In the ASCRS classification of hemorrhoidal disease, Grade IV internal hemorrhoids are best defined as:

• A Hemorrhoids that prolapse and reduce spontaneously
• B Hemorrhoids that prolapse and require manual reduction
• C Hemorrhoids confined to the anal canal with painless bleeding only
• D Hemorrhoids that prolapse and cannot be reduced ✓

Explanation

The standard four-grade classification of internal hemorrhoids defines Grade IV as hemorrhoids that are permanently prolapsed and cannot be reduced manually, representing the most severe stage. Grade I bleed without prolapse; Grade II prolapse with defecation but reduce spontaneously; Grade III prolapse and require manual reduction. Grade IV hemorrhoids typically require surgical hemorrhoidectomy as they do not respond to office-based procedures.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.