Grade 4 hemorrhoids

There are two main grades of hemorrhoids: Internal and External. Internal hemorrhoids are not sensitive, while external hemorrhoids are very sensitive, indiapiles

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Grade 4 Hemorrhoids Guide: Symptoms,
Causes, Treatments & Recovery





There are two main Types of hemorrhoids: internal and external. Internal hemorrhoids are not
sensitive to touch, pain, stretch, or temperature, while external hemorrhoids are covered by skin that is
very sensitive.

When talking about hemorrhoids, one needs to understand the meaning of 'prolapse'. The anal
cushions are normally fastened in the sphincter by muscles and tissue. In case too much pressure is
applied, as on straining, the system of securing these cushions is damaged. Subsequently, they
protrude outside the anus and this protruding mass is called the prolapse.
Internal hemorrhoids are thus graded by the degree to which they have prolapsed into:

Grade 1 : Slightly enlarged hemorrhoidal tissue with no prolapse.

Grade 2 : Prolapse that protrudes on pressure but goes back on its own

Grade 3 : Prolapse that needs to be manually pushed in by the patient

Grade 4 : Prolapse that constantly remains on the outside and does not go back even on manual
repositioning. At this stage they are usually painful.

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External hemorrhoids usually occur as a painful lump outside the anus. In case of clot formation (
Thrombosed external hemorrhoid ), there may be severe pain.
You've been told that you have a grade 4 hemorrhoid. What does that mean? Grade 4
hemorrhoids are the most severe level of internal hemorrhoids. Their symptoms can be
problematic and uncomfortable, and your doctor may recommend surgery to treat them.
I've put together this complete guide to grade 4 hemorrhoids for you. It will help you
understand what this condition involves and what you can do about it.
Symptoms
Grade 4 hemorrhoids are the most severe level of internal hemorrhoids, so you are likely to notice
symptoms as a result of these enlarged vessels.
Rectal bleeding is a common sign of hemorrhoids. The blood can drip into the toilet bowl when you
use the bathroom, or it may be present on toilet paper after a bowel movement. You may also notice
a discharge of mucus.Hemorrhoids can cause unpleasant discomfort. They may itch, sting, hurt or
feel sore. Some people feel a burning sensation.
Causes
Hemorrhoids are enlarged blood vessels that become swollen because too much pressure is exerted
on them. Sometimes this pressure is from carrying around extra weight, whether from the normal
gains of pregnancy or the excess pounds associated with obesity.Other times, the pressure comes
from bathroom troubles. Ongoing problems with diarrhea or constipation can lead to hemorrhoids.
Straining in the bathroom or sitting for a long time on the toilet can be particularly problematic.

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Differences Between Other Grades
Internal hemorrhoids are divided into four classifications, and grade 4 hemorrhoids are the most
severe. They are rated based on their level of prolapse.While grade 1 hemorrhoids do not protrude
from the anus at all, grade 2 poke out during a bowel movement and then return to their normal
location.
As hemorrhoids worsen, their prolapse is harder to resolve. Grade 3 hemorrhoids require manual
manipulation to return them to their spot. Grade 4, the most severe, do not reduce at all. They are
permanently prolapsed, and even pushing them back in place will not keep them inside the rectum.
Treatments
Dr Ashwin Porwal is the founder and lead surgeon of Healing Hands Clinic (HHC). He has
dedicated his career to practice and research in Proctology – the branch of medicine dealing
with the disorders of the rectum and anal canal. He has had the privilege of receiving training
in Proctology from the world-renowned Colorectal surgeon, Dr Antonio Longo of Italy. Dr
Longo invented the MIPH/PPH (Stapler surgery) for Piles and Dr Porwal has received
hands-on training from the master himself.
Grade 4 hemorrhoids treatment is usually surgical. Patients sometimes delay treatment because they
are concerned about pain or complications, but modern removal options have made the process
easier and less painful.

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Laser Treatment
A laser procedure can be an effective grade 4 hemorrhoids treatment. In this procedure, a specialized
laser fiber is inserted directly into a hemorrhoid. With pulses of intense light, it targets the blood
vessels of the hemorrhoid and coagulates them. Therefore, the blood supply to the problematic tissue
is stopped, and the hemorrhoid will shrivel up.
Recovery Time
Both rubber band ligation, rarely used for level 4 hemorrhoids, and a laser hemorrhoidectomy typically
involve an easier recovery period than that associated with traditional surgical removal of
hemorrhoids.
Rubber band ligation pain usually lasts for only one or two days. Again, most always recommended
for level 1 and 2 hemorrhoids. Over-the-counter pain medication can help manage the discomfort.
Patients may notice bleeding when the shriveled tissue separates from the rectal wall. This usually
happens one to two weeks after the banding procedure.
Studies have indicated that patients who undergo laser procedures do not deal with significant pain
for as long as those who have traditional excisions. By the one-week mark after surgery, patients who
have laser procedures typically report no pain or only mild pain. With traditional procedures, it can
take over two weeks to get to that point.

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For any treatment method, your doctor will probably recommend treating your healing rectum gently
by using stool softeners or eating a bowel-friendly diet during the recovery process.
After recovery, there may be lifestyle changes you can make to help prevent a recurrence. To
discourage constipation, your diet should be high in fiber and water intake. You should also get
regular exercise and establish healthy bowel habits. Learn more in the video "How to Prevent
Hemorrhoids."
A grade 4 hemorrhoid involves permanently prolapsed tissue and may cause pain, discomfort or
bleeding.Consult a doctor for diagnosis and treatment of hemorrhoidsYour doctor may recommend
rubber band ligation or laser surgery to remove your hemorrhoid.You may be able to feel the
hemorrhoid protruding from your anus. That's because grade 4 hemorrhoids are permanently
prolapsed.