The Four Grades of Haemorrhoids, A Ranking Nobody Asked For

Haemorrhoids are very common, very annoying and very under discussed. Around half of adults will meet them at some point, yet almost nobody wants to talk about them. So consider this your calm, slightly cheeky guide to the four grades of haemorrhoids, laid out clearly so you know what is going on and what to do next.

Before we begin, a quick note. This grading system usually refers to internal haemorrhoids. External ones can still be painful, itchy and swollen, they are just not put into the same neat categories. 

Grade I Haemorrhoids: The Quiet Overachievers

Grade I haemorrhoids sit inside the back passage. They do not poke out, and you will not see them around the outside. They are like the colleague who causes trouble in meetings but never leaves their chair.

What you might notice

• Bright red blood on the toilet paper or in the bowl after a poo
• Itching or mild discomfort inside the bottom
• A feeling that things are a bit swollen or irritated

Grade I haemorrhoids are often linked to straining, constipation, long toilet sessions or pregnancy. At this stage, small changes can make a big difference: more fibre, more water, less scrolling on the loo, and gentler cleaning around the area.

Grade II Haemorrhoids: The Peekaboo Ones

Grade II haemorrhoids still begin inside, but during a bowel movement they can slide out a little, then go back in on their own. They are the “in and out” crowd, appearing only under extra pressure.

What you might notice

• A small lump that appears during a poo then disappears again
• Bleeding, itching and soreness, especially after wiping
• A feeling of fullness or pressure in the back passage

Grade II haemorrhoids are still often managed with lifestyle changes and topical treatments. High fibre foods, staying hydrated, avoiding heavy straining and using gentle, soothing wipes instead of dry toilet paper can all help calm things down and reduce irritation.

Grade III Haemorrhoids: The Hands-On Variety

Grade III haemorrhoids come out during a bowel movement and do not slide back in by themselves. You may need to gently push them back in with a clean finger after going to the toilet. Glamorous, no, common, yes.

What you might notice

• A tender lump that stays on the outside after a poo until you push it back in
• More noticeable pain, swelling and discomfort when sitting or walking
• Ongoing bleeding, mucus or irritation around the anus

At Grade III, it is a good idea to talk to a GP. Treatments might still be non surgical, such as rubber band ligation (a small band placed around the haemorrhoid inside the rectum) or other procedures done in clinic. Good hygiene and soothing care still matter here, especially because the area is more sensitive and swollen.

Grade IV Haemorrhoids: The Full-Time Outsiders

Grade IV haemorrhoids are prolapsed all the time. They stay outside and cannot be pushed back in. This can be very painful, quite distressing and will usually need medical treatment.

What you might notice

• Large, swollen lumps around the anus that stay out all the time
• Significant pain, especially when sitting, walking or going to the toilet
• Bleeding, mucus and possible difficulty cleaning the area

Grade IV haemorrhoids are definitely one for the GP or specialist team. They may discuss different procedures or surgery to relieve symptoms and prevent complications like strangulation or blood clots. If you are in this category, you deserve proper medical support and a care plan that gives you your comfort back.

When To See a GP About Haemorrhoids

Whatever the grade, it is worth speaking to a healthcare professional if:

• You notice blood in your poo or on the paper
• The pain is strong, sudden or getting worse
• You have a lump that is very hard, dark or extremely tender
• Your symptoms keep coming back even after home care
• You have changes in bowel habits, such as unexplained diarrhoea or constipation

Blood from the bottom is not always caused by haemorrhoids, so it is important to have it checked, especially if you are over 40 or have a family history of bowel problems.

Caring For Your Bum at Every Grade

Whether you are in Grade I or Grade IV territory, a few everyday habits can support whatever your GP recommends and help keep future flare ups calmer.

1. Support softer, easier poos

• Eat more fibre rich foods such as wholegrains, beans, fruit and vegetables
• Drink enough water across the day to keep stools soft
• Move your body regularly to help keep the bowel moving too

2. Be kinder on the loo

• Respond when you feel the urge, try not to keep putting it off
• Avoid long reading sessions on the toilet that keep pressure on the veins
• Try a small footstool so your knees are slightly raised, which can help the angle of the bowel

3. Switch to gentle, soothing hygiene

Dry, rough toilet paper plus sore, inflamed veins is not a friendly combination. A soft, pH balanced wipe that uses plant based ingredients, like witch hazel and other calming extracts, can help clean the area without adding more friction or sting.

Pat rather than scrub, and allow the area to air dry where you can. Think quiet kindness, not scouring pad.

4. Build a small “flare up plan”

• A simple sitz bath or warm soak for a few minutes
• Any creams, ointments or treatments your GP has recommended
• Soft, breathable underwear and clothing that does not dig in
• Soothing wipes within reach, especially on work days or when travelling

Having a plan turns a flare up from a panic into a list. Less drama, more “I know what to do with this.”