Hemorrhoidal disease is on the rise in Vietnam; however, due to embarrassment, many individuals avoid seeking medical care and silently endure the condition. This often results in disease progression, making treatment more complex and costly. Therefore, classifying hemorrhoids into specific stages helps patients recognize which stage they are in, thereby guiding them toward appropriate treatment options.
What are hemorrhoids?
Hemorrhoids are not merely a venous disorder. They represent a disease of the entire vascular system of the anal canal, involving arterioles, venules, arteriovenous anastomoses, smooth muscle, and connective tissue, all covered by the normal epithelium of the anal lining. The venous plexus located in the submucosal layer is supported by elastic fibrous tissue.
Frequent increases in intra-abdominal and anal pressure such as repeated straining during bowel movements together with persistent venous congestion, lead to dilation and the formation of hemorrhoidal cushions within the anal canal. With advancing age, the supporting connective tissue progressively weakens, causing hemorrhoidal prolapse through the anal opening, which manifests as internal hemorrhoids.
Hemorrhoids are classified into different stages to help patients recognize the severity of their condition and seek appropriate, timely treatment. Both men and women can be affected, most commonly between the ages of 30 and 60. Statistically, one in every two individuals over the age of 50 will develop hemorrhoids at least once in their lifetime.
Hemorrhoids are a condition characterized by the dilation of veins in the lower rectum and anus.
Types of hemorrhoids
Internal hemorrhoids: these develop above the dentate line, within the mucosal lining of the anal canal. Hemorrhoidal prolapse typically occurs only in grade III or IV disease, when the hemorrhoidal mass protrudes outside the anus and cannot spontaneously retract. Internal hemorrhoids are generally more complex and carry greater risks than external hemorrhoids.
External hemorrhoids: these originate below the dentate line, where the hemorrhoidal mass is covered by squamous epithelium and located beneath the perianal skin. Unlike internal hemorrhoids, external hemorrhoids are not classified into grades but rather described according to different stages of progression.
Most individuals with hemorrhoids may remain asymptomatic and otherwise healthy. Often, the condition is only discovered when pain occurs and medical evaluation is sought. Without timely treatment, hemorrhoids can lead to complications such as proctitis, rectal stricture, perianal abscess, anal fistula, rectal prolapse, or anal fissure. For this reason, it is important for patients to understand the stages of hemorrhoidal disease in order to recognize their condition and receive appropriate treatment promptly.
Stages of hemorrhoidal disease
Internal hemorrhoids
According to the classification of the Ministry of Health, internal hemorrhoids are divided into four grades: grade I, grade II, grade III, and grade IV, as follows:
Grade I internal hemorrhoids: at this stage, hemorrhoids remain entirely within the anal canal. Early endoscopic examination reveals small, soft, reddish nodules of varying size on the lower rectal mucosa. Because the hemorrhoids are still small, they do not protrude outside the anus. Patients may only experience mild anal itching or discomfort during defecation, and in some cases, slight rectal bleeding.
Grade II internal hemorrhoids: in this stage, hemorrhoids remain inside the anal canal under normal conditions but prolapse slightly during straining with bowel movements. After defecation, the hemorrhoidal tissue spontaneously retracts back into the anal canal.
Grade III internal hemorrhoids: hemorrhoids prolapse outside the anal canal and cannot retract on their own. They can only be repositioned manually by the patient. Symptoms such as pain, bleeding, and discomfort worsen during defecation and may even occur while sitting.
Grade IV internal hemorrhoids: this represents the most advanced stage, where hemorrhoids are persistently prolapsed and remain outside the anal canal. At this point, the hemorrhoids become swollen and engorged, venous circulation is obstructed, and bleeding often ceases. Instead, excessive mucus secretion occurs, leading to persistent moisture, ulceration, and even necrosis of the hemorrhoidal tissue.
Hemorrhoidal disease is classified into several different stages.
External hemorrhoids
Unlike internal hemorrhoids, which are classified into four grades, external hemorrhoids are described in four progressive stages:
Stage I: the disease has just developed, so symptoms are often subtle and difficult to recognize. Patients may only experience slight discomfort, a sensation of fullness, or itching around the anus.
Stage II: dilated and tortuous veins begin to protrude outside the anus. During bowel movements, patients often feel pain and discomfort; without proper hygiene, the risk of local infection is high.
