A 38-year-old woman describes prolapsing anal lumps during defecation that reduce spontaneously initially but now require manual replacement every time. There is no constant prolapse and no irreducible episode. Bleeding is minimal. Which Goligher grade of internal haemorrhoids does she have?

• A Grade III ✓
• B Grade II
• C Grade I
• D Grade IV

Explanation

Goligher classification: grade I bleed but do not prolapse, grade II prolapse and reduce spontaneously, grade III prolapse and require manual reduction, and grade IV are permanently prolapsed and cannot be reduced. This patient needs manual reduction, so she is grade III, which typically warrants surgical intervention such as rubber band ligation failing, haemorrhoidectomy, or stapled haemorrhoidopexy depending on findings. Grade IV would be irreducible.

Reference: Bailey and Love Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.