Clinical staging or grading: According to the degree of internal hemorrhoids, the staging of internal hemorrhoids at home and abroad is not completely unified. The following are representative ones.
①Miles (1919) 3-degree classification:
Degree I: also known as early internal hemorrhoids, bleeding during defecation, no prolapse, no pain.
Degree Ⅱ: also known as hemorrhoids in the intermediate period, internal hemorrhoids prolapse during defecation. It can be paid back naturally.
Degree Ⅲ: also known as advanced internal hemorrhoids, internal hemorrhoids are easy to protrude outside the anus and need to be repaid by hand.
②Goligher (1961) 4th period classification:
Phase 1: Bleeding during defecation, but not prolapse. Most patients have no obvious conscious symptoms, but only show blood, dripping or spurting when defecation, and bleeding is more. The hemorrhoids do not protrude outside the anus. Anoscopy showed that the rectal column was enlarged and showed nodular protrusions on the dentate line (Figure 5).
Phase 2: Internal hemorrhoids prolapse during defecation and can be returned naturally. The patient has intermittent blood, dripping or spurting blood during defecation, with moderate bleeding. Hemorrhoids protrude out of the anus during defecation and repay by itself after defecation (Figure 6).
Phase 3: Internal hemorrhoids prolapse outside the anus and need to be returned by hand. The internal hemorrhoids prolapse when the patient defecates, or when he is tired, walks for a long time, or coughs. Internal hemorrhoids cannot be repaid by themselves after prolapse, and they must be supported by hands, or can be repaid only after resting in bed. The amount of bleeding is less (Figure 7).
Phase 4: Combined with external hemorrhoids, it cannot be fully repaid. Hemorrhoids stay outside the anus for a long time and cannot be repaid or come out immediately after replenishment. Since the anal cushion is mostly fibrotic and less bleeding, the hemorrhoids develop into the latter three stages and become mixed hemorrhoids. Because the prolapsed hemorrhoids are larger, the internal and external venous plexus of the hemorrhoids have been involved, and the surface is covered by the rectal mucosa and the skin of the anal canal. Therefore, mixed hemorrhoids are the consequence of hemorrhoids getting worse.
③Zijingfeng (1974) 5-degree classification (Figure 8):
Degree I: Only hemispherical uplifts (early internal hemorrhoids) can be seen on the dentate line.
Degree II: There are hemispherical internal hemorrhoid nodules on the dentate line, but no hemorrhoids prolapse (initial internal hemorrhoids).
Degree Ⅲ: The internal hemorrhoids swell in a spherical shape. The internal hemorrhoids protrude out of the anus during defecation and can be repaid naturally (medium hemorrhoids).
Degree IV: The internal hemorrhoids expand to the part of the anal canal below the dentate line, and the internal hemorrhoids prolapse during defecation, requiring manual rehabilitation (late internal hemorrhoids).
Degree V: Internal hemorrhoids develop into mixed hemorrhoids, internal hemorrhoids prolapse and cannot be fully repaid (end-stage hemorrhoids).
④China (1975) three-phase classification: China's domestic hemorrhoid classification is three-phase, which was formulated by the National Anorectal Conference (Hengshui Conference) in 1975.
Phase 1: Bloody during defecation, no prolapse, nodular bulge of mucosa on the dentate line.
Phase 2: Bloody, dripping or ejection during defecation, prolapse of internal hemorrhoids, self-recovery.
Phase 3: Internal hemorrhoids prolapse during defecation or when abdominal pressure increases due to coughing, fatigue, or weight-bearing, and hemorrhoids must be repaid by hand.