Stage III: bleeding occurs during defecation due to strangulation of the hemorrhoidal mass. Patients frequently suffer from pain, and in severe cases may develop anemia or anal fissures.
Stage IV: this is the most advanced stage. Hemorrhoids become visibly enlarged and swollen, causing severe itching and discomfort. In many cases, infection develops, leading to significant pain and interference with daily activities.
At each stage of the disease, patients may present with different clinical manifestations. In general, the most common signs and symptoms of hemorrhoids include:
Rectal bleeding with bright red blood, occurring after defecation and not mixed with stool: this results from excessive dilation of the hemorrhoidal veins, leading to congestion and swelling. In some cases, blood may accumulate in the rectum and be expelled as clots. In early stages, bleeding appears only as streaks on stool or toilet paper. In advanced stages, bleeding may present as spurting or dripping, and in severe cases even vigorous movement can trigger bleeding.
Anal itching, burning, and pain: these symptoms are more common in grade I and II hemorrhoids. Depending on disease severity, pain may last for hours or become persistent. Because internal hemorrhoids arise in areas without sensory nerves, patients with internal hemorrhoids often experience less pain compared to those with external hemorrhoids.
Hemorrhoidal prolapse: this occurs when the hemorrhoidal tissue protrudes outside the anal canal. In mild stages, hemorrhoids retract spontaneously without causing significant discomfort. In more advanced stages, prolapsed hemorrhoids must be manually repositioned, which can be painful. In severe cases, hemorrhoids remain permanently prolapsed, leading to strangulation, infection, and even necrosis if proper hygiene is not maintained.
Excessive anal discharge: prolapsed hemorrhoids impair closure of the anal sphincter, allowing mucus and stool to leak. This results in constant perianal moisture and persistent discomfort.
Patients with hemorrhoids often experience symptoms such as pain, pressure, and itching in the anal region.
High-risk groups for hemorrhoids
The following groups are at greatest risk of developing hemorrhoidal disease:
Individuals with chronic constipation or diarrhea, as repeated straining increases venous pressure, leading to dilation and congestion of hemorrhoidal veins.
Individuals with a low-fiber diet, which significantly increases the likelihood of hemorrhoids.
Overweight and obese individuals, who face a higher risk of developing the disease.
Individuals with increased intra-abdominal pressure due to heavy physical labor (e.g., porters, weightlifters, tennis players) or occupations requiring prolonged sitting or standing (e.g., secretaries, tailors, sales staff). These conditions hinder venous return to the heart and promote anal venous dilation.
Patients with pelvic tumors, including colorectal tumors, uterine tumors, or advanced pregnancy, all of which obstruct venous return and cause venous dilation in the anorectal region.
When should you seek medical care for hemorrhoids?
If you notice abnormal symptoms, even from the earliest stage (grade I), such as anal itching, burning, persistent moisture, difficulty with bowel movements, rectal bleeding, or general fatigue, these may be warning signs of hemorrhoidal disease. At that point, you should promptly visit the gastroenterology department of a reputable hospital or medical facility for timely examination and evaluation.
In severe cases with complications such as profuse bleeding in spurts, signs of anal necrosis, or intense pain and burning that interfere with daily activities patients must seek immediate hospital care for urgent medical intervention. Self-treatment at home is strongly discouraged, as it can pose serious risks to health and even to life.
Where to undergo reliable and effective hemorrhoid examination
To determine the stage and severity of hemorrhoidal disease, patients should seek care at reputable medical facilities, where they can be properly examined and treated by experienced specialists.
Hong Ngoc General Hospital brings together a highly skilled team of surgeons and is equipped with advanced diagnostic and treatment technologies, making it a trusted destination for many patients in need of hemorrhoid care.
Patients can feel completely assured with the hospital’s team of colorectal and gastrointestinal surgery experts, including: People’s Physician, Assoc. Prof. Dr. Nguyễn Xuân Hùng – Former Director of the Center for Colorectal and Perineal Surgery at Viet Duc University Hospital, Vice President of the Vietnam Association of Colorectal Surgeons, and Member of the French Society of Coloproctology; Distinguished Physician, Dr. Phạm Văn Cường – Specialist Level II, with nearly 40 years of experience and a member of the Vietnam Association of Endoscopic and Laparoscopic Surgery; MSc. Dr. Cù Trung Kiên – specialized training in gastrointestinal surgery in Hong Kong, former physician at Bach Mai Hospital, currently Deputy Head of the Department of Gastrointestinal Surgery at Hong Ngoc General Hospital – Yen Ninh; and Specialist Level I Dr. Bạch Phúc Huy – over 15 years of experience, Head of the Gastrointestinal Surgery Unit at Hong Ngoc General Hospital – Phuc Truong Minh, among others.
