In the previous article, we answered the 3 most frequently asked questions about haemorrhoids. in this article, we will answer another question about haemorrhoids.
4 ) WHAT ARE THE GRADES OF HEMORRHOIDS?
Haemorrhoids are divided into four grades. They are divided into grades according to the prolapse of haemorrhoids through the anal canal. According to these grades management of haemorrhoids changes.
1] grade 1– It does not prolapse while defecating.
2] grade 2 – It prolapse while defecating but reposite (come to its normal position ) back on its own once defecation is over.
3] grade 3 – It prolapse while defecating but does not reposite back on its own. The patient has to reposit it (push ) back with his fingers.
4] grade 4 – It remains prolapsed always. The patient cannot reposit it back with his fingers.
Grades 1 and 2:-
These grades of haemorrhoids [ piles grades ] Can we manage with medicine? But if any other pathology existed along with it like a fissure in ano, then it may become difficult to manage with medicine.
Grade 3 and 4:-
These grades of haemorrhoids [ piles grades ] need to manage surgically. Because these grades of haemorrhoids often bleed profusely.
Qu. 5 ) Internal haemorrhoids and external haemorrhoids.
These are divided according to the location of the anal canal from where they arise.
For general meaning, external hemorrhoids are located at the anal verge. Means at the outer opening of the anal canal. you can palpate it even before anal canal open for defaecation.
These are covered with anal skin. May be placed circumferentially. ( In medical terms we call it the 3,7 and 11 ‘o’clock position ). Many times these are not painful. And also very less likely to bleed.
You should not confuse it with the Sentinel tag of the anal canal. These are present along with fissure-in-ano. They are commonly palpable at the front (12 positions) and back ( 6 positions).
For self-assessment, it is very difficult to assess it. Hence you should always consult a Proctologist or General surgeon.
External haemorrhoids have no gradations. Whatever grades I have explained to you are of Internal Hemorrhoids.
But external Hemorrhoids rarely exist alone. They always co-exist with internal haemorrhoids.
The complications of external haemorrhoids are the Formation of ulcers over external haemorrhoids and Thrombosis of external haemorrhoids.
Qu. 6 ) How to differentiate the bleeding of haemorrhoids from other anal bleeding?
This is very important to know the variation or types of bleeding from the anal canal while defecating.
There are many conditions in which you can get bleeding from the anal canal. These are as follows.
1 ] Hemorrhoids
2 ] Fissure
3 ] Rectal polyp
4 ] Tumor of the large gut . ( Rectal Cancer, colonic cancer )
5 ] Ulcerative colitis
6 ] Chrohn disease
7 ] Ulceration in the small and large gut
8 ] Trauma to the large colon
For your self-assessment (As patient ) it is not possible to differentiate each type of bleeding. But you must differentiate it from the fissure and rectal cancer.
It always bleeds after defaecation and along with defecation. Also, keep on bleed after it. Many times it’s a painless bleed. After bowel motion, no burning, No Pain at the anal site feel.
Fissure:-
Many times its bleeding occurs with constipated stool. It does not bleed profusely. Blood has been seen sticking to the side of the constipated stool. After completion of motion, it bleeds drop-like. In this condition, you may feel severe pain, especially one-sided cutting pain. And you will feel burning in the anal canal for about 1 hour or maybe for a longer duration.
Rectal cancer:-
Why I am so much emphasizing the importance of cancer because many patients self-diagnose their bleeding as bleeding of piles and take it very lightly.
Especially in countries like India, Pakistan, Nepal, and Srilanka, people always consider piles are a normal part of their lifestyle and their eating habits of spicy food. They just stop eating spicy food and wait to disappear the disease. By default bleeding of piles stops on its own. And they feel safe and cured. But if they are carrying rectal cancer, they missed the chance to diagnose it early and better treatment. Because early diagnosis is the key factor for better treatment in case of any cancer.
Please watch details of piles over you tube.