Hemorrhoids are a common condition involving swollen and inflamed veins in or around the anus and lower rectum. These vascular cushions are a normal part of human anatomy, but when enlarged, they can cause uncomfortable symptoms. About half of all individuals experience hemorrhoids by age 50, and their severity varies considerably. This article provides a clear understanding of Grade 3 hemorrhoids, their characteristics, and management approaches.
The Hemorrhoid Grading System
Hemorrhoids are categorized into grades based on the degree to which internal hemorrhoids prolapse outside the anal canal. This classification helps medical professionals assess severity and determine suitable treatment options. Internal hemorrhoids originate above the dentate line.
Grade 1 hemorrhoids are internal and do not prolapse outside the anus, though they may cause bleeding or itching. Grade 2 hemorrhoids protrude from the anus during straining or bowel movements but retract spontaneously. Grade 3 hemorrhoids prolapse outside the anus during straining or bowel movements, but unlike Grade 2, they require manual manipulation to be pushed back inside. Grade 4 hemorrhoids are permanently prolapsed outside the anus and cannot be manually reinserted. This grading system applies primarily to internal hemorrhoids, distinguishing their behavior and guiding therapeutic decisions.
Identifying Grade 3 Hemorrhoids
Individuals with Grade 3 hemorrhoids often experience bright red bleeding, observed on toilet paper or in the toilet bowl. Discomfort, itching, and a persistent feeling of fullness or a lump at the anal opening are also reported. Pain can become more pronounced if the hemorrhoid becomes thrombosed, meaning a blood clot forms within it. These symptoms arise because the prolapsed tissue is exposed and can become irritated or inflamed. The need for manual reduction is a clear indicator, distinguishing Grade 3 hemorrhoids from Grade 2, which reduce on their own, and Grade 4, which cannot be reduced at all.
Management for Grade 3 Hemorrhoids
Managing Grade 3 hemorrhoids typically involves a combination of conservative measures and procedural or surgical interventions, as lifestyle changes alone are often insufficient to resolve the prolapse. Initial steps include increasing dietary fiber intake to 25-30g daily, ensuring adequate fluid consumption, and avoiding prolonged straining during bowel movements. Sitz baths can also provide temporary relief from discomfort.
When conservative approaches do not adequately address the symptoms, non-surgical office-based procedures are often considered. Rubber band ligation (RBL) is a common method where a small band is placed around the base of the hemorrhoid, cutting off its blood supply, causing it to shrink and fall off. Sclerotherapy, which involves injecting a solution to shrink the hemorrhoid, and infrared coagulation (IRC), using heat to cause the hemorrhoid to coagulate and shrink, are also options.
For more advanced or persistent Grade 3 cases, surgical options may be recommended. Hemorrhoidectomy involves the surgical removal of the enlarged hemorrhoids. Stapled hemorrhoidectomy, also known as procedure for prolapse and hemorrhoids (PPH), uses a stapling device to reposition the hemorrhoidal tissue and reduce blood flow. Transanal Hemorrhoidal Dearterialization (THD) is another technique that uses ultrasound to locate and ligate the arteries supplying blood to the hemorrhoids, often combined with a procedure to lift the prolapsed tissue. The selection of treatment depends on individual circumstances and is best determined in consultation with a healthcare professional.