Haemorrhoids (piles) are swollen blood vessels in and around the anal canal. Almost everyone develops them at some point, most often from straining during bowel movements, chronic constipation, pregnancy, or prolonged sitting. The right treatment depends heavily on the degree, or severity, of the haemorrhoids — so understanding this classification helps patients know what to expect.
Grading Haemorrhoids
Doctors classify internal haemorrhoids into four grades based on how much they prolapse (protrude) from the anal canal:
- Grade I — Bleed but do not prolapse outside the anus.
- Grade II — Prolapse during straining but reduce (go back in) on their own.
- Grade III — Prolapse and require the patient to push them back in manually.
- Grade IV — Permanently prolapsed and cannot be pushed back in.
Grade I: Lifestyle and Medical Management
At this early stage, treatment is almost entirely non-invasive. A high-fibre diet (25–30 grams daily), plenty of water, and avoiding straining or prolonged toilet sitting form the foundation of care. Stool softeners or fibre supplements such as psyllium husk reduce the pressure that worsens haemorrhoids. Topical creams or suppositories containing local anaesthetics, steroids, or soothing agents can ease discomfort and itching, though they do not shrink the haemorrhoid itself. Warm sitz baths, taken for 10–15 minutes a few times a day, relieve irritation effectively. Most Grade I haemorrhoids respond well to these measures within a few weeks.
Grade II: Office-Based Procedures
When bleeding or discomfort persists despite lifestyle changes, simple outpatient procedures are usually effective and avoid the need for surgery.
Rubber band ligation is the most common and successful option — a small band is placed at the base of the haemorrhoid, cutting off its blood supply so it withers away within days. Sclerotherapy, in which a chemical solution is injected to shrink the haemorrhoid, suits patients who cannot tolerate banding. Infrared coagulation uses heat to seal off the blood supply and is well suited to smaller haemorrhoids. These procedures are quick, done in the clinic without anaesthesia, and carry a low complication rate, though repeat sessions are sometimes needed.
Grade III: Combined Approach
Grade III haemorrhoids may still respond to rubber band ligation, particularly in mild cases, but many patients eventually need a more definitive procedure. Stapled haemorrhoidopexy (the “PPH” procedure) repositions the prolapsed tissue and interrupts its blood supply, causing less pain than traditional surgery and allowing a faster recovery. Doppler-guided haemorrhoidal artery ligation (THD/HAL-RAR) locates and ties off the specific arteries feeding the haemorrhoids, again with less postoperative pain since no external wound is created. For larger or symptomatic Grade III haemorrhoids not suited to these techniques, conventional excisional haemorrhoidectomy remains a reliable option.
Grade IV: Surgical Excision
Grade IV haemorrhoids, being permanently prolapsed, generally require surgery. Excisional haemorrhoidectomy (commonly the Milligan-Morgan or Ferguson technique) remains the gold standard, offering the lowest recurrence rate of any treatment, though it involves more postoperative pain and a recovery period of two to four weeks. Stapled haemorrhoidopexy can be used in select cases but is less suitable when there is significant external tissue involvement. Where haemorrhoids are complicated by thrombosis (a painful clot) or strangulation, urgent surgical treatment is usually needed to relieve pain and prevent tissue damage.
When to See a Doctor
Rectal bleeding should never be assumed to be from haemorrhoids without a proper examination, since conditions such as colorectal cancer, anal fissures, and inflammatory bowel disease can present similarly. Anyone experiencing persistent bleeding, severe pain, a lump that will not go back in, or a change in bowel habits should seek medical evaluation promptly.
Key Takeaway
Treatment for haemorrhoids progresses in a stepwise fashion: dietary and lifestyle change for Grade I, simple office procedures for Grade II, a combination of minimally invasive and surgical options for Grade III, and surgery for Grade IV. Early diagnosis allows most patients to avoid surgery altogether, which is why prompt evaluation of symptoms matters as much as the treatment itself.
This article is for general health awareness and does not replace professional medical advice. Please consult a qualified doctor or surgeon for diagnosis and treatment tailored to your condition.