A patient undergoing hemorrhoid examination with People’s Physician, Assoc. Prof. Nguyễn Xuân Hùng.
Hemorrhoid treatment with specialists to ensure:
Accurate diagnosis: avoiding confusion with colorectal cancer, polyps, or other anorectal conditions.
Adequate treatment: around 50% of cases can be managed with medication and lifestyle modification, while 45% require only minimally invasive procedures.
Effective intervention: minimal tissue damage, rapid recovery, very low complication rates, and a cure rate exceeding 95%.
>>>Book an appointment with a specialist: 0911 908 856 >>>Surgical consultation: 0949 646 556
---------------------------
Note: The information provided in this article by Hong Ngoc General Hospital is for reference only and does not replace professional medical diagnosis or treatment. Patients should not self-medicate. For an accurate assessment of your condition, please visit a hospital for direct examination, diagnosis, and treatment planning by a physician.
Follow the official fanpage of Hong Ngoc General Hospital to receive more useful health information and updates on special hospital programs.
Hemorrhoidal disease is on the rise in Vietnam; however, due to embarrassment, many individuals avoid seeking medical care and silently endure the condition. This often results in disease progression, making treatment more complex and costly. Therefore, classifying hemorrhoids into specific stages helps patients recognize which stage they are in, thereby guiding them toward appropriate treatment options.
What are hemorrhoids?
Hemorrhoids are not merely a venous disorder. They represent a disease of the entire vascular system of the anal canal, involving arterioles, venules, arteriovenous anastomoses, smooth muscle, and connective tissue, all covered by the normal epithelium of the anal lining. The venous plexus located in the submucosal layer is supported by elastic fibrous tissue.
Frequent increases in intra-abdominal and anal pressure such as repeated straining during bowel movements together with persistent venous congestion, lead to dilation and the formation of hemorrhoidal cushions within the anal canal. With advancing age, the supporting connective tissue progressively weakens, causing hemorrhoidal prolapse through the anal opening, which manifests as internal hemorrhoids.
Hemorrhoids are classified into different stages to help patients recognize the severity of their condition and seek appropriate, timely treatment. Both men and women can be affected, most commonly between the ages of 30 and 60. Statistically, one in every two individuals over the age of 50 will develop hemorrhoids at least once in their lifetime.
Hemorrhoids are a condition characterized by the dilation of veins in the lower rectum and anus.
Types of hemorrhoids
Internal hemorrhoids: these develop above the dentate line, within the mucosal lining of the anal canal. Hemorrhoidal prolapse typically occurs only in grade III or IV disease, when the hemorrhoidal mass protrudes outside the anus and cannot spontaneously retract. Internal hemorrhoids are generally more complex and carry greater risks than external hemorrhoids.
External hemorrhoids: these originate below the dentate line, where the hemorrhoidal mass is covered by squamous epithelium and located beneath the perianal skin. Unlike internal hemorrhoids, external hemorrhoids are not classified into grades but rather described according to different stages of progression.
Most individuals with hemorrhoids may remain asymptomatic and otherwise healthy. Often, the condition is only discovered when pain occurs and medical evaluation is sought. Without timely treatment, hemorrhoids can lead to complications such as proctitis, rectal stricture, perianal abscess, anal fistula, rectal prolapse, or anal fissure. For this reason, it is important for patients to understand the stages of hemorrhoidal disease in order to recognize their condition and receive appropriate treatment promptly.
Stages of hemorrhoidal disease
Internal hemorrhoids
According to the classification of the Ministry of Health, internal hemorrhoids are divided into four grades: grade I, grade II, grade III, and grade IV, as follows:
Grade I internal hemorrhoids: at this stage, hemorrhoids remain entirely within the anal canal. Early endoscopic examination reveals small, soft, reddish nodules of varying size on the lower rectal mucosa. Because the hemorrhoids are still small, they do not protrude outside the anus. Patients may only experience mild anal itching or discomfort during defecation, and in some cases, slight rectal bleeding.
