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Regardless of the size or swelling of a hemorrhoid, no treatment is required if symptoms do not exist.Prevention is perhaps the most effective treatment. Diet and adequate hydration are very important to maintain normal bowel movements. Hemorrhoid symptoms can occur with the passage of hard stool and constipation, as well as diarrhea and frequent bowel movements. For patients with constipation, high fiber diet, adequate hydration and stool softeners may be required. For those with too frequent bowel movements, antidiarrheal medications and diet adjustments may be required. These preventive measures decrease the amount of straining that is required to have a bowel movement, thus decreasing the pressure within the blood vessels to prevent swelling.Once hemorrhoidal symptoms develop, a variety of treatment options exist, depending upon the situation and severity of the hemorrhoids.Internal hemorrhoids are graded by the degree of prolapse below the pectinate line into the anal canal.
Grade 1: the internal hemorrhoid bulges into the canal but does not prolapse or fall completely into it. These may bleed.
Grade 2: the hemorrhoid protrudes past the anal verge with straining for a bowel movement or passage of flatus, but spontaneously return to their original internal position once the straining has subsided.
Grade 3: the hemorrhoid may protrude past the anal verge without any straining and requires the patient to push them inside manually.
Grade 4: the internal hemorrhoid always stays protruded or prolapsed and is at risk for thrombosis or strangulation should the anal muscles go into spasm.