Fast Five Quiz: Hemorrhoid Diagnosis and Treatment

Praveen K. Roy, MD


March 07, 2019

Internal hemorrhoids do not have cutaneous innervation and can therefore be destroyed without anesthetic, and the treatment may be surgical or nonsurgical. Internal hemorrhoid symptoms often respond to increased fiber and liquid intake and to avoidance of straining and prolonged toilet sitting. Nonoperative therapy works well for symptoms that persist despite the use of conservative therapy. Most nonsurgical procedures currently available are performed in the clinic or ambulatory setting.

The following is a quick summary of treatment for internal hemorrhoids by grade:

  • Grade I hemorrhoids are treated with conservative medical therapy and avoidance of nonsteroidal anti-inflammatory drugs (NSAIDs) and spicy or fatty foods.

  • Grade II or III hemorrhoids are initially treated with nonsurgical procedures.

  • Significantly symptomatic grade III and grade IV hemorrhoids are best treated with surgical hemorrhoidectomy.

  • Treatment of grade IV internal hemorrhoids or any incarcerated or gangrenous tissue requires prompt surgical consultation.

Read more on the treatment of hemorrhoids.

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