Internal Hemorrhoid Grades Above dentate line, painless dripping and bright red, on wiping tissue or in toilet) Grade 1 - No prolapse, just prominent blood vessels Grade 2 - Prolapse upon bearing down, but spontaneous reduction Grade 3 - Prolapse upon bearing down requiring manual reduction Grade 4 - Prolapse with inability to be manually reduced Treatment: Fluid & Fiber! - Grade 1-2 -Medical (Phlebotonics) - Grade 2-3 -Ligation (RBL) - Grade 3 (unresponsive) & 4 -Surgery Virgil Lo, MD @pinoygastro #Internal #Hemorrhoid #Grades #grading #classification #gastroenterology
