessed based on pain, size, and clot formation.

MEDICALLY REVIEWED CONTENT

🔍 REVIEWED BY

Dr. Pankaj Sareen

MBBS, MS - General Surgery

24 Years Experience yrs experience

✍️ WRITTEN BY

Pristyn Care Team

Healthcare Expert

Peer reviewed · Apr 2026

What Our Patients Say

DI

DINAKAR

29 Mar, 2026

5/5

Recommends

5/5

Recommends

Doctor dealing good with patient

City : Hyderabad

Treated by : Dr. P. Thrivikrama Rao
A

Abirami

5 Mar, 2026

5/5

Recommends

5/5

Recommends

Doctor explanation and concern was good and hospitality was too good. And doctor is very concern abt his patients and very great treatment i had with Mr.Emmanueal stephen sir.

City : Coimbatore

Treated by : Dr. Emmanuel Stephen J
SS

Swami satyabindu Saraswati

4 Mar, 2026

5/5

Recommends

5/5

Recommends

I was very very knowledgeable... meeting with dr. Piyush sharma ji

City : Delhi

Treated by : Dr. Piyush Sharma
LK

Lalit Kumar

2 Mar, 2026

5/5

Recommends

5/5

Recommends

His care towards the patients is admirable

City : Hyderabad

Treated by : Dr. Rakesh Kumar
SW

swati

1 Mar, 2026

5/5

Recommends

5/5

Recommends

Experienced Dr.. Consulted very well

City : Pune

Treated by : Dr. Parag Nawalkar
AK

AAKASH KUMAR

28 Feb, 2026

5/5

Recommends

5/5

Recommends

. Piyush Gulabrao Nikam is a very nice and polite person. He explained my problem clearly and listened to me patiently. I felt comfortable during the consultation. He gave proper guidance and answered all my questions calmly. Overall, I am satisfied with the treatment and would definitely recommend him to others.

City : Delhi

Treated by : Dr. Piyush Gulabrao Nikam