Grade II internal hemorrhoids: in this stage, hemorrhoids remain inside the anal canal under normal conditions but prolapse slightly during straining with bowel movements. After defecation, the hemorrhoidal tissue spontaneously retracts back into the anal canal.
Grade III internal hemorrhoids: hemorrhoids prolapse outside the anal canal and cannot retract on their own. They can only be repositioned manually by the patient. Symptoms such as pain, bleeding, and discomfort worsen during defecation and may even occur while sitting.
Grade IV internal hemorrhoids: this represents the most advanced stage, where hemorrhoids are persistently prolapsed and remain outside the anal canal. At this point, the hemorrhoids become swollen and engorged, venous circulation is obstructed, and bleeding often ceases. Instead, excessive mucus secretion occurs, leading to persistent moisture, ulceration, and even necrosis of the hemorrhoidal tissue.
Hemorrhoidal disease is classified into several different stages.
External hemorrhoids
Unlike internal hemorrhoids, which are classified into four grades, external hemorrhoids are described in four progressive stages:
Stage I: the disease has just developed, so symptoms are often subtle and difficult to recognize. Patients may only experience slight discomfort, a sensation of fullness, or itching around the anus.
Stage II: dilated and tortuous veins begin to protrude outside the anus. During bowel movements, patients often feel pain and discomfort; without proper hygiene, the risk of local infection is high.
Stage III: bleeding occurs during defecation due to strangulation of the hemorrhoidal mass. Patients frequently suffer from pain, and in severe cases may develop anemia or anal fissures.
Stage IV: this is the most advanced stage. Hemorrhoids become visibly enlarged and swollen, causing severe itching and discomfort. In many cases, infection develops, leading to significant pain and interference with daily activities.
At each stage of the disease, patients may present with different clinical manifestations. In general, the most common signs and symptoms of hemorrhoids include:
Rectal bleeding with bright red blood, occurring after defecation and not mixed with stool: this results from excessive dilation of the hemorrhoidal veins, leading to congestion and swelling. In some cases, blood may accumulate in the rectum and be expelled as clots. In early stages, bleeding appears only as streaks on stool or toilet paper. In advanced stages, bleeding may present as spurting or dripping, and in severe cases even vigorous movement can trigger bleeding.
Anal itching, burning, and pain: these symptoms are more common in grade I and II hemorrhoids. Depending on disease severity, pain may last for hours or become persistent. Because internal hemorrhoids arise in areas without sensory nerves, patients with internal hemorrhoids often experience less pain compared to those with external hemorrhoids.
Hemorrhoidal prolapse: this occurs when the hemorrhoidal tissue protrudes outside the anal canal. In mild stages, hemorrhoids retract spontaneously without causing significant discomfort. In more advanced stages, prolapsed hemorrhoids must be manually repositioned, which can be painful. In severe cases, hemorrhoids remain permanently prolapsed, leading to strangulation, infection, and even necrosis if proper hygiene is not maintained.
Excessive anal discharge: prolapsed hemorrhoids impair closure of the anal sphincter, allowing mucus and stool to leak. This results in constant perianal moisture and persistent discomfort.
Patients with hemorrhoids often experience symptoms such as pain, pressure, and itching in the anal region.
High-risk groups for hemorrhoids
The following groups are at greatest risk of developing hemorrhoidal disease:
Individuals with chronic constipation or diarrhea, as repeated straining increases venous pressure, leading to dilation and congestion of hemorrhoidal veins.
Individuals with a low-fiber diet, which significantly increases the likelihood of hemorrhoids.
Overweight and obese individuals, who face a higher risk of developing the disease.
Individuals with increased intra-abdominal pressure due to heavy physical labor (e.g., porters, weightlifters, tennis players) or occupations requiring prolonged sitting or standing (e.g., secretaries, tailors, sales staff). These conditions hinder venous return to the heart and promote anal venous dilation.
Patients with pelvic tumors, including colorectal tumors, uterine tumors, or advanced pregnancy, all of which obstruct venous return and cause venous dilation in the anorectal region.
When should you seek medical care for hemorrhoids?
If you notice abnormal symptoms, even from the earliest stage (grade I), such as anal itching, burning, persistent moisture, difficulty with bowel movements, rectal bleeding, or general fatigue, these may be warning signs of hemorrhoidal disease. At that point, you should promptly visit the gastroenterology department of a reputable hospital or medical facility for timely examination and evaluation.
In severe cases with complications such as profuse bleeding in spurts, signs of anal necrosis, or intense pain and burning that interfere with daily activities patients must seek immediate hospital care for urgent medical intervention. Self-treatment at home is strongly discouraged, as it can pose serious risks to health and even to life.
Where to undergo reliable and effective hemorrhoid examination
To determine the stage and severity of hemorrhoidal disease, patients should seek care at reputable medical facilities, where they can be properly examined and treated by experienced specialists.
Hong Ngoc General Hospital brings together a highly skilled team of surgeons and is equipped with advanced diagnostic and treatment technologies, making it a trusted destination for many patients in need of hemorrhoid care.
Patients can feel completely assured with the hospital’s team of colorectal and gastrointestinal surgery experts, including: People’s Physician, Assoc. Prof. Dr. Nguyễn Xuân Hùng – Former Director of the Center for Colorectal and Perineal Surgery at Viet Duc University Hospital, Vice President of the Vietnam Association of Colorectal Surgeons, and Member of the French Society of Coloproctology; Distinguished Physician, Dr. Phạm Văn Cường – Specialist Level II, with nearly 40 years of experience and a member of the Vietnam Association of Endoscopic and Laparoscopic Surgery; MSc. Dr. Cù Trung Kiên – specialized training in gastrointestinal surgery in Hong Kong, former physician at Bach Mai Hospital, currently Deputy Head of the Department of Gastrointestinal Surgery at Hong Ngoc General Hospital – Yen Ninh; and Specialist Level I Dr. Bạch Phúc Huy – over 15 years of experience, Head of the Gastrointestinal Surgery Unit at Hong Ngoc General Hospital – Phuc Truong Minh, among others.
A patient undergoing hemorrhoid examination with People’s Physician, Assoc. Prof. Nguyễn Xuân Hùng.
Hemorrhoid treatment with specialists to ensure:
Accurate diagnosis: avoiding confusion with colorectal cancer, polyps, or other anorectal conditions.
Adequate treatment: around 50% of cases can be managed with medication and lifestyle modification, while 45% require only minimally invasive procedures.
Effective intervention: minimal tissue damage, rapid recovery, very low complication rates, and a cure rate exceeding 95%.
>>>Book an appointment with a specialist: 0911 908 856 >>>Surgical consultation: 0949 646 556
---------------------------
Note: The information provided in this article by Hong Ngoc General Hospital is for reference only and does not replace professional medical diagnosis or treatment. Patients should not self-medicate. For an accurate assessment of your condition, please visit a hospital for direct examination, diagnosis, and treatment planning by a physician.
Follow the official fanpage of Hong Ngoc General Hospital to receive more useful health information and updates on special hospital programs.
Để lại câu hỏi của bạn để nhận được giải đáp từ các bác sĩ của Hồng Ngọc
Lorem ipsum dolor
Lorem ipsum dolor sit amet, consectetur adipiscing elit. Mauris odio lectus, pretium faucibus nisi eu, accumsan consectetur orci. In blandit vehicula nisl, vel lacinia ligula finibus a. Donec fermentum rhoncus
Lorem ipsum dolor sit amet, consectetur adipiscing elit. Mauris odio lectus, pretium faucibus nisi eu, accumsan consectetur orci. In blandit vehicula nisl, vel lacinia ligula finibus a. Donec fermentum rhoncus
Lorem ipsum dolor sit amet, consectetur adipiscing elit. Mauris odio lectus, pretium faucibus nisi eu, accumsan consectetur orci. In blandit vehicula nisl, vel lacinia ligula finibus a. Donec fermentum rhoncus
Lorem ipsum dolor sit amet, consectetur adipiscing elit. Mauris odio lectus, pretium faucibus nisi eu, accumsan consectetur orci. In blandit vehicula nisl, vel lacinia ligula finibus a. Donec fermentum rhoncus
Lorem ipsum dolor sit amet, consectetur adipiscing elit. Mauris odio lectus, pretium faucibus nisi eu, accumsan consectetur orci. In blandit vehicula nisl, vel lacinia ligula finibus a. Donec fermentum rhoncus
