Internal Hemorrhoids (5 of 5)

This colonoscopic view of internal hemorrhoids is appreciated using a magnifying colonoscope. Most clinicians use the grading system proposed by Banov et al in 1985, which classifies internal hemorrhoids by their degree of prolapse into the anal canal. This system both correlates with symptoms and guides therapeutic approaches. Grade I hemorrhoids project into the anal canal and often bleed but do not prolapse. Grade II hemorrhoids may protrude beyond the anal verge with straining or defecating but reduce spontaneously when straining ceases. Grade III hemorrhoids protrude spontaneously or with straining and require manual reduction. Grade IV hemorrhoids chronically prolapse and cannot be reduced. They usually contain both internal and external components and may present with acute thrombosis or strangulation.