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

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

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.


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.

You may be able to feel the hemorrhoid protruding from your anus. That's because grade 4 hemorrhoids are permanently prolapsed.


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.

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.


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.

Rubber Band Ligation

Hemorrhoid banding is an increasingly common treatment for hemorrhoids. Although often recommended for hemorrhoids of a lesser grade, this ligation procedure can be helpful for patients with severe hemorrhoids who are not good candidates for other treatment options.

In this procedure, a special tool is used to draw the hemorrhoid away from the rectal wall. The tool is then used to apply a small rubber band around the hemorrhoid. This cuts off its blood supply, so the tissue shrinks and eventually falls off.

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.

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 hemorrhoids.
  • Your doctor may recommend rubber band ligation or laser surgery to remove your hemorrhoid.

Questions about hemorrhoids? Comment below with your grade 4 questions.

Brian Chandler

Brian Chandler

Nancy Hodges - September 27, 2017

I was told I had grade 4 internal and external hemorrhoids. Two were banded but the bands came off as soon as I had a bowel movement and now I am back to bleeding. Should I do banding again or ask for laser??

Comments are closed