Internal Hemorrhoid can be classified by a grading system, depended on its severity.

Grade 1: Bleeding during bowel opening. No prolapsed hemorrhoid.

Grade 2: Bleeding and prolapsed hemorrhoid during bowel opening. Hemorrhoid returns inside the anus spontaneously after bowel opening.

Grade 3: Hemorrhoid is prolapsed during bowel opening, prolonged standing or carrying heavy objects. It returns inside the anus with the help of finger pushing.

Grade 4: Hemorrhoid is prolapsed and does not return inside the anal canal.

Severe and Fatal Hemorrhoids

• Thrombosis, prolapse, ulceration or gangrene may occur when complications arise.
• When gangrene occurs in thrombosed hemorrhoids, infection happens subsequently. Severe degree of infection occasionally occurs, such as Fournier gangrene. If treatment is not appropriate, such severe infection can lead to bacteremia, septicemia and rarely death.
• Severe and persistent hemorrhoids bleeding may occur. It might cause hemorrhagic shock and dead.

Common Sites for Hemorrhoid

• As branches of superior rectal vein locate at left (3 o’clock), rear right (7 o’clock) and front right (11 o’clock) position in anal canal, isolated or a combination of hemorrhoids are mostly locate in these positions. These hemorrhoids are called Primary Hemorrhoids.
• Hemorrhoids locate at front left (1 o’clock), rear left (5 o’clock) and right (9 o’clock) called Secondary Hemorrhoids.
• Most hemorrhoids are Primary Hemorrhoids locating at 3, 7, and 11 o’clock position of anus. Secondary Hemorrhoids are less common. Hemorrhoids can occur at individual position or any combinations of positions.