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Classification of Internal Hemorrhoids

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Grade	Features
I	Prominent hemorrhoids No prolapse
II	Prolapse after a Valsalva maneuver Prolapse reduces spontaneously
III	Prolapse after a Valsalva maneuver Prolapse needs manual reduction
IV	Chronic prolapse Manual reduction of prolapse ineffective
Adapted from Hawkins AT, Davis BR, Bhama AR, et al. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Hemorrhoids. Dis Colon Rectum. 2024;67(5):614-623. doi:10.1097/DCR.0000000000003276