Internal haemorrhoids are classified by the Goligher classification. A Grade III haemorrhoid is best described as:

• A Prolapse on straining requiring manual reduction ✓
• B Prolapse on straining that reduces spontaneously
• C Permanent prolapse that cannot be manually reduced
• D Prolapse confined to the anal canal, visible only on proctoscopy

Explanation

The Goligher classification of internal haemorrhoids: Grade I — bleed but do not prolapse; Grade II — prolapse on straining but reduce spontaneously; Grade III — prolapse on straining requiring digital manual reduction; Grade IV — permanent prolapse, irreducible. Grades I–II are managed conservatively or with office procedures (injection sclerotherapy, rubber band ligation). Grade III haemorrhoids are amenable to rubber band ligation or haemorrhoidopexy (Longo's procedure), while Grade IV usually require formal haemorrhoidectomy